What is a temporary pacemaker?
A temporary pacemaker keeps the heart beating at a safe rate for a short period, usually hours to a few days, until the underlying problem is treated or a permanent pacemaker can be implanted. A thin wire is passed through a vein into the heart and connected to a small external box at the bedside, which sends gentle electrical impulses whenever your own heartbeat is too slow. Nothing is left permanently in the body, and the wire is removed once it is no longer needed.
Why is it done?
It is used in urgent situations where the heart has become dangerously slow: complete block of the heart's electrical wiring, a very slow rhythm during a heart attack, slowing caused by an overdose of medication or a high potassium level, or a rhythm problem after heart surgery. It is also used to protect a patient during another procedure. Its purpose is to buy time safely, either until the cause reverses or until a permanent device is fitted.
What happens on the day?
The procedure is often done as an emergency, in the catheterisation laboratory or at the bedside with X-ray or ultrasound guidance. You are given a drip and continuous monitoring, and the skin over a vein in the neck or groin is numbed with local anaesthetic; sedation is given if your condition allows. The wire is guided through the vein into the right lower chamber of the heart and its position is tested until it reliably paces the heart, after which it is stitched and taped securely and connected to the external box. It usually takes twenty to forty minutes. External pacing pads on the chest may be used first if the situation is very urgent.
What to expect afterwards
You are cared for in a high care or coronary care unit, where the rhythm and the pacing box are checked frequently and the wire connections are protected. Movement is restricted so that the wire does not shift, and you will need help with getting up. Most patients feel considerably better once a normal rate is restored. The team continually reassesses whether your own rhythm is returning; if it does not, a permanent pacemaker is arranged, usually within a day or two. Removing the wire is quick and simple, and only mild pressure over the site is needed afterwards.
Possible complications
Because it is used in urgent situations and stays in only briefly, a temporary pacemaker has a higher complication rate than a permanent one. The wire can move out of position and stop pacing, which is why continuous monitoring is essential. Other problems include bleeding, bruising or clot formation at the vein, infection at the site or in the bloodstream if the wire stays in for several days, extra beats or fast rhythms triggered by the wire, and puncture of the heart wall with bleeding into the sac around the heart, which is uncommon but serious. If the neck vein is used, the lung can be nicked, causing air to leak around it. The team weighs these risks against the danger of leaving a dangerously slow heart untreated.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.