A pacemaker is a small, lightweight device that is usually placed in the upper chest. The procedure is done in the hospital and is usually an outpatient visit. The procedure is called a pacemaker implant.
The “brain” of the pacemaker is called the generator. It is about the size of a silver dollar. It is placed in the upper chest down from the collar bone. A small incision is made through the skin and the generator is put under the skin; on top of the chest muscle. The left upper chest is usually used, let your provider know if you are left handed, have had lymph nodes removed from either arm, or have had radiation to the chest.
The way the generator “talks” to the heart is by using leads. Leads are flexible wires that are placed into a vein under the collarbone and threaded into the heart. A pacemaker can have one, two or three leads depending on the electrical support the heart needs.
A lead in the right atria will signal the atria to pump; a lead in the right ventricle will trigger the ventricles to pump. Frequently a lead in the atria and a lead in the right ventricle is all that is placed. At times both ventricles need to be triggered to improve pumping and a lead is placed in the right ventricle and another in the coronary vein to the left ventricle. This helps coordinate the signal to the ventricles to improve the pumping function and is called bi-ventricular pacing.
The battery that sends the electrical signal to the heart is in the generator. The battery lasts several years. You will have your pacemaker checked every 3-6 months to check the pacemaker function including the battery and leads.
A biventricular (right and left ventricle) pacemaker is used in some patients who have weakened heart muscles, the electrophysiologist may recommend placing this special type of to improve heart pumping. In this procedure, a third lead is placed in a heart vein to trigger the right and left ventricles to pump together. Threading the third lead into the heart vein can be difficult and add time to the pacemaker implant.