Pacemaker Placement Care Guidelines

Pre-Procedure Care

The American College of Cardiology recommends identifying patients with implanted devices before surgery and obtaining appropriate records from the device clinic monitoring the patient's device 3
The American College of Cardiology suggests determining the original indication for device placement and whether the patient is pacemaker-dependent, having an unstable or absent spontaneous rhythm with hemodynamic instability in the absence of pacing 3, 1
The American College of Cardiology advises evaluating the device within 3-6 months before significant surgical procedures, especially those involving major abdominal or thoracic surgery with large amounts of electrocautery 3
The American College of Cardiology recommends documenting device type, whether the patient is pacemaker-dependent, programmed settings, and battery status 3

The American College of Cardiology recommends ensuring the device is reprogrammed to an asynchronous mode or a magnet is placed over the device during surgery for pacemaker-dependent patients 3
The American College of Cardiology suggests maintaining continuous ECG monitoring and pulse monitoring during surgery, as electrocautery may interfere with ECG monitoring 3
The American College of Cardiology advises minimizing electromagnetic interference by using bipolar electrocautery systems, short intermittent bursts of electrocautery, maximizing distance between electrocautery and the device, and ensuring proper placement of the ground patch 3

The American Heart Association recommends providing continuous ECG monitoring for 12-24 hours after implantation to detect potential complications 1, 4
The American Heart Association suggests monitoring for lead dislodgement, which is a well-known early complication after insertion of pacemakers 1
The American Heart Association advises watching for sudden increases in pacing threshold or failure to sense, which can be identified with ECG monitoring and corrected with non-invasive reprogramming 1
The European Society of Cardiology recommends evaluating the wound and generator pocket for signs of infection or hematoma 5
The European Society of Cardiology suggests obtaining 12-lead ECGs and chest radiographs to confirm proper lead placement 5
The European Society of Cardiology advises ensuring appropriate programming of primary pacing and sensing parameters 5

The American Heart Association recommends documenting all symptomatic tachy- or bradyarrhythmias and all rhythms requiring immediate treatment in the patient's permanent record 6
The European Society of Cardiology suggests maintaining proper documentation of the patient's pacing system in a database for monitoring performance and reliability 5
The European Society of Cardiology recommends scheduling follow-up visits to the outpatient cardiac pacemaker control department, with the first follow-up after 4-6 months for single-chamber pacemakers and 6-monthly basis thereafter for dual-chamber pacemakers 5