This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request.

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1 Information for patients This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request. Your doctor has recommended you have a pacemaker fitted to regulate your heartbeat (arrhythmia), which if left untreated could cause death in some cases. Having a pacemaker fitted reduces the chances of this happening and symptoms such as dizziness and blackouts. This leaflet will help you understand what will happen before, during and after the procedure. How does the heart work? The heart is a muscle that pumps blood around the body. It is made up of four chambers; two upper chambers (the 'atria') and two lower chambers (the 'ventricles'). The heart has its own electrical system that keeps it working by adjusting the heart rate when required. Some patients develop problems with their heart's electrical system. A pacemaker can help overcome these problems. Your doctor or nurse will have explained why you are recommended to have a pacemaker. What is a permanent pacemaker? A pacemaker is an electronic device about the size of a small biscuit, protected by a metal casing. When in place, the pacemaker sits under the skin below the collar bone. It is connected to one or more leads which have been passed along blood vessels in the chest to the heart. Using these leads, the pacemaker is able to monitor the heart's electrical activity and to stimulate the heart to beat by sending electronic impulses along the leads. What should I do before my pacemaker implant? Your procedure will be performed at the Cardiology Day Unit at the University Hospital of North Tees. You will be sent a letter telling you when and where to come. The pre-assessment nurse will also tell you if you need to stop any medication (drugs) such as Warfarin or Clopidogrel (Plavix). All your other medication must be taken as normal and you should bring all your medication with you. The letter will give you instructions on when you should stop eating and drinking. It is important you arrive at your appointment time so we can prepare you for your procedure and answer any questions you may have. We cannot give you a specific time for your procedure as this depends on the needs of all our patients. We will try and keep you fully informed. Med/368.2 (2015) Page 1 of 7 For Review Autumn 2018

2 Most patients need to stay in hospital overnight after the procedure. This is to allow your blood pressure, heart rate, temperature and wound to be checked and to allow a chest x-ray and pacemaker check to be performed, if needed. Who will be present during my procedure? North Tees and Hartlepool NHS Foundation Trust is a teaching organisation. We could not train future doctors, nurses or other health professionals without the co-operation of patients. A team of healthcare professionals including a cardiologist (a doctor who specialises in conditions of the heart), nurses, cardiac physiologists (a person qualified to perform tests on the heart), and a radiographer (a person qualified to take x-rays and scans). You will be informed if there are to be any observers present. Healthcare professionals in training may take part in your procedure according to their experience and stage of training. They will be supervised by fully qualified staff at all times. What will happen when I arrive at the Cardiology Day Unit? A nurse will show you to a bed in a screened area. You will need to change into a theatre gown and your own dressing gown. The information given at your pre-assessment appointment will be checked for changes. Your blood pressure, pulse and temperature will be checked. A cannula (a fine tube) will be inserted into a vein in the back of your hand or arm using a small, fine needle. This allows blood samples to be taken and medication to be given before and during the procedure. A doctor or nurse will explain the procedure and also confirm you have signed a consent form. What will happen during the procedure? The procedure takes about 90 minutes. You will be taken to the procedure room on your bed and moved on to a theatre bed with an x-ray machine above it. A nurse will be with you throughout to make sure you are comfortable. You will be given antibiotics to reduce the risk of infection. You will also be offered light sedation to help you relax and ease any anxiety. You will be connected to equipment to monitor your heart rate and rhythm, blood pressure and blood oxygen levels, throughout the procedure. The theatre nurse will clean your upper chest with an antiseptic solution and place sterile drapes under your back and over your upper chest, leaving a small area exposed for the pacemaker to be implanted. Med/368.2 (2015) Page 2 of 7 For Review Autumn 2018

3 You will have a local anaesthetic which means you will be awake during your procedure. You will be given additional painkillers and/or strong sedation to reduce any discomfort and make you drowsy. If at anytime during the procedure you feel pain or would like to have more painkillers or sedation, let your nurses or doctor know. A small incision (cut) will be made below the collarbone and a suitable vein found which is used to pass the lead or leads into the heart. The leads are positioned using x-rays. You may be aware of the camera moving, it will not touch you. If your doctor has problems passing the leads into a vein he or she may insert a special dye, called contrast medium, into your cannula. You may hear team members talking to each other during the procedure as checks are made to the leads and pacemaker. This is all normal and nothing to worry about. Several different lead positions may need to be tried before the best one is found. You may be asked to take deep breaths or to cough. The pacemaker is connected to the lead and placed under the skin in your upper chest before the wound is closed using dissolvable stitches. A sterile dressing is applied over the wound. What happens after the procedure? After the procedure you will return to your bed in the Cardiology Day Unit. We will continue to monitor your blood pressure, pulse, temperature and wound. You will be offered drinks and snacks. Your doctor will see you and answer any questions you may have before you are transferred to a ward for overnight stay. You will be given a discharge advice leaflet telling you how to care for your wound where the pacemaker is fitted. When can I go back to work? This will depend on your job; you will probably need at least 1 week off work. This will be discussed with you before you go home. When can I drive? If you drive, you must inform the DVLA and your insurance company you have a pacemaker. If you hold a normal driving licence, you are not allowed to drive for at least 1 week after your pacemaker is fitted. If you have a Group 2 licence, for example, vocational, HGV or PSV, the DVLA will advise when you can start driving again. Med/368.2 (2015) Page 3 of 7 For Review Autumn 2018

4 What are the risks and possible complications? As with any procedure complications can occur. You will have an opportunity to discuss these before signing the consent form. You will be checked for signs of any problems throughout the procedure. The following are common or important complications: pneumothorax (puncture) of the lung. This can happen to 1 patient in every If this happens you may need a short stay in hospital and another procedure. haemothorax (bleeding into the lung). This is less common than a pneumothorax. If this happens you will need to stay in hospital and may need another procedure. While it doesn t usually cause problems, it can be life threatening. pericardial effusion (blood leak around the heart). This is rare but can happen to 2 patients in every 1, If this happens you may need a short stay in hospital and another procedure. air embolus (air entering a vein). This can happen when the leads are inserted into the vein. Staff follow methods to reduce the risk of this happening. lead displacement. There is a small risk that one of the pacemaker leads may move out of position. This usually needs a further procedure to reposition them. infection. There is a small risk of getting an infection at the site of the pacemaker. You will be given antibiotics at the time of your procedure to help prevent this happening. pain. You may feel a small amount of pain during or after the procedure. Taking painkillers such as paracetamol should help. Always follow the instructions provided in the leaflet supplied with your tablets. conscious light sedation. This can sometimes cause problems with your breathing, heart rate and blood pressure. bleeding, bruising and swelling. There maybe some bleeding and bruising to the skin above the pacemaker. This will settle over the 4 weeks. scar. There will be a small scar visible on your chest wall. Med/368.2 (2015) Page 4 of 7 For Review Autumn 2018

5 radiation. Radiation risks from x-rays are small with the doses used during this procedure. If you think you may be pregnant you must let the staff know as soon as possible before the procedure. Contact numbers If you need further advice, or have any problems, please contact the appropriate number below. University Hospital of North Tees Pacemaker Clinic Cardiac Investigations Unit telephone: Monday - Friday, 9.00am pm Non-urgent messages can be left at any time on the answering machine. Cardiology Day Unit telephone: Monday - Thursday, 8.30am pm Friday, 8.30am 5.00pm, telephone: : if no reply leave a message or telephone: (These are Hartlepool codes but you will be diverted to North Tees.) University Hospital of Hartlepool Pacemaker Clinic Cardiac Investigations Unit telephone: Monday - Friday, 9.00am pm Non-urgent messages can be left at any time on the answering machine. If you have any worries or concerns you should contact your GP during normal surgery hours. Outside surgery hours you should contact your GP s surgery for the Out of Hours Service number. Med/368.2 (2015) Page 5 of 7 For Review Autumn 2018

6 Further information is available from: NHS Choices telephone: 111 (when it is less urgent than 999) Calls to this number are free from landlines and mobile phones or via the website at British Heart Foundation Greater London House 180 Hampstead Road London NW1 7AW telephone: Heart helpline: Monday - Friday, 9.00am pm or via the website at Arrhythmia Alliance P O Box 3697 Stratford-upon-Avon Warwickshire CV37 8YL telephone: hours a day, 7 days a week or via the website at Reference 1. Timperley J, Leeson P, Mitchell ARJ, Betts T, 2008, Pacemakers and ICD s, Oxford specialist handbooks in cardiology, Oxford University Press. Med/368.2 (2015) Page 6 of 7 For Review Autumn 2018

7 This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Quality Assurance Team, University Hospital of North Tees or Comments, Concerns, Compliments or Complaints We are continually trying to improve the services we provide. We want to know what we re doing well or if there s anything which we can improve, that s why the Patient Experience Team is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. If you would like to contact or request a copy of our PET leaflet, please contact: telephone: Monday Friday, 9.00 am 4.00 pm Messages can be left on the answering machine and will be picked up throughout the day. freephone: Mobile: (can use text): patientexperience@nth.nhs.uk Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person. telephone: hours a day, 7 days a week The Patient Experience Team is available to discuss your concerns in person Monday Friday, 1.30 pm 4.30 pm. Data Protection and use of patient information The Trust has developed a Data Protection Policy in accordance with the Data Protection Act 1988 and the Freedom of Information Act All of our staff respect this policy and confidentiality is adhered to at all times. If you require further information please contact the Head of Communications. telephone: or University Hospital of North Tees, Hardwick, Stockton-on-Tees. TS19 8PE University Hospital of Hartlepool, Holdforth Road, Hartlepool. TS24 9AH Telephone: Fax: Med/368.2 (2015) Page 7 of 7 For Review Autumn 2018