A pacemaker is an electrically-charged medical device. Your surgeon implants it under your skin to help manage irregular heartbeats called arrhythmias.
Modern pacemakers consist of two parts. One part contains the battery and the electronics that control your heartbeat. The other part is one or more leads, which send electrical signals to your heart. Leads are small wires that run from the pulse generator to your heart muscle.
Pacemakers generally treat two types of arrhythmias:
- tachycardia, or a heartbeat that’s too fast
- bradycardia, or a heartbeat that’s too slow
There are also special types of pacemakers called biventricular pacemakers, or bivents. A person may need one of these pacemakers if they have severe heart failure. They make the two sides of the heart beat in sync. This is also known as cardiac resynchronization therapy (CRT).
You need a pacemaker if your heart is pumping too quickly or slowly. In either case, the body doesn’t get enough blood. This can cause:
- fainting or lightheadedness
- shortness of breath
- damage to vital organs
- eventual death
A pacemaker regulates the electrical system that controls your heart rhythm. With each heartbeat, an electrical impulse travels from the top of the heart to the bottom, signaling the heart’s muscles to contract. A pacemaker can also track and record your heartbeat. This can help your doctor get a better understanding of 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. They can also be necessary 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.
Prior to receiving a pacemaker, you’ll undergo 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.
- An electrocardiogram uses sensors placed on your skin to measure your heart’s electrical signals.
- Holter monitoring tracks your heart rhythm for 24 hours with a wearable device.
- A stress test monitors your heart rate while you exercise.
If a pacemaker is right for you, you’ll plan for the surgery. Your doctor will give you complete instructions on how to prepare.
- Don’t drink or eat anything after midnight before your surgery.
- Stop taking any medications as advised by your doctor.
- Take any medications your doctor prescribes.
- Shower and shampoo well, possibly with a special soap. This reduces the risk of a potentially serious heart infection during surgery.
Implanting a pacemaker typically takes one to two 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. Through the incision, they’ll guide a small wire into a major vein near your collarbone. The surgeon will lead the wire through the 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 other end of the wire attaches to a pulse generator. This contains the battery and electrical circuits. The generator is typically implanted under the skin near the collarbone.
If you’re getting a biventricular pacemaker, a second lead will attach to your heart’s right atrium. The atrium is the upper chamber of the heart.
When your surgeon is satisfied with the procedure, they’ll close your incision with stitches.
Every medical procedure carries some risks. The majority of risks associated with a pacemaker are from the surgical installation. They include:
- an allergic reaction to anesthesia
- 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.
You can expect to stay in the hospital overnight. The day after the procedure, 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. 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.
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.