Designed to operate for 3 to 20 years, a permanent pacemaker is a self-contained device that the surgeon implants in a pocket beneath the patient’s skin. This procedure is usually done in the operating room or cardiac catheterization laboratory. Nursing responsibilities involve monitoring the electrocardiogram (ECG) and maintaining sterile technique.

Permanent pacemakers function in the demand mode, allowing the patient’s heart to beat on its own but preventing it from falling below a preset rate. Pacing electrodes can be placed in the atria, the ventricles, or both chambers (atrioventricular sequential, dual chamber). (See Understanding pacemaker codes.) The most common pacing codes are VVI for single-chamber pacing and DDD for dual-chamber pacing.

Candidates for permanent pacemakers include patients with myocardial infarction and persistent bradyarrhythmia and patients with complete heart block or slow ventricular rates stemming from congenital or degenerative heart disease or cardiac surgery.¹ Patients who suffer from Stokes-Adams, Wolff-Parkinson-White, or sick sinus syndrome may also benefit from permanent pacemaker implantation.

Permanent pacemakers are also used in patients other than those with symptomatic bradycardia. These include patients with hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy, atrial fibrillation, neurocardiogenic syndrome, and long-QT syndrome.

A biventricular pacemaker is effective in patients with heart failure who have intraventricular conductor defects. This device differs from a standard pacemaker in that it has three leads instead of one or two. One lead is placed in the right atrium and the others are placed in each of the ventricles, where they simultaneously stimulate the right and left ventricle. This allows the ventricles to coordinate their pumping action, making the heart more efficient.