A pacemaker is an electrical device. It is implanted 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 controls your heartbeat. The other part is one or more leads, which send signals to your heart. Leads are small wires that run from the pulse generator to your heart muscle.
Pacemakers are generally used to treat two types of arrhythmias.:
- tachycardia - a heartbeat that is too fast
- bradycardia - a heartbeat that is too slow
There are also special types of pacemakers called biventricular pacemakers. These pacemakers are used for 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 does not get enough blood. This can cause:
- shortness of breath
- damage to vital organs
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. (NHLBI) 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 be used to control certain types of problems. You may need a temporary pacemaker after a heart attack or heart surgery. They can also be used if your heart has been temporarily slowed by a medication overdose.
Your doctor will test you to see if you are a good candidate for a pacemaker.
Every medical procedure carries some risks. The majority of risks associated with a pacemaker are from the surgical installation. They include:
- allergic reaction to anesthesia
- damaged nerves or blood vessels
- infection of the incision wound
- collapsed lung (rare)
- puncturing the heart (also rare)
Most complications are temporary. Life-altering complications are rare.
Prior to receiving a pacemaker, you’ll undergo several tests. These will ensure 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 small 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 for how to prepare.
- Do not drink or eat anything after midnight before your surgery.
- Stop taking any medications 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 be given 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, he or she will 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. (Mayo)
Using the wire, your surgeon will attach an electrode to your heart’s right ventricle. The other end of the wire is attached 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 be attached to your heart’s right atrium. This is the upper chamber of the heart.
When your surgeon is satisfied with the procedure, your incision wound will be closed with stitches.
You can expect to stay in the hospital overnight. The day after the procedure, your doctor will make sure the pacemaker is programmed for your heart’s needs. The device can be reprogrammed at follow-up appointments.
Over the next month, you’ll want to 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 will hook your pacemaker up to a phone line. This is done 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 (Mayo)
Your doctor will give you more detailed instructions about how to minimize your risks.