Before we insert a pacemaker, we clean your chest and insert an IV into your forearm with medication to relax you. We use local anesthesia to numb the area for pacemaker insertion. You will usually be lightly sedated or fully awake during the procedure. If we do a surgical placement of the pacemaker, we may put you to sleep (general anesthesia). 

For a pacemaker with wires, we use one of two approaches. If we use the transvenous approach, we insert the wires into a vein near your collarbone. If we use the epicardial approach, we make a small chest incision and insert the wires through the incision. In both procedures, we attach one end of each wire to the inside of your heart. The other end of each wire attaches to the part of the pacemaker that sends electric pulses (pulse generator).

In the transvenous approach, we place the pulse generator under your skin in your upper chest. In the epicardial approach, we place the pulse generator under your abdomen skin.

For a leadless pacemaker, we insert it through a catheter into a blood vessel in your groin and guide the pacemaker to your heart. 

You will likely spend about a day recovering in the hospital after we place your pacemaker. We will monitor your heartbeat and make sure the pacemaker works correctly. We may also use an X-ray and an electrocardiogram (EKG) to check on the pacemaker’s placement and look at your heart rhythm.