When receiving a pacemaker, the device is typically implanted under your collarbone. Prior to the procedure, the area is thoroughly sterilised using antiseptic solution and allowed to dry. It's important that you keep your arm still and avoid contaminating the operating area. Sterile drapes will cover your face temporarily, but they will be removed shortly after.

To ensure your comfort during the procedure, an anaesthetist may be present. Alternatively, sedating medication may be given through a drip in some settings. Despite receiving medication, you will remain aware of your surroundings and able to communicate with your doctor. It's vital that you communicate any discomfort or concerns to your doctor, so they can adjust the medication dosage accordingly. Moreover, a mix of fast- and slow-acting local anaesthetics is used to numb the site, which will continue to work for several hours after the procedure.

The pacemaker wires are inserted into a vein that channels blood from the arm back to the heart. Using an x-ray called an image intensifier, the wires are threaded through the vein and into different areas of the heart. This part of the procedure may take a while, as your doctor will frequently test the wires to ensure they are in the optimal position to deliver energy to the heart. Once the wires are in place, the pacemaker is connected to the leads and implanted in a "pocket" under the skin, with the incision closed.

You may experience some pain after the local anaesthesia wears off, which should be manageable with paracetamol. If you need additional pain relief while in the hospital, please inform the nursing staff. The duration of the procedure varies depending on several factors, but it may take several hours.

Following the procedure, a compression dressing will be applied for a few hours. Some patients may have a skin adhesive, which should be kept dry for 24 hours and can then be exposed to water but should not be scrubbed, picked or soaked. The adhesive will gradually peel off by itself over the next few weeks. The stitches in the wound will dissolve, so they won't need to be removed.

After the procedure, a chest X-ray will be taken, and the pacemaker will be checked using a special computer known as a programmer. This programmer enables your doctor to examine the pacemaker and make any necessary changes to ensure it meets your specific needs. If the pacemaker checks out well and you feel well, you will be discharged with a short course of antibiotics.

For the safety and well-being of patients, preventing infection during pacemaker implantations is of utmost importance. The utmost care is taken during the procedure to prevent this complication. However, it's essential that patients monitor their wound daily for any signs of infection, including fever, redness, heat, increased swelling, or new drainage. If you experience any of these symptoms, please report them to Dr. Hsieh immediately. Please refrain from tampering with the operating site yourself.

For the first two weeks after the procedure, it's important to avoid using the arm for strenuous activity and refrain from raising the arm on the side of the device above shoulder level for 4-6 weeks. This allows time for the lead(s) to attach firmly to the heart tissue and for the incision to heal properly. It's also important to avoid bumping or hitting the area around the implant, so contact sports are not recommended. However, you are encouraged to use the arm for light activities to prevent developing a frozen shoulder.

The Roads and Traffic Authority requires that patients refrain from driving for two weeks after a pacemaker implantation for a private vehicle and four weeks for a commercial vehicle. Patients will no longer be able to hold an unconditional license, but a conditional license is permissible with routine medical review.

Pacemaker checkups are necessary at two weeks and every few months thereafter. However, if you experience any unusual symptoms, such as difficulty breathing, dizziness, fainting, chest pain, hiccupping, or signs of infection, please report them to Dr. Hsieh.

After the implantation, you will receive a Medical Device ID card from the pacemaker company, which you should keep with you to alert medical and security personnel that you have an implanted device. Please note that the metal components of the device may set off airport security metal detector alarms and that airport security wands can temporarily affect the device. If security personnel use a handheld wand, ask them to perform the search quickly and avoid holding the wand over the device. If you have any doubts about equipment to avoid, please speak to your doctor or the device manufacturer for guidance. Most manufacturers have engineers who can determine whether the electrical field generated by a piece of equipment can interfere with the pacemaker.

While mobile phones can potentially interfere with the proper operation of the device, simple precautions, such as not carrying the phone directly over the pacemaker and holding it up to the ear that is farthest from the pacemaker, can minimise the risk.

Pacemaker implantation is a procedure with a relatively low risk of complications. The most common side effect is bruising at the site of the procedure, which occurs in less than 3% of cases, or up to 10% for patients on blood thinning medications. However, re-operation or blood transfusion due to bleeding is rare, occurring in less than 1% of cases. Lung puncture is also a rare complication, but can result in a longer hospital stay and a chest drainage tube for a few days. The leads can also move out of place in the heart, requiring a repeat procedure to reposition them. Infection is a rare complication, but the most serious risk. Precautions are taken to avoid it, but if the device becomes infected, it may need to be removed. Finally, significant electromagnetic interference may prevent the device from working properly.