Sometimes once we know a patient needs a pacemaker we will briefly discuss the matter and refer the patient to an electrophysiologist (EP). He/she is a specialized cardiologist who deal strictly with the electricity that causes your heart to beat. The procedure of actually having a pacemaker implanted actually goes rather quickly in experienced hands (less than one hour). I absolutely would not allow a device to be implanted unless it is with a physician who specializes in these procedures (not a general surgeon). A small incision (3-4 inches) is made below you collar bone of your non-dominate hand. A pocket to accomodate the device about the size of a credit card and as thick as two silver dollars is made between the skin and above the muscle. A small incision is made in your subclavian artery and the leads are advanced down and into your heart. Usually one lead is on the top of the heart (atria) and the one lead is sent to the bottom of the heart (ventricle). The leads have a small corkscrew-like end and it is twisted into the side of the heart to anchor it. The leads are connected to the device and it is tested to be sure it is working as it is supposed to. The device is then sealed (often with glue to avoid sutures and infection) inside the pocket. You will be restricted in raising your arm affected arm above your shoulder for about 4 weeks after the procedure. Patients in our practice stay over night in the hospital after a new device is implanted on telemetry (monitoring of your heart) to ensure the device is functioning as it should. The are discharged the next morning. We have them back in the office at one week for a wound check and to verify the device continues to work as it should. The surgeon or one of his/her assistants will tell you more specific details if you are inclined to want to know more. Good luck.