For a permanent pacemaker it is important that you not eat or drink anything after midnight from the night before. If you are on blood thinners it will probably be necessary for them to be stopped for a period of time prior to the procedure. It is acceptable for you to take any medications you normally take in the morning of the procedure with a little bit of water.

You will be instructed where and at what time to report to the hospital. You will need to check in at the admissions area, and then will be brought to the preoperative area. At that point the nurses will obtain some more history from you, take your vital signs, and place an intravenous in your arm. You will also be given some medication, if ordered; to help you become a little bit more relaxed. Thereafter you will be taken into the electrophysiology room where the right and left upper chest area will be cleaned. Any body hair may be shaved. Sterile drapes will be placed over you, which are blue sheets, to keep the area clean. You will probably be given a little bit more medicine at the time of the procedure to give you a bit more relaxation. Thereafter the doctor will arrive, and will perform the implantation of the pacemaker or defibrillator. If a defibrillator is being placed, you may actually have a period of time where you are deeply sedated and actually asleep. For pacemaker or defibrillator implantation it generally takes about an hour to do. After the procedure you will generally be brought back to the recovery area, or possibly back up to a hospital room. Generally speaking, most patients will spend one night in the hospital after an implantation of a defibrillator or a pacemaker. The day after the procedure has been performed you will probably be discharged to home. You will be instructed as to wound care at the site of the operation. Generally speaking, after a pacemaker or defibrillator has been implanted, we generally ask the patient to not get the area directly wet in the shower for a week. The area certainly can be cleaned with a little bit of soapy water on a facecloth. We generally ask that the patient not lift the arm on the side of the surgery more than shoulder level for one week. If a defibrillator has been placed, we usually ask the patient not to drive for two weeks after the procedure. If a pacemaker has been placed, the patient generally can drive the next day. It should be noted that if the implantation is done on the left side it may be beneficial to avoid driving for a few days as the seatbelt will tend to go over the site where the pacemaker or defibrillator was placed. Certainly if one were to have to stop shortly, this could cause some local trauma to the area. After your implantation your medications may be changed. It is important to go over your medications with your doctor or discharge nurse prior to leaving the hospital.

If your doctor has ordered a cardiac catheterization on you, you will be required to get blood work and possibly a chest x-ray prior to the day of the procedure. On the day of the procedure you will be instructed to go to the hospital to the admissions office. It is important that you not eat or drink anything after midnight from the night before. After checking in at the hospital you will be brought to a pre-op area where a nurse will start an IV, obtain further history from you, and check your vital signs. Thereafter you will be brought into one of cardiac catheterization laboratories where your right and left groin areas will be cleaned with an iodine- like preparation. There may be a very small amount of shaving of any body hair in that area. Thereafter they will put a series of sterile blue drapes on you to keep the area perfectly clean. Your doctor will probably have ordered some medications prior to this to cause some relaxation, such as Valium and Benadryl. The cardiac catheterization laboratory tends to be somewhat on the cool side. We can give additional medication in the laboratory to make you more relaxed. After the doctor arrives he will inject numbing medicine in your right or left groin. Thereafter a small needle will be placed in the artery through which a tube will be placed into the large artery from your leg up to the heart. Through this tube, which is about the size of a large piece of string, an iodine contrast will be injected to allow the doctor to visualize the arteries in your heart. At one point in the procedure he may inject a large amount of dye, and that will show how well the heart muscle is squeezing. This tends to make one feel warm from head to toe. This part of the procedure only lasts for a few seconds. After finishing the procedure, if it is deemed possible or necessary, you may go on to an interventional procedure in which a wire is placed across a blocked artery. Over that wire a balloon will be advanced into the blockage, and then opened up to open up the blockage. Thereafter a stent may be placed, which is a metal sleeve to keep the artery open. If an interventional procedure is not done, expect the catheterization procedure to take anywhere from twenty to forty minutes. If an intervention needs to be done, the procedure may take up to an hour. After the procedure is done, whether it be intervention or catheterization, the catheter will be removed from the right or left groin area. It may be possible to actually use a closure device to stop any bleeding, and allow you to get up out of bed more quickly. Expect to be in bed after the procedure from anywhere from three to five hours to allow the leg to heal. You will know the results of the procedure as soon as it is done. If an interventional procedure is done, you may end up spending the night in the hospital, otherwise most of the catheterizations are done as an outpatient. It is important to note that you cannot drive home after the procedure. You will need to have someone give you a ride. The night after the procedure, if you need to cough, sneeze, laugh or cry, it is always helpful to put a little bit of pressure at the site of the catheterization to prevent any potential bleeding, which rarely can occur. The same holds true if you need to walk up steps at night to go to bed. It is advised to not do any truly extertional activities such as running or heavy lifting for a couple of days after the procedure unless otherwise instructed by your doctor. Your medications may change after the procedure, so it is important to speak with your doctor or the nurses prior to the discharge to determine if any medication changes have been made.

As with all procedures, if you should develop any nausea, vomiting, fever, chills, chest pain or shortness of breath after any of the procedures are performed, it is important that you call our office immediately.