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The most common cause of a pacemaker malfunction is a broken (fractured) lead. Leads, also called electrodes, are made of one or two wires that are separated and covered with insulation. These wires deliver energy to the heart. The wires or the insulation can break, the contact point in the heart can stop responding to the spark from the pacemaker, or an infection can occur. When this happens, the lead must be replaced.

Tell a health care provider about:

  • Any allergies you have.

  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.

  • Any problems you or family members have had with anesthetic medicines.

  • Any blood disorders you have.

  • Any surgeries you have had.

  • Any medical conditions you have.

  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Allergic reactions to medicines or dyes.

  • Infection.

  • Bleeding.

  • Damage to nearby structures or organs.

  • Piercing (puncturing) a lung.

  • Another lead malfunction.

  • Fluid buildup around the heart or lungs.

  • Blood clots in the vein that is used for the procedure.

What happens before the procedure?

Staying hydrated

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Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.

  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.

  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.

  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you take diabetes medicines or blood thinners.

  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.

  • Taking over-the-counter medicines, vitamins, herbs, and supplements.

Tests

  • You may have an exam or testing, such as blood tests or urine tests.

  • You may have a chest X-ray.

  • Your pacemaker will be evaluated. It may be checked in-person using a specific type of magnet, or it may be checked remotely with a computer.

Surgery safety

Ask your health care provider:

  • How your surgery site will be marked.

  • What steps will be taken to help prevent infection. These may include:

    • Removing hair at the surgery site.

    • Washing skin with a germ-killing soap.

    • Taking antibiotic medicine.

General instructions

  • Do not use any products that contain nicotine or tobacco for at least 4 weeks before the procedure. These products include cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.

  • You may be asked to shower with a germ-killing soap the night before or the morning of the procedure.

  • Plan to have someone take you home from the hospital or clinic.

  • It is common to have to spend the night in the hospital after this procedure. If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

  • An IV will be inserted into one of your veins.

  • You will be given one or more of the following:

    • A medicine to help you relax (sedative).

    • A medicine to numb the area (local anesthetic).

    • A medicine to make you fall asleep (general anesthetic).

  • An incision will be made in your chest, typically at the scar from the pacemaker implantation surgery.

  • The fractured lead will be unscrewed from the pacemaker. There is usually an effort to remove the broken lead. Sometimes this is too difficult or dangerous, so the fractured lead may be left in place.

  • A new lead will be moved through a vein with the use of X-ray images. The lead tip will be positioned into the heart muscle.

  • The other end of the lead will be attached to the generator.

  • Your incision will be closed with stitches (sutures), skin glue, or germ-free (sterile) adhesive strips.

  • A bandage (dressing) may be applied over the incision site.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.

  • You may have chest X-rays to check the new leads and ensure that no complications have occurred.

  • You will have your pacemaker evaluated to ensure it is functioning properly.

  • If you were given a sedative during the procedure, it can affect you for several hours. Do not drive or operate machinery until your health care provider says that it is safe.

  • Do not raise the arm on the side of your procedure higher than your shoulder for 6 weeks, or as long as directed by your health care provider. Except for this restriction, continue to use your arm as normal to prevent problems.

Summary

  • The most common cause of a pacemaker malfunction is a broken (fractured) lead, which must be replaced.

  • Before the procedure, ask your health care provider about changing or stopping your normal medicines, especially any blood thinning medicines.

  • Do not raise the arm on the side of your procedure higher than your shoulder for 6 weeks, or as long as directed by your health care provider. Except for this restriction, continue to use your arm as normal to prevent problems.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.