THERAPEUTIC PROCEDURES << BACK Biventricular Pacemaker Placement Symptomatic bradycardias and heart blocks are treated with the implantation of a pacemaker. A pacemaker is a small device that is permanently implanted near the heart. The device is battery-operated and is used to monitor the heart's electrical impulses. When needed, a pacemaker delivers an electrical impulse, or discharge, to make the heartbeat in a more normal rhythm. To implant a pacemaker, the surgeon will insert a thin metal box, called a pulse generator, just under the skin, usually under the collar bone. The pacemaker leads are usually inserted into a major vein in the shoulder or neck, and advanced down the vein until they are placed at the proper location in the heart muscle. The other ends of the leads are then attached to the pulse generator. The procedure can take as little as 15 minutes, or as long as three hours or more if a triple-chambered pacemaker for heart failure is being implanted. Sometimes (such as when other cardiac surgery is taking place) leads are placed on the heart's surface, and the pulse generator is fitted under the skin of the upper abdomen. Recovery from pacemaker implantation is generally brief, with only a short hospital stay necessary if there are no complications. Patients are usually advised to restrict their arm movement and activities for the first few weeks, and periodic follow-up tests to check on the electrical activity of the pacemaker are ongoing. Routine checks may be performed over the telephone.