Pacemaker Replacement - What should I expect?

I have had a Medtronic pacemaker since September 1999, and it's being replaced in 1 1/2 weeks. My doctor said the leads are good, so it's just the pacer being replaced. I've been told this is an easier recovery than the original surgery, which is good since the first one was LONG and painful. (I was a skinny 21 year old, and they had to do some serious digging to carve out a spot for it.)

At the pre-op consult with my surgeon (same one as last time), I only thought to ask about lifting my baby (12 1/2 pound, 8 month old) and he said not for a few days. But that's all the info I got, and the appt. was too rushed for me to remember everything else.

When the leads aren't being done, do we still have to follow the "no arms above head" rule for awhile, or is it safe to just go by what feels comfortable? What is recovery like for a simple pm replacement?

I know he'll tell me all this stuff at the hospital, but I need to plan ahead for what kind of help I'll need after, and for how long. I have an 8 month old and a 3 year old. I also babysit a 4 year old nephew and 7 year old niece and need to know approx. how long I'll need off.

Hubby has the day of surgery, as well as the 2 days after, off from work, and I have people who can help me during the days after that, but will I still need help at night to lift baby? (He wakes a few times a night to eat still).

Any other info that I might need to know, but haven't thought of?

Thanks!
Anjii


6 Comments

forgot to add...

by anjii - 2008-06-06 04:06:43

How long do leads generally last, and what happens if they "go" before the current pacer? (Just thinking ahead)

Replacement surgery

by ElectricFrank - 2008-06-06 06:06:11

Hi,
With replacement the original leads are well scarred into the heart and veins so there shouldn't be any risk of pulling them loose. The recovery should be about the same as any surgery in the area of the pacer. Your activity afterward is more a matter of comfort which is related to where yours is located. I am thin, male, and mine was implanted just under the skin below my clavicle. It healed quite fast and since it didn't displace any major muscles I could pick up most anything. My newly installed leads kept me from reaching about shoulder height though.

If yours is implanted under a breast as is often done in women then there is more displacement of sensitive tissue and it might take a bit longer. I would plan on avoiding lifting the weight of the children for at least 2 and maybe 3 weeks. You might be able to lift the little one with the opposite arm.

These are just some guesses and an idea of how I manage my own surgeries. I just listen to what my body is telling me and respect it. I had back surgery in 1984 and was up walking around the room 6 hours after the surgery. I've also had minor surgery where I didn't use the affected area for 3 weeks.

One other suggestion. If you can handle it there is less impact on your body and faster recovery if you have it done under local anesthesia.

frank

thanks

by anjii - 2008-06-06 07:06:46

Well, that's good to hear... mine is actually implanted exactly where you describe yours being. (I wonder if putting it under the breast is maybe reserved for women past their breastfeeding years?) I also plan/hope to have only local anesthesia. I did last time, but I was resistant to it and felt most of the procedure quite graphically and painfully. Also, during an emergency c-section with baby #2, the epidural wasn't working fully and they had to knock me out. According to the docs, it took full effect about 1/2 hour later (although I'm not sure how they would know that, since I was still under at that point), so if we had been able to wait awhile I could have been concious, but the situation was far too critical. So, my pm surgeon says I may be resistant, but I'm hoping if they just wait long enough for it to kick in, local may be enough. I don't want general if I can help it.

Sorry for rambling... anyways, thanks for your insight. All things considered, so far I'm thinking this recovery may not be too bad at all, after the first few days.

similar surgery

by CathrynB - 2008-06-06 08:06:05

I haven't yet had my pacemaker replaced, but I had surgery 6 months after the intial implant to have my PM re-positioned, and I believe that surgery is very similar to a replacement as long as the leads are not involved, which mine were not. I guess the re-positioning is possibly slightly more invasive as it requires removing the PM from the old pocket and creating a new pocket, but otherwise the same. In any case, it was very minor surgery. I was told to "take it easy" with my left arm for 2 weeks, but no restriction on lifting my arm above my shoulder, except as indicated by comfort/pain as EFrank suggests, and no heavy lifting at all for 2 days. It was a much easier recovery than the initial implant. I had local anesthesia and was back at home 4 hours after arriving at the hospital. My PM is behind my breast (I'm 51 years old, past breast-feeding age) and it was quite tender for 2 days requiring full-time bra wearing, but otherwise no big deal at all. Caring for 4 children age 7 and under is probably not a good idea for a week or two, and you'll probably want to have someone lift the baby into your lap for feeding for a week. If the 7-year-old is quite a helpful child, you may be okay a little sooner.
Best wishes for an easy surgery and quick recovery. Take care, CathrynB

Hi Anjii,

by Gellia2 - 2008-06-06 08:06:40

I had my pacer replaced last July. It was my 7th replacement and I no longer want to stay awake with these anymore (novelty has worn off - LOL), so they give me a very short acting intravenous drug called PROPOFOL. I can't recommend this highly enough. I remember nothing, no pain at all, and woke up to be able to get off the operating table, onto a gurney, and wheeled into recovery. From there, I went home three hours later. It was super. The anesthesia didn't make me sick or sleepy and I went home and made dinner!
If you don't feel you want to do the just the local thing (they gave me a local, too.), try propofol.
It made it my easiest replacement to date.
Also, my wires were implanted in 1982 and are still functioning.
Hope some of this helps.
My very best to you,
Gellia

Implant under local

by ElectricFrank - 2008-06-07 02:06:24

It really depends on how you feel about and handle it. All I felt was some pain from needle punctures when the injected the local. After that it was mainly a sense of pressure particularly when they were making the pocket. That's kind of a brutal process of separating the skin from the underlying tissue. Reminds me of removing the skin from an uncooked turkey breast. You shouldn't have to have that done this time though unless the new pacer is a different shape.
Another advantage to being awake is that you can take care of yourself better. There is a tendency for O.R. to treat an unconscious patient like a piece of meat. Several times they started to move me into a position that cramped my neck or shoulder and I stopped them. They didn't like it, but they had to loosen my arm straps and let me adjust my position a bit. I've seen a number of reports here of stiff or "frozen" neck or shoulders and I really wonder if it didn't come from surgery.
The way I arranged it with the anesthesiologist was for him to be ready to give me either anti anxiety or the works if I ask for it. I never came near it, but there is no reason to make it a challenge. If things get rough then use it.

best of luck and we will be watching for your report,

frank

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At age 20, I will be getting a pacemaker in few weeks along with an SA node ablation. This opportunity may change a five year prognosis into a normal life span! I look forward to being a little old lady with a wicked cane!