How is a cardiac pacemaker or defibrillator implanted?

The procedure is usually performed under local anaesthesia and takes about an hour. First, a vein in the upper arm or the vein below the collarbone is exposed through a small skin incision or punctured by a hollow needle. Through this venous route, the doctor introduces a flexible insulated electrode, advances it as far as the ventricle under X-ray control and fixes it in correct position. In many cases, another electrode is placed in the right ventricle to ensure coordinated heart action. The systems are accordingly called single- or dual-chamber systems. The other end of the electrode is connected to an analytical device to measure individual electrode position parameters. The electrodes are then fixed and connected to the pacemaker device. A pocket is made in the fat below the collarbone and the device is inserted and fixed there.

In contrast to the cardiac pacemaker, the pocket for a defibrillator is located behind the chest muscle. When a defibrillator is implanted, arrhythmias are triggered deliberately in order to test the function of the system. This requires brief general anaesthesia. If necessary, other electrodes are added.

The wound is closed with dissolving sutures beneath the skin. A pressure dressing is applied in order to avoid secondary bleeding. Prior to discharge from the clinic, the device is checked again and programmed to individual requirements.

When a triple-chamber pacemaker system is implanted, a third electrode is placed on the left side of the heart through a cardiac vein.