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Pacemaker

What is a pacemaker?

A pacemaker is an electrically-charged medical device. Your surgeon implants it under your skin to help manage irregular heartbeats called arrhythmias.

Modern pacemakers have two parts. One part, called the pulse generator, contains the battery and the electronics that control your heartbeat. The other part is one or more leads to send electrical signals to your heart. Leads are small wires that run from the pulse generator to your heart.

Pacemakers generally treat two types of arrhythmias:

  • tachycardia, a heartbeat that’s too fast
  • bradycardia, a heartbeat that’s too slow

Some people need a special type of pacemaker called a biventricular pacemaker, or bivent. You may need a bivent if you have severe heart failure. A bivent makes the two sides of the heart beat in sync. This is known as cardiac resynchronization therapy (CRT).

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Purpose

Why do I need a pacemaker?

You need a pacemaker if your heart is pumping too quickly or slowly. In either case, your body doesn’t get enough blood. This can cause:

  • fatigue
  • fainting or lightheadedness
  • shortness of breath
  • damage to vital organs
  • eventual death

A pacemaker regulates your body’s electrical system, which controls your heart rhythm. With each heartbeat, an electrical impulse travels from the top of your heart to the bottom, signaling your heart’s muscles to contract. A pacemaker can also track and record your heartbeat. A record can help your doctor better understand your arrhythmia.

Not all pacemakers are permanent. Temporary pacemakers can control certain types of problems. You may need a temporary pacemaker after a heart attack or heart surgery. You may also need one if a medication overdose temporarily slowed your heart.

Your doctor or cardiologist will test you to see if you’re a good candidate for a pacemaker.

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Preparation

How do I prepare for a pacemaker?

Before receiving a pacemaker, you’ll need several tests. These tests can ensure that a pacemaker is the right choice for you.

  • An echocardiogram uses sound waves to measure the size and thickness of your heart muscle.
  • For an electrocardiogram, a nurse or doctor places sensors on your skin that measure your heart’s electrical signals.
  • For Holter monitoring, you wear a device that tracks your heart rhythm for 24 hours.
  • A stress test monitors your heart rate while you exercise.

If a pacemaker is right for you, you’ll need to plan for the surgery. Your doctor will give you complete instructions on how to prepare.

  • Don’t drink or eat anything after midnight the night before your surgery.
  • Follow your doctor’s instructions about which medicines to stop taking.
  • If your doctor prescribes medicines for you to take before the test, take them.
  • Shower and shampoo well. Your doctor may want you to use a special soap. This reduces your chances of developing a potentially serious infection.
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Procedure

How is pacemaker surgery performed?

Implanting a pacemaker typically takes 1 to 2 hours. You’ll receive a sedative to relax you and a local anesthetic to numb the incision site. You’ll be awake during the procedure.

Your surgeon will make a small incision near your shoulder. They’ll guide a small wire through the incision into a major vein near your collarbone. Then the surgeon will lead the wire through your vein to your heart. An X-ray machine will help guide your surgeon through the process.

Using the wire, your surgeon will attach an electrode to your heart’s right ventricle. The ventricle is the lower chamber of the heart. The other end of the wire attaches to a pulse generator. This contains the battery and electrical circuits. Typically, your surgeon will implant the generator under your skin near your collarbone.

If you’re getting a biventricular pacemaker, your surgeon will attach a second lead to your heart’s right atrium. The atrium is the upper chamber of the heart.

At the end, your surgeon will close your incision with stitches.

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Complications

What are the complications associated with a pacemaker?

Every medical procedure has some risks. Most risks associated with a pacemaker are from the surgical installation. They include:

  • an allergic reaction to anesthesia
  • bleeding
  • bruising
  • damaged nerves or blood vessels
  • an infection at the site of the incision
  • a collapsed lung, which is rare
  • a punctured heart, which is also rare

Most complications are temporary. Life-altering complications are rare.

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Follow-Up

What happens after pacemaker surgery?

You may go home that evening, or you could stay in the hospital overnight. Before you go home, your doctor will make sure the pacemaker is programmed properly for your heart’s needs. Your doctor can reprogram the device as needed at follow-up appointments.

Over the next month, you should avoid rigorous exercise and heavy lifting. You may also need to take over-the-counter medications for any discomfort. Ask your doctors what pain relievers are safest for you.

Every few months, you’ll hook your pacemaker up to a phone line using special equipment provided by your doctor. It allows your doctor to receive information from your pacemaker without the need for an office visit.

Modern pacemakers are not as sensitive to electrical devices as the old ones, but certain devices could cause interference with your pacemaker. For example, you should avoid:

  • keeping a cell phone or MP3 player in the pocket over your pacemaker
  • standing for too long near certain appliances, such as microwaves
  • long exposures to metal detectors
  • high-voltage transformers

Your doctor will give you more detailed instructions about how to minimize your risks.

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