Pacemaker/ICD insertion is done in the cardiac catheterization laboratory, or the electrophysiology laboratory. The patient is awake during the procedure, although local anesthesia is given over the incision site, and generally sedation is given to help the patient relax during the procedure. A night or two of hospitalization may be recommended so that the functioning of the implanted device may be observed.
A small incision is made just under the collarbone. The pacemaker/ICD lead(s) is inserted into the heart through a blood vessel which runs under the collarbone. Once the lead is in place, it is tested to make sure it is in the right place and is functional. The lead is then attached to the generator, which is placed just under the skin through the incision made earlier. Once the procedure has been completed, the patient goes through a recovery period of several hours.
There are certain instructions related to having an implanted permanent pacemaker or ICD. For example, after you receive your pacemaker or ICD, you will receive an identification card from the manufacturer that includes information about your specific model of pacemaker and the serial number as well as how the device works. You should carry this card with you at all times so that the information is always available to any health care professional who may have reason to examine and/or treat you.