The pulse generator, which is about the size of a matchbook or smaller, is usually implanted below the collarbone just beneath the skin. The leads are threaded into the heart through a vein located near the collarbone. The tip of each lead is positioned in direct contact with the tissue inside the inside the heart. Usually, the implant is done with the patient awake, using local anesthetic and some medication that helps with relaxation. Though this implant procedure is the most common, sometimes the pulse generator is positioned in the abdomen and the pacemaker leads are attached to the outside of the heart.
Patients are asleep for such a procedure.
This type of surgery is less common in adults but more common in children or other patients whose body structure makes an implant near the collarbone difficult. Of course, where and how to implant your pacemaker system is determined by your physician based on your individual needs. Preparation and Followup What to Expect Your doctor or nurse will give you specific instructions about preparing for your pacemaker implant. Common guidelines involve whether you should continue or stop certain medications, if you should avoid eating or drinking in the hours before surgery and what the hospital check-in procedures are. During the surgery, you will be attached to several monitors.