Temporary pacemakers are used in emergency settings, or when the underlying cause of the abnormal heart rhythm is expected to resolve itself (e.g., an overdose of medications). They are also used to reestablish a normal heart rhythm until a permanent pacemaker is installed. Temporary pacing may be required among heart attack patients, severely symptomatic patients with bradycardia, patients with tachycardia, after open-heart surgery and other settings. Complications can occur in up to 20 percent of cases, and patients on a temporary pacemaker require constant monitoring.

Temporary pacing may be accomplished a number of ways, including:

• With leads inserted through a vein, usually by catheter
  
  
• With leads inserted through a needle placed directly through the chest wall
  
  
• With leads connected to the heart during surgery
  
  
• Or more rarely, with leads connected to the heart through the esophagus.

Internal or permanent pacemakers are used when the slow heart rate becomes chronic or is believed to be irreversible. The pacemaker is implanted into the chest or abdomen, usually on the left side of the chest. When it is implanted into the chest, patients may be asked if they have a preference for where the pacemaker will be implanted.

For both types of pacemaker insertion, patients will be asked to sign a consent form and to stop eating or drinking after midnight prior to the procedure. Certain medications may need to be reduced or stopped temporarily, so patients should discuss their medication schedules with their cardiologist before surgery. Patients wear a hospital gown for the insertion and may be asked to remove dentures, jewelry, nail polish and/or glasses.