What happens at a pacemaker/ICD implantation procedure?


The implantation of pacemakers /ICDs is a very common procedure. Although it is a safe procedure, there are some risks. These include:

  • Bleeding at the site of implantation.
  • Infection – this can be treated with antibiotics, but the device may have to replaced.
  • Lung or heart puncture, in which case immediate treatment would be required.
  • Dislodging of the device – in this case the issue may be resolved non-surgically, or with a second surgery.
  • Blood clotting in the vein in which the lead is placed.


What do I need to know before the procedure?

It is important to bear in mind the following before your procedure is conducted:

  • Fast the night before the surgery (this means no food or water).
  • Get to the hospital early the morning of your procedure, and remember to provide your medical team with a list of all your medications.
  • Your doctor or nurse will insert a peripheral intravenous line into the side in which the device will be placed. This is usually the left side.
  • You will meet your team of doctors, nurses and technologist in the operating theatre.
  • Your chest will be washed with a sterile solution, and in some cases, shaved. You will then be covered with sterile sheets.
  • Throughout the procedure, you will be given medication to ensure your relaxation and comfort via your intravenous line. You will also receive a local anaesthetic to numb the area where the pacemaker will be inserted.
  • Your cardiologist will make a small incision in the area below your collarbone, and with the use of x-rays, the wires of the pacemaker are secured to the heart through the veins.
  • The pulse generator is placed under the skin, and connected to the pacemaker lead.
  • The incision will be closed with self-dissolving stitches.
  • The procedure generally takes an hour or two to complete.


What do I need to know after the procedure?

When the procedure is complete, you will be monitored for some time. Your cardiologist will keep an eye on your heart rhythm, blood pressure and oxygen saturation, and will make sure that the device is properly placed and functioning correctly with the use of an ECG and chest x-ray. After between 6 and 12 hours, you will be permitted to leave the hospital, but you will not be allowed to drive at this point.

After around two days, you should remove the bandages. Remember to keep the area clean and dry for at least ten days. For the first few weeks after your procedure, it is normal to experience the following at the site of your incision:

  • Swelling
  • Discolouration
  • Bruising


Can I resume normal activity after the procedure?

It can take time to fully recover from the procedure. Keep the following in mind:

  • Avoid lifting your arm on the side of the device for at least the first two weeks.
  • Avoid heavy lifting and vigorous exercise for at least a month after the procedure.

If you notice any of the following, it is important to contact your doctor as soon as possible:

  • A lump at the site of incision
  • Tenderness at the site of incision
  • Redness at the site of incision
  • Warmth at the site of incision
  • Pus or fluids at the site of incision
  • Severe pain at the site of incision
  • Fever

You will need to schedule a follow-up visit with Dr Thomas 2 to 4 weeks after the procedure.  When you arrive at your appointment, remember to bring a full list of your medications. Dr Thomas will provide an assessment of your implant site, as well as an x-ray, ECG and pacemaker interrogation to check the functioning of the device. More follow-up visits will be set after this.

Dr Thomas may recommend that you wear a medic alert bracelet or necklace, which includes information about your device. Medic alert bracelets and necklaces can be ordered from medicalert.ca