Pacemaker Treatment: Electrophysiology Laboratory, EP heart, implant surgery – Doctor | National Heart Centre Singapore
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Who and where will the pacemaker implantation be done?
A specialist doctor called an Electrophysiologist will perform the procedure. The procedure will be done in the Electrophysiology Lab.

Is the procedure done under general anaesthetic?
A combination of local anaesthetic (to numb the implant site) and sedation will be used so you do not experience pain or undue discomfort during the procedure. Medication will be given through your IV to relax you and make you feel drowsy, but you will not be asleep during the procedure. Note that this is not open heart surgery; opening up the chest is not needed.

How long does the procedure take? What should I expect?

Most cases will take around 60 to 90 minutes.

You will be taken to a special area called the Electrophysiology Laboratory to have the pacemaker implanted:

You will lie on a bed and the Electrophysiology Lab staff will connect monitoring equipment to your chest. They will also start an IV (intravenous) drop in a vein in your arm or hand. The IV is used to deliver antibiotic medication and fluids during the procedure.

The doctor will then clean the chest using a special soap, and cover you using sterile drapes from your neck to your feet. He or she will then inject local anaesthetic to the skin and give you sedation before implanting the pacemaker.

The pacemaker is implanted through a small (approximately 5 cm) incision in the upper chest, usually on the left side. After the incision is made, the pacemaker “lead” is placed under X ray guidance into the heart; the pacemaker box is then connected to the other end of the lead and secured under the skin incision, in a little “pocket”.

At this point, the doctor would test the device to make sure it is working properly. Once he or she is satisfied with the device, the skin will be sutured up and you will be woken up and returned to the ward.

How will the device be implanted?

The pacemaker is usually implanted using the endocardial (transvenous) approach. During the procedure, a local anesthetic (pain-relieving medication) is injected to numb the area, and you will be awake during the procedure.

Small incisions are made in the chest where the lead (or leads) and device are inserted. The lead is inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine. The lead tip is attached to the heart muscle, while the other end of the lead is attached to the pulse generator. The generator is placed in a pocket created under the skin in the upper chest.

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