Pacemakers are most often needed for children with a type of arrhythmia in which heart rhythms are too slow. It is a device that follows your child's heart beat and makes sure it doesn't fall below a certain rate. The procedure to implant a pacemaker usually requires a 24-hour hospital stay.

Preparation

Plan to arrive early the morning of the procedure.

We recommend that you contact Child Life Services to help prepare your child for the hospital experience. Child life specialists can explain procedures and equipment to your child with age-specific teaching tools, and may help lessen anxiety.

Because patients receive general anesthesia for the procedure, your child will not be able to eat or drink for eight hours before the pacemaker surgery. Your doctor will tell you exactly when your child should stop eating solid foods and drinking clear liquids. It is extremely important that your child have an empty stomach before receiving sedation for the procedure.

If your child appears ill, has a fever, cold, cough, vomiting, diarrhea, diaper rash or has recently been exposed to chicken pox, the pacemaker procedure may be postponed. Please call your doctor's office prior to the scheduled procedure date to discuss any symptoms your child may have.

Procedure

Single Chamber Pacemaker. Illustrations courtesy of Medtronic.

Before the procedure, a nurse will check your child's temperature, pulse rate and blood pressure and will give your child pajamas to wear while in the hospital.

Sedation will be given to your child before and during the pacemaker surgery. During the procedure, you will be given a pager so we can easily reach you.

Depending on your child's age, size and the type of pacemaker to be implanted, the procedure will be performed either in the operating room or in a special laboratory with X-ray cameras. The pacemaker procedure usually takes four to six hours.

Dual Chamber Pacemaker. Illustrations courtesy of Medtronic.

The area where the pacemaker will be implanted — either the chest or abdomen — will be washed with a yellow antiseptic soap. Your child will be covered with sterile drapes. He or she will have general anesthesia to ensure comfort. The doctor will inject a local anesthetic to numb the area where the pacemaker will be implanted. Nurses and doctors will closely monitor your child at all times.

The pacemaker is made of two main parts: the leads and the generator. The leads are thin wires that connect the heart with the generator. The leads can be attached to the surface of the heart or passed through a vein inside the heart. The lead is then attached to the generator. The generator is a small metal case that includes a battery and a microcomputer, which is the "brain" of the pacemaker. The generator is sutured under the skin in the upper chest or abdomen.

At the end of the procedure, sutures are placed under the skin to seal the wound and a dressing placed over the wound. The sutures will be absorbed as the wound heals.

Recovery

After the pacemaker is implanted, your child will be taken to a hospital room and may feel sleepy for several hours. He or she will be asked to lie in bed for four to six hours. When awake, your child can drink clear liquids and later have something to eat. In most cases, your child will return home the following morning.

Before leaving the hospital, you'll receive a temporary identification card that contains important information about the model and serial number of your child's pacemaker. Within six months, you'll receive a permanent card in the mail from the pacemaker manufacturer. This card should be kept with you and your child at all times.

Before you and your child go home, please make sure you receive the following materials from your child's doctor or nurse:

• Pacemaker informational brochures
• Follow-up appointment information

At-Home Recovery

Please adhere to the following instructions to ensure your child has a smooth recovery.

Wound Care

Your child's dressing may be removed the following day after he or she return home. Beneath the dressing are small pieces of tape, called steri-strips. These will fall off in one to two weeks. Absorbable sutures are located beneath the skin and do not need to be removed.

The best treatment is to keep the wound clean and dry. No ointments or creams should be used. Sponge baths are allowed, but the pacemaker site should be kept dry. Two weeks after the procedure, your child will be allowed to shower.

Although your child will be given antibiotics during and after the procedure, it is important to watch for signs of infection. These signs include redness, swelling, increased pain, drainage or fever. If these occur, please notify your child's doctor immediately.

Activities

Limit your child's sports activities for four to six weeks while healing. For two to four weeks after surgery, children with pacemakers implanted in the chest must avoid lifting their arm over the head on the side where the pacemaker is implanted.

Before leaving the hospital, discuss your child's activity restrictions with the doctor or nurse.

Interference with the Device

Inform your child's doctors and dentist that he or she has a pacemaker.

Microwave ovens and other appliances that are in good repair will not interfere with your child's pacemaker. Computers, hair dryers, power tools, radios, televisions, stereos, electric blankets and cars also won't interfere with a pacemaker.

A few things, however, might cause interference. These include very strong magnets such as those used for MRI scans, heavy-duty electrical equipment such as arc welders, and certain surgical instruments.

Pacemakers may set off a metal detector, such as those at airports. When traveling, your child may need to show a pacemaker identification card to security personnel.

Digital cell phones are unlikely to interfere with pacemaker function but avoid holding them directly over your child's pacemaker.

Follow-up Appointments

Your child's first follow-up appointment should occur one to two weeks after the procedure. This appointment should be made with the Pediatric Heart Center at UCSF Benioff Children's Hospital or with the doctor who referred you to UCSF.

At the clinic appointment, the doctor and nurse will examine your child's wound and check the pacing thresholds. This is the energy needed to safely pace the heart. Feel free to ask any questions you or your child may have concerning pacemakers.

Your doctor will determine future follow-up appointments.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.
Last updated July 14, 2010