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Getting a pacemaker or an implantable cardioverter defribillator (ICD) is a specialized surgical procedure to insert the device in your chest, and to ensure it functions properly to help manage the beating of your heart. This procedure is performed at the regional cardiac care centre.


Your cardiologist will contact you to discuss preparation for your procedure, and will have you sign a consent form. If you have any questions or concerns, please ask the doctor before signing the consent.

Do not stop taking any of your medications without first checking with your doctor, who can tell you if you should stop taking any and when to stop taking them. Usually you will be instructed to stop taking aspirin or Coumadin (warfarin) a few days before the procedure. Your doctor may also ask you to stop taking other medications, such as those that control your heart rate. If you have diabetes, please be sure to find out about any adjustment that need to be made to your diabetes medications or insulin.

The night before your procedure:

  • Eat a normal meal the evening before your procedure, but do not eat, drink or chew anything after 12 midnight before your procedure
  • If you must take medications, only take them with small sips of water
  • Remove makeup, nail polish and jewelry
  • Take a shower or bath
  • Pack a robe, slippers and personal care items
  • Pack a light snack for after the procedure

The day of your procedure:

  • Do not have breakfast the morning of the operation
  • Please leave any valuable items at home (we are not responsible for lost or stolen items)
  • Ensure you have someone who can drive you home after your test

Please arrive at the hospital 15 minutes before your booking time, and go directly to Admitting on the main floor (level 2) where you will be registered. You will also receive instructions on how and when to go the cardiac short-stay unit for your procedure.

You can expect to stay overnight at the hospital. The pacemaker/ICD implant procedure may last from two to five hours, and then you will stay overnight to recover and be monitored.

Before you go for the implant procedure, a nurse will help you get ready. You will be asked to use the bathroom (empty your bladder) and put on a hospital gown (you can wear your glasses, hearing aid and/or dentures). Then an intravenous (IV) line will be started to provide you with medications and fluids during the procedure. You will be given a light sedative to help you relax.

You will lie on an X-ray table and be monitored (heartbeat, breathing) by the cardiologist and nurses throughout the procedure. The left side of your chest will be shaved and washed with a pink antiseptic. Sterile blue sheets will cover the rest of your body.

The procedure will begin with a small incision being made in the shoulder area to insert the pacemaker/ICD. Before the devic is placed, the lead—or wires that carry the electrical impulse to your heart—will be tested to make sure they function properly and can increase your heart rate. After the leads are tested, the doctor will connect them to the pacemaker/ICD. Be sure to report if you feel any pain or discomfort.

When the pacemaker/ICD implant has been completed, the IV and heart monitor will be removed and you will be admitted to the medical floor to recover. A monitor will be connected to you to monitor your heart rhythm. You will also have a holter monitor, which is used to ensure that the pacemaker/ICD is working properly.

Your left arm will be in a sling for 24 hours. Try to restrict movement of your arm. Be sure to report any pain or swelling.

A chest X-ray will be done to check your lungs and the pacemaker. Before you leave the hospital, the doctor will review the results of the holter monitor.

Caring for your wound

Observe the surgical incision for signs of infection. Consult a health care professional if you note any of the following: fever, increased pain, redness, bleeding, swelling, unusual odor, increased drainage or cloudy or foul drainage.

Tegaderm™ Absorbent Clear Acrylic Dressing

  • You can remove the dressing seven days after your procedure, or otherwise as instructed.
  • Do not shower until after your first post-operative visit.
  • You may notice that the dressing created a bubble and has some fluid in it. This is normal, and it will evaporate slowly through the Tegaderm Absorbent Dressing.

Tegaderm + Pad

On the fourth day after your operation, please remove the top dressing. As of this day, you may shower. Be sure to dry the incision lightly.

Steri Strip and gauze dressing

  • On the fourth day after your operation, please remove the top dressing.
  • Remove the Steri Strip on the tenth day after your operation.

Patient activity

Take prescribed medication following your implant so that you can do gentle arm and shoulder rotations each day to prevent stiffness. Gradually increase these movements until your normal pre-implant activity level has been achieved (takes about five days).

Do not do any heavy lifting or excessive reaching above the head (i.e. digging, washing walls and windows). These jobs should be avoided until the lead tip has had a chance to stabilize (takes about six weeks).

If you received a new ICD implant, do not drive until your case is reviewed and discussed with your cardiologist or with the electrophysiologist on duty.


Keep your pacemaker/ICD identification card in your wallet so that you can show it to airport security to avoid setting off the alarm system. The arrhythmia management staff will give you a copy of your device printout to keep with your card in case of an emergency. If you wish, we can give you the name of a device clinic near your destination.


A properly maintained microwave oven will not interfere with your pacemaker. All pacemakers/ICDs today, are made with special shielding so that there is no interference. If you experience symptoms when you are near any operating electrical device, remove yourself from the immediate area.

To schedule your follow-up visits with a cardiologist, please contact the arrhythmia management clinic at 416-281-7400.

Your first visit should be scheduled 24 to 72 hours after your operation. The next visits are at six weeks and as instructed thereafter depending on the device you received. Eventually pacemaker are followed every 12 months, and ICDs are followed every six months.

Appointments may be rescheduled if you are unable to attend or the weather makes it unsafe to travel. It is sometimes necessary for us to change your appointments to a mutually acceptable day. Please bring a current list of your medications at each visit.

Note: These appointments do not take the place of regular medical follow up by your family doctor.

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