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Your heart relies on a consistent rhythm to send blood to your major organs. If a woman’s heart isn’t in a consistent rhythm, a doctor may recommend a pacemaker.

The indications, average age, and considerations for a pacemaker in women are different than for men. Keep reading to find out more about under-the-skin pacemaker implantation in women.

A doctor may recommend pacemaker implantation if your heart doesn’t keep a regular rhythm. While the most common reason for pacemaker implantation in men is atrioventricular block (an interruption of electrical signals from the heart’s atria to its ventricles), the indications in women are usually different.

The most common conditions that lead to pacemaker insertion in women include:

  • Sick sinus syndrome (SSS). SSS is a condition where the heart’s normal pacemaker cells don’t function appropriately. As a result, the heart can’t always maintain a normal rhythm. The heart may beat too fast, too slow, or flip-flop between the two.
  • Atrial fibrillation with bradyarrhythmias. Atrial fibrillation occurs when there is a disconnect between the electrical messages sent from the top of the heart (atria) to the bottom of the heart (ventricles). As a result, the heart may fail to beat in a regular rate and rhythm. If this occurs with bradycardia (a slow heart rate), you may have symptoms such as feeling faint, dizziness, and fatigue.

Types of devices

The heart has special cells called pacemaker cells that send electrical signals through a specific pathway to generate a heartbeat. Sometimes these cells don’t work well, and the heart gets out of rhythm.

An implantable pacemaker treats these conditions by sending its own electrical signals to keep the heart in rhythm. To do this, a doctor will usually implant special wires called leads to the heart’s upper and possibly lower chambers.

The doctor connects the wires to a small device called a generator that is about the size of a matchbox. The device has a battery and computer circuit that works to keep the heart in rhythm.

Some of the different types of pacemakers and cardiac implantable devices include:

  • Implantable pacemaker. Most pacemakers pace the atria, or upper chambers of the heart. This is because, traditionally, the pacemaker cells start in the atria.
  • Biventricular pacemaker. Also known as a cardiac resynchronization therapy device, this type of pacemaker coordinates the pumping of the right atrium and both ventricles.
  • Implantable cardioverter defibrillator (ICD). This device is slightly larger than the average pacemaker and can send a small electric shock to the heart if the heart goes into a potentially fatal rhythm.
  • Pacemaker and ICD. Some people may benefit from both a pacemaker and ICD. However, not all implanted devices do both.

Device placement

Each of these implantable device options is placed under the skin, which can be visible. There is an alternative called a leadless pacemaker. A doctor inserts this device into the right ventricle. While the pacemaker is internal and implanted, it is not visible, like a typical pacemaker.

However, not all patients can get a leadless pacemaker. This is especially true if you need dual-chamber pacing or have been told you have sinus node dysfunction.

What to expect during the pacemaker insertion procedure

Pacemaker implantation may be performed on an outpatient or inpatient basis, depending on why you’re having the pacemaker placed. Some of the basic steps look like this:

  • You will not eat or drink for at least 8 hours before the procedure.
  • You will go to a hospital the day of your procedure. You will usually have an IV, undergo an electrocardiogram (EKG) before the procedure, and have monitoring devices placed.
  • You will go into a special operating room where a doctor uses fluoroscopy (X-ray) to view the heart and blood vessels to identify where to place the pacemaker.
  • Your chest and shoulder will be cleaned with a special solution and numbed with a local anesthetic.
  • Your doctor will make a small incision in your chest and identify a vein that allows them to thread the device’s leads to the heart. You shouldn’t feel this taking place.
  • Your doctor will make an incision in the chest (usually) that will serve as the “pocket” for the pacemaker device. The doctor connects the leads to the device and tests it.
  • You will be taken to a recovery room and given instructions for how to care for your pacemaker insertion site.
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You can expect some soreness following pacemaker implantation. Some immediate steps to follow include:

  • keeping the insertion site clean and dry
  • resuming bathing and showering when your doctor recommends
  • avoiding strenuous movements related to the arm near where the pacemaker is inserted, such as lifting the arm overhead or excessively stretching
  • refraining from moving or frequently touching the pacemaker under your skin
  • changing the dressing over the pacemaker insertion site as recommended

You can typically expect your symptoms (such as soreness) to resolve about 1 to 2 weeks after pacemaker implantation. However, your doctor may recommend that you limit your activity for up to 4 to 6 weeks. This may or may not include sexual activity.

If at any time you are uncertain of a symptom or instruction, contact your doctor.

Women are known to have certain increased risks related to pacemaker implantation compared to men. Specifically, they are more likely to experience pneumothorax (collapsed lung) and pocket hematoma (internal bruising or swelling of the insertion area), according to research.

However, women typically experience fewer device-related infections compared to men.

You should call your doctor immediately if you experience any of the following symptoms related to your pacemaker insertion site:

  • the wound is red, hot to the touch, or swollen
  • the wound starts to drain fluid
  • your pain gets worse instead of better
  • you have bright red blood coming from the incision site or the incision comes open

Call 911 if you experience any of the following:

  • you pass out
  • you have trouble breathing
  • you feel as if your heart is starting to beat irregularly

There are also considerations for women in terms of the placement of the pacemaker. Because the pacemaker is usually in the chest region, scarring or its size may make some activities uncomfortable, such as wearing a bra or purse. If you have body image or functionality concerns related to the pacemaker, you should talk with your doctor.

Some doctors may choose to consult a plastic surgeon who can suggest unique approaches, such as skin flaps or a subpectoral approach, to reduce the pacemaker’s visibility.

For people who require a pacemaker, implantation can lead to improved quality of life. Women specifically have longer survival times than men, even though women typically receive pacemakers at an older average age.

The pacemaker device itself is typically designed to last between 7.5 to 15 years, according to the Food and Drug Administration. Most people may require battery replacement between 6 and 10 years after implantation. A cardiologist will typically “interrogate” or monitor the device at regular appointments to check on its battery life.

Pacemakers can be a life-saving intervention. They help to correct heart rhythms that can improve your quality of life. However, if you have concerns about pacemaker insertion, complications, or placement, you should talk with your doctor about them before the procedure.