Transvenous pacemaker · Example base 2026-09-25.2
START HERE
Your transvenous pacemaker checklist
Keep this page with your medication plan and discharge instructions.
Before you arrive
- Read the “Getting ready” section. Use the medicine and food-and-drink plans recorded there; blank lines must be completed by your team before you use them.
- Complete the tests in your appointment instructions. Bring your current medicine list, identification and insurance information.
- Arrange an adult to drive you home and stay with you the first night.
Procedure date / arrival time:
Facility / check-in location:
Before you leave the facility
- Make sure you have your medication restart plan, wound-care and activity instructions, and your follow-up plan (appointments or timeframes with booking instructions).
- Keep the “Your recovery” and “When to get help” sections available at home. Call 911 for the emergency symptoms listed there.
Follow-up appointment or timeframe / booking instructions:
Practice phone: 202-555-0148
After-hours number / route: 202-555-0148 — ask for the on-call device team
Keep the instructions together
Your personalized medication, anesthesia and discharge instructions take priority over general template wording. The team should record the current documents below and resolve any conflicting instructions before you leave.
Medication / anesthesia plan title and date:
Discharge instructions date:
UNDERSTANDING YOUR PROCEDURE
Your transvenous
pacemaker
Before and after a new transvenous pacemaker implant
What the pacemaker does
A transvenous pacemaker has a small battery-powered device, usually under the skin near the collarbone, connected to the heart by one or more thin wires called leads. Transvenous means the leads pass through a vein. The pacemaker senses your heartbeat and sends small electrical signals when needed to prevent a slow heartbeat. Your team selects the number and position of the leads for your heart’s needs. Some systems also help the heart’s chambers pump together.
This guide covers a new permanent transvenous pacemaker with a chest incision. It is not for a leadless pacemaker, an ICD that delivers shocks, a generator-only replacement, or lead removal. A pacemaker does not cure every rhythm problem or automatically replace your medicines.
On the day
The skin near the collarbone is cleaned and numbed with local anesthetic. You usually receive sedation to help you relax; some patients need a different anesthesia plan. The lead or leads are positioned using imaging, tested, and connected to the device. The incision is closed and covered. Antibiotics are given around the procedure to reduce infection risk.
Before discharge, the team checks the device and wound and usually obtains a chest X-ray. Some people go home the same day; others stay overnight.
Benefits and risks
Pacing may reduce fainting, dizziness or fatigue caused by a slow heartbeat. Benefit depends on why you need the device. Risks include bleeding or a blood collection around the device, infection, lead movement, a collapsed lung, heart perforation or fluid around the heart, blood-vessel injury, and a need for another procedure. Serious complications and death are uncommon but possible.
Getting ready
Medicines and fasting
Use the written plan below. Blood thinner and antiplatelet instructions depend on your medication, kidney function, bleeding risk and any recent coronary stent. Do not copy an AF ablation hold plan or stop these medicines on your own. A missing or conflicting procedure-day plan needs clarification before you change a dose.
Blood thinner / antiplatelet plan
PROVIDER TO COMPLETE BEFORE PATIENT USE. Blank lines are not medication or fasting instructions.
Medication and before-procedure continue/hold plan:
Restart plan / confirming clinician:
Provider initials / date:
Food and drink plan
Do not eat or drink after midnight before your procedure, unless your anesthesia team gives different instructions. Take the morning medicines listed in your preparation plan with small sips of water; do not take medicines marked HOLD. Insulin and other diabetes medicines follow your separate diabetes plan, not a blanket take-all-medicines rule.
SGLT2 medicines
If you take empagliflozin (Jardiance), dapagliflozin (Farxiga), or canagliflozin (Invokana), hold it for at least 3 days before the procedure. Ertugliflozin (Steglatro), including combination tablets, needs at least 4 days. Restart after the procedure when you are clinically stable and eating and drinking normally, unless your discharge plan says to keep holding it. Do not restart while vomiting, dehydrated, or unable to eat; contact the team if these occur.
Last dose date / time (provider to complete):
GLP-1 medicines
If your pre-anesthesia review found low risk for delayed stomach emptying, continue your GLP-1 medicine on its usual schedule unless your written plan says otherwise. Contact the team before the procedure if you have newly started or increased the dose, develop nausea, vomiting, bloating, belly pain or constipation, or have a condition that slows stomach emptying. Higher-risk patients may need a 24-hour liquid-only diet, a different anesthesia plan, or a delay. Follow any written individualized instructions below.
Exceptions to the routine plan (only if applicable):
Bring your current medication list, identification, and insurance information. Complete the tests listed in your appointment instructions. Arrange an adult to drive you home and stay with you the first night.
Additional preparation
- Bring allergy information with the items on your “Start here” checklist.
- Report fever, an active infection, or broken/infected skin near the planned implant before coming for the procedure.
- Wear a loose, front-opening shirt. Do not shave the implant area yourself.
Recovering at home
What is usually expected
Mild soreness, bruising and a small stable swelling around the incision can occur. You may feel the device under the skin. These should improve, not become increasingly painful, red or swollen. Follow the discharge medication list; a pacemaker by itself does not mean you must start a blood thinner.
Wound care and movement
Walk gently and use your arm for comfortable daily activities. Avoid pressure or rubbing over the device. Use the wound-care plan below for your dressing and shower timing. Do not soak the incision until it has healed.
Use gentle, comfortable arm and shoulder movements; do not keep the shoulder rigid or use a sling continuously unless specifically prescribed. Keep the wound clean. Do not pick skin glue or strips, or apply creams. Avoid baths, pools and hot tubs until the incision is fully healed.
Keep the outer dressing dry for 7 days. Wash around it with a damp cloth. On day 7, gently remove only the outer dressing; leave skin glue, strips and stitches alone. If the incision is closed and dry, shower briefly and pat it dry. If it is open, draining or increasingly red, contact the device clinic instead. A wet, loose or soaked-through dressing needs earlier attention. Follow a different plan if you were given a special dressing.
No baths, swimming or hot tubs until the incision is fully healed. Do not apply creams or pick the closure.
For 3 weeks, avoid lifting more than 10 pounds with the implant-side arm, forceful pushing or pulling, and strenuous upper-body exercise. Continue walking and gentle, comfortable shoulder movement and daily tasks; do not hold your arm rigid or routinely use a sling. Return gradually afterward if the wound has healed and there are no symptoms, unless your implant team gave different limits.
Do not drive until your implanting clinician or device-clinic team explicitly clears you. Before discharge, have the team record when and how clearance will be given. A wound check alone does not automatically provide driving clearance, and the later device-check date is not an automatic driving start date. Arrange rides until cleared. Never drive while dizzy, faint, taking sedating pain medicine or unable to steer comfortably. Prior fainting, commercial driving or local licensing requirements may mean a longer restriction; this guide does not provide commercial-driver clearance.
Return-to-work date / restrictions if needed:
Any handwritten exceptions must be completed by the implant team. Never drive while dizzy, faint, or impaired by sedating medicine. Commercial driving and a history of fainting require a separate plan.
Follow-up and remote monitoring
Keep your scheduled wound and device checks. Set up your remote monitor or app using the supplied instructions, ideally before discharge or within 2 weeks. Keep it connected. Remote monitoring is not an emergency service; do not wait for a transmission response if you feel seriously unwell.
Plan a wound check around 7 days and a device-clinic visit at 4–6 weeks. Before discharge, have either the appointment details or the timeframe and booking instructions written in your discharge plan. Earlier symptoms should be assessed promptly rather than waiting for the visit.
Wound / device appointments or timeframes / booking instructions:
For monitor setup or connection problems, use the manufacturer support number supplied with the monitor. For symptoms, use the emergency and same-day warning signs in this guide. Keep your device ID card with you and show it to medical and dental staff.
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Everyday life & when to get help
Phones, magnets and medical tests
- Keep phones, magnetic earbuds and other small magnetic electronics at least 6 inches (15 cm) from the pacemaker. Use the opposite ear and do not store a phone in a chest pocket over the device.
- Do not place magnets or magnetic therapy products over the implant. Strong industrial magnets and certain equipment need device-specific advice.
- Most ordinary household appliances, including microwaves in good working order, can be used normally.
- Tell the imaging team about your pacemaker before any MRI. Many patients can have MRI under a special protocol, but the complete device-and-lead system must be checked and the device may need programming. Do not assume it is safe without that check.
Call 911
- Severe or sudden trouble breathing, severe chest pain, fainting, or stroke symptoms such as facial droop, arm weakness or trouble speaking.
- Heavy bleeding that does not stop with firm pressure, or rapidly expanding painful swelling with weakness or faintness.
Do not drive yourself. The pacemaker monitor is not an emergency alert system.
Contact the device clinic the same day
- Fever or chills; increasing redness, warmth, pain or swelling; drainage; wound opening; or visible device/lead material.
- New swelling of the arm on the implant side, persistent hiccups or twitching, or return of dizziness or near-fainting.
- Growing swelling or bleeding around the implant, even if you otherwise feel well.
Use the clinic’s after-hours contact route if needed. If you cannot reach the team and symptoms are worsening, seek urgent assessment; use 911 for severe symptoms.
Follow your personalized medication and recovery plan. This guide supports, but does not replace, the consent discussion or your implant team’s instructions.