This is a relatively easy operation.
It is carried out under local anaesthetic in an X-ray department or specialised Cardiology room especially designed to be a sterile environment like an operating theatre.
A large area of skin on the top of the chest and neck are cleaned and local anaesthetic is injected to numb this area and also around the collar bone (clavicle).
A cut is made in the skin about 2-3 inches in length and a space is created under the skin and fat that is large enough that the pacemaker can sit comfortably within it.
A needle is used to pass a wire into the vein under the collar bone (subclavian vein) and the a tube is passed over this wire. The pacing wire is then passed down this tube and on into the inside of the heart.
Depending on your personal circumstances you may be suited by having a single chamber pacemaker (single wire) or a dual chamber pacemaker (two wires). In a single chamber pacemaker the wire is passed through the right atrium into the right ventricle.
In a dual chamber pacemaker the second wire is placed in the right atrium.
It is important that the wires are in a stable position against the heart wall and that they make good electrical contact with the heart tissues. This makes later displacement of the wire(s) less likely and, the better the contact, the longer the pacemaker battery will last.
Once the wires are in a good stable position they are connected to the pacemaker which is buried under the skin and fat in the space that has already been made and the skin wound is closed with stitches.
Antibiotics are given for five days to protect against any chance of infection.