Psychological Aspects of Pacemaker Implantation

THE implantation of a cardiac pacemaker is a procedure of dramatic importance to the patient, but an operation so commonplace that is is considered routine by the medical staff. Although external electrodes were used in 1952 to pace the heart, 1 it was only in 1957 that the technique of internal implantation in the myocardium was developed. 2 Since it was first undertaken as a treatment for heart block, the techniques of insertion and the devices used have been progressively refined and a considerable literature regarding surgical technique has resulted. Surprisingly, a procedure of such profound psychological impact on the recipient has aroused little psychiatric interest and references to it in the psychiatric literature are few. 3,4 The implanted pacemaker is a small, battery-operated device which rhythmically stimulates the myocardium at a controllable rate. It is used for the treatment of heart block when