Day 8: Friday, 11th October 2025
My recovery took an unexpected turn today as persistent heart rhythm issues necessitated additional intervention - the implantation of a permanent pacemaker to replace the temporary external device I've been carrying since the valve replacement surgery.
Early Morning Blood Test
The day started at 5:30 AM when the night shift nurses arrived for a blood test. They had kindly advised me the previous evening that this would be happening, which made the early wake-up call less jarring. It's these small considerations that make hospital life more bearable.
Morning Consultation with the Doctors
During the morning catch-up with the medical team, they explained that whilst my heart's behaviour isn't dangerous, it continues to exhibit patterns that can't be allowed to persist after discharge. The team mentioned that the rhythmologue - we don't seem to use that word in English, preferring the more straightforward "heart rhythm specialist" - would be speaking with me today. This specialist focuses specifically on cardiac rhythm disorders and would have the final say on treatment.
The Rhythmologist's Decision
Shortly after breakfast, the surgical assistant dropped by with a message from the rhythmologist. The misbehaviour of my heart rhythm was significant enough to make a permanent pacemaker the best next step. For me, this represents quite an improvement over the portable external Osypka Pace 203H I've been carrying around for the past week, with its electrode cables threaded through my chest wall.
A permanent pacemaker will be completely internal, eliminating the need to carry external equipment and providing more reliable, long-term rhythm management.
Understanding Pacemaker Implantation
Compared to the major open-heart surgery I underwent eight days ago, pacemaker implantation is a relatively straightforward procedure. The operation typically takes 1-2 hours and is performed under local anaesthetic with sedation.
The procedure involves:
- Incision: A small cut (typically 5-8 cm) is made just below the collarbone, usually on the left side
- Lead insertion: Two thin, insulated wires (leads) are threaded through a vein and guided into position in the heart chambers using X-ray imaging
- Lead attachment: The leads are attached to the heart muscle where they can sense the heart's electrical activity and deliver electrical impulses when needed
- Pacemaker placement: The pacemaker device itself - about the size of a large wristwatch - is inserted into a small pocket created under the skin beneath the collarbone
- Connection: The leads are connected to the pacemaker generator
- Testing: The system is tested to ensure proper functioning
- Closure: The incision is closed with dissolvable stitches
In my case, due to being relatively young for a pacemaker recipient, the doctor opted for a cutting-edge approach: His bundle pacing (HBP) or left bundle branch area pacing (LBBAP). This technique provides more natural stimulation of the heart with less energy consumption, which translates to longer battery life for the pacemaker - an important consideration given my age.
The pacemaker will monitor my heart rhythm continuously and provide electrical impulses to maintain a steady heartbeat whenever needed. Modern pacemakers are incredibly sophisticated, automatically adjusting to my activity levels and only intervening when necessary.
Pre-Operation Preparation
At 12:00, the pre-operative preparations began:
- Chest shave: Clearing the surgical site for optimal sterility and electrode placement
- Isobetadine wash: The familiar dark red antiseptic wash I'd experienced before my valve surgery
- Mouthwash: Part of the standard infection prevention protocol
At 15:00, I was taken through to the surgical wing of the hospital for final preparation. I received my top-quality hospital bed socks - essential for keeping warm in the chilly operating theatre. An IV line was inserted, and with a hair net on, I was ready to go.
The operation was scheduled for 16:00 (4:00 PM).
Post-Procedure Update
The surgery started on time at 16:00, and the attempt to use the branch bundle approach was a success. By 17:15, I was back in my hospital room with my wife, sporting a brand new freshly stitched and glued wound. I'm now confined to bed until morning - somewhat more comfortable as I can't wear the post-thorax protective gilet.
My shoulder started to wake up at about 19:30 - an interesting feeling. Not pain yet, but frozen, heavy, and I can't move it. Having explained this to the nurses, pain medicine was prescribed, as it will be pain before morning. I was able to get some sleep quite quickly.
I was woken by the night shift nurses doing their check around 21:30, and there was pain - quite a lot of pain. They quickly fixed that with some analgesics, and thankfully I was able to sleep again. At 3:30, either noises in the corridor or the pain woke me - pretty bad again. I buzzed for the nurse and got more pain relief, and again, thankfully, quickly back to sleep, this time all the way until breakfast time.
Reflections
Whilst an additional surgical procedure wasn't in the original recovery plan, it's reassuring to know the medical team is taking a proactive approach to ensure the best long-term outcome. The temporary pacemaker has been functional but cumbersome - having an internal, permanent solution will be a significant quality of life improvement.
The fact that this is considered a relatively minor procedure compared to the valve replacement helps put it in perspective. Eight days ago, I underwent open-heart surgery with a heart-lung bypass machine. Today's procedure, whilst important, is far less invasive and carries significantly lower risks.
I was awake throughout the pacemaker procedure. The worst pain was from the local anaesthetic injections. The surgeon warned me I might feel the cutting - I could, and I didn't like it. They gave me some more local anaesthetic, and after that, the only things I felt were the beating of my heart racing as they tested things and being pulled around as they stitched and glued me back together. I don't think I even got sedated - just an antibiotic drip.
I'm grateful for the thorough monitoring that identified this need before discharge, and for the expertise of the cardiac rhythm team in making this decision.