A pacemaker is an electric medical device that’s generally about the size of a matchbox. A surgeon implants it under your skin to help manage irregular heartbeats called arrhythmias. Pacemakers can also be used to treat some types of heart failure.
Typically, the electrical signal that causes your heart to beat starts at an area of your heart called the sinoatrial (SA) node. The SA node is your heart’s natural pacemaker. Electrical signals generated by the SA node travel from the top of the heart to the bottom in a synchronized fashion, leading to a heartbeat.
In some situations, there are problems with this electrical signaling, which can lead to a heartbeat that’s too fast (tachycardia), too slow (bradycardia), or otherwise irregular. This is an arrhythmia. A pacemaker generates electrical impulses that help your heart beat at a normal rate, rhythm, or both.
Below, we’ll cover more about pacemakers, including:
- the different types
- how they’re implanted
- the risks associated with them
Keep reading to learn more.
Modern pacemakers have two parts:
- the pulse generator, which contains the pacemaker’s battery and the electronics that generate electrical signals
- one or more leads, which are thin wires that deliver electrical signals from the pulse generator to your heart
The leads contain the pacemaker’s electrodes. The electrodes, which often rest inside your heart and sense your heartbeat, deliver electrical signals if your heart is beating too quickly or too slowly.
Traditional pacemakers typically have one or two leads. A single-lead pacemaker sends electrical signals to either the right atrium or right ventricle of your heart. A dual-chamber pacemaker sends electrical signals to both the right atrium and right ventricle of your heart.
Some people need a special type of pacemaker called a biventricular pacemaker, or bivent.
A biventricular pacemaker has three leads, which send electrical signals to the right atrium, right ventricle, and left ventricle, helping the two sides of the heart beat in sync. The implantation of a biventricular pacemaker is known as cardiac resynchronization therapy (CRT).
Wireless pacemakers are also available. In a wireless pacemaker, the pulse generator and electrodes are combined into a single device that’s about the size of a pill or capsule. This type of pacemaker is typically positioned into the right ventricle.
A medical device called an implantable cardioverter defibrillator (ICD) can also be used to prevent life threatening arrhythmias, in particular heartbeats that are too fast and unstable. If an ICD senses these arrhythmias, it can deliver electric impulses to restore a normal heartbeat. Most newer ICDs also have a pacemaker function.
Your doctor or cardiologist will test you to see if you’re a good candidate for a pacemaker. One of the main reasons a pacemaker is recommended is a heartbeat that’s too slow. A pacemaker may also be used for:
- a heartbeat that pauses
- a heartbeat that’s irregular or too fast
- some types of heart failure
These symptoms may be caused by a variety of factors, such as:
- age-related changes to the heart tissue
- damage to the heart due to:
- a prior heart surgery
- a previous heart attack
- congenital heart conditions
- taking medications that can slow the heart rate, such as beta-blockers or calcium channel blockers
- having certain health conditions, such as:
- pericarditis, an inflammation of the tissue surrounding the heart
- myocarditis, an inflammation of the heart muscle
- cardiomyopathy, which involves changes to the heart muscle that affect its ability to pump blood
- systemic sclerosis, a rare condition that can cause inflammation and scarring of the skin and internal organs
- sarcoidosis, a rare condition that causes swollen areas of tissue called granulomas to appear in the organs of the body
- hypothyroidism, in which your thyroid produces too little thyroid hormone
Some signs that you may have an arrhythmia or heart failure that requires a pacemaker are:
- dizziness or lightheadedness
- heart palpitations
- chest pain or tightness
- shortness of breath
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.
Every medical procedure has some risks. Most risks associated with a pacemaker are a result of the implantation procedure. These include:
- an allergic reaction to anesthesia
- bleeding or bruising
- blood clots
- damaged nerves or blood vessels
- an infection at the site of the incision or of the leads themselves
- buildup of scar tissue around the pacemaker
- pacemaker syndrome, which is when a pacemaker only stimulates one ventricle, leading to fatigue, shortness of breath, low blood pressure, and pacemaker-related cardiomyopathy
- pneumothorax, or a collapsed lung
- fluid collection around the heart
- a punctured heart, which can be caused by displaced leads
Most complications are temporary. Life-altering complications are rare.
It’s also possible, although unlikely, for a pacemaker to malfunction, or stop working properly. This can happen if:
- one or more leads move out of position
- the battery in the pulse generator dies
- a strong magnetic field has damaged your pacemaker
- there’s a programming error with your pacemaker
If your pacemaker malfunctions, you may notice that your arrhythmia or heart failure symptoms begin to get worse. Should this occur, it’s important to make an appointment with your doctor or cardiologist so that they can check to see if your pacemaker is working properly.
Before receiving a pacemaker, you’ll need several tests. These tests can ensure that a pacemaker is the right choice for you. They include:
- Electrocardiogram (ECG or EKG). During an electrocardiogram, a nurse or doctor places sensors on your skin that measure your heart’s electrical signals.
- Echocardiogram. An echocardiogram uses sound waves to measure the size and thickness of your heart muscle.
- Holter monitoring. During Holter monitoring, you wear a device that tracks your heart rhythm for up to 48 hours (typically 24 hours).
- Stress test. A stress test monitors your heart rate while you exercise.
Your doctor or cardiologist will review the results of these tests as well as your medical history to determine if a pacemaker is a good option for you. It’s important to note that not everyone with an arrhythmia or heart failure needs a pacemaker.
For example, a pacemaker may not be recommended if an arrhythmia is asymptomatic or happens with only mild symptoms. Another example of when a pacemaker isn’t necessary is when your symptoms are due to a reversible cause, such as an infection or drug toxicity.
If a pacemaker is right for you, you’ll need to plan for the surgery. Important factors to consider include:
- Food and drink. You’ll be asked to fast before your procedure. This means that you can’t eat or drink anything besides water. You may need to fast for the 6 hours prior to your procedure or potentially longer.
- Medications. Follow your doctor’s instructions about which medications and supplements to stop taking. If your doctor prescribes medications for you to take before the procedure, take them as directed.
- Clothing. Plan to wear comfortable, loose-fitting clothes on the day that your pacemaker is placed. You’ll be asked to change into a hospital gown prior to your procedure.
- Hygiene. Shower and shampoo well. Your doctor may want you to use a special soap. This reduces your chances of developing a potentially serious infection.
Your doctor will give you complete, specific instructions on how to prepare. Be sure to follow all preparation instructions carefully. If anything is unclear, don’t hesitate to ask questions.
Most wired pacemakers are implanted using a transvenous procedure. This means that the leads and electrodes are threaded through your veins and into your heart. Veins in the neck, chest, or thigh are typically used.
Transvenous placement typically includes the following steps:
- You’ll first 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, typically near your collarbone.
- They’ll then guide the leads through the incision and into a major vein. An X-ray machine will help them guide the leads through your vein to your heart.
- Once the leads have reached the heart, your surgeon will attach the electrodes to your heart muscle. The other end of the lead is attached to the pulse generator that contains the battery and electrical circuits.
- After the leads and electrodes are in place, your surgeon will implant the generator under your skin near your collarbone.
- At the end of the procedure, your surgeon will test the pacemaker to make sure it’s working properly before closing your incision with stitches.
Placing a pacemaker this way typically takes about 1 hour. However, this may vary depending on the number of leads. For example, placing a biventricular pacemaker, which has three leads, will often take longer than placing a single-lead pacemaker. Your surgeon will let you know what to expect.
A less common way for a pacemaker to be implanted is through the epicardial method. This is where the electrodes are attached at the surface of the heart as opposed to inside the heart. It requires general anesthesia. Some examples of when epicardial placement is done include:
- as a precaution during heart surgery
- when the structure of your heart or veins would make it difficult to use the transvenous method
- when a pacemaker is being placed in an infant or a child
Wireless pacemakers are placed using a thin tube called a catheter. An X-ray machine is used to guide the catheter and wireless pacemaker through a vein in your thigh to your heart. This procedure typically takes
After pacemaker placement
It’s likely that you’ll need to stay in the hospital overnight after your pacemaker has been placed. In some situations, you may be able to return home the same day.
Before you go home, your doctor will make sure the pacemaker is programmed properly for your heart’s needs and may order a chest X-ray. Your doctor can reprogram the device as needed at follow-up appointments.
You’ll probably feel some pain or discomfort after your procedure. You may need to take over-the-counter medications to alleviate this. Ask your doctors which pain relievers are safest for you.
It’s also important to make sure to care for your incision after you return home. Your surgeon will give you instructions on how to clean the wound and prevent infection. Consider wearing loose-fitting clothing during your recovery to avoid irritating the area.
You’ll probably be able to return to your daily activities in the days following the placement of your pacemaker. However, you should continue to avoid any rigorous exercise or heavy lifting for about 4 to 6 weeks, especially lifting the arm on the side of the pacemaker overhead.
Since the electrical signals that a pacemaker sends are very small, it’s unlikely that you’ll feel them. If you do, your doctor or cardiologist can adjust the programming of your pacemaker to minimize this. Also, because the pulse generator is implanted under the skin, you may feel it when you lie in certain positions.
Modern pacemakers aren’t as sensitive to electrical devices as the old ones, but certain devices could cause interference with your pacemaker. If possible, try to keep at least 6 inches away from these devices. For example, try to avoid:
- being around magnets or equipment that uses magnets
- keeping a cell phone in the pocket over your pacemaker
- holding a cell phone up to the ear that’s on the same side of your body as your pacemaker
- allowing headphones to rest on or be close to your chest
- wearing a smartwatch
- extended exposure to metal detectors, including handheld metal detectors
- lingering near anti-theft systems, such as those found in department stores
- some types of electrical equipment, such as high-voltage transformers, electric fences, or portable car battery chargers
Most common household and office appliances pose little to no risk to people with pacemakers. If you’re concerned about the safety of having different devices around your pacemaker, your doctor or cardiologist will give you more detailed instructions about how to minimize your risks.
There are also several medical procedures that can interfere with your pacemaker. Some examples include:
- CT scans
- MRI scans
- electrocauterization, which is used to stop bleeding during surgery
- electrolysis, a procedure that’s used to remove body hair
- microwave diathermy, which is used in physical therapy
- radiation therapy for cancer
- radio frequency ablation procedures, which destroy the nerves that send pain signals
- shock wave lithotripsy, which is used to treat kidney stones
- transcutaneous electrical nerve stimulation (TENS)
When you receive a pacemaker, you’ll be given a pacemaker ID card.
The information on this card includes:
- the type of pacemaker that you have
- when it was implanted
- your doctor’s contact information
Always carry your pacemaker ID card on you. Be sure to show this card in emergencies or when someone, such as a healthcare professional or an airport security staff member, needs to know about your device.
Many people who receive a pacemaker find that it has a very positive effect on their life. Not only can a pacemaker prevent complications due to arrhythmias or heart failure, but it can also reduce your symptoms and help you feel better.
Benefits of a pacemaker
Getting a pacemaker can also help improve life expectancy.
For example, a
Wireless pacemakers may have their own unique benefits.
Living with a pacemaker
Your pacemaker can also track and record your heartbeat. Remote monitoring can help your doctor or cardiologist see how your pacemaker is working for you as you go about your daily activities. You’ll typically only need to have an in-office visit once or twice per year to get your pacemaker checked.
During this time, your pacemaker’s battery and function will be evaluated. A pacemaker’s batteries typically last 6 to 10 years. Your doctor will give you a heads-up when your battery needs to be switched. This typically involves a simple procedure to replace the pulse generator.
If you have a condition that affects your heartbeat, a pacemaker can be used to help your heart to beat at a normal rate or rhythm.
A pacemaker can help alleviate your symptoms and prevent complications. Not everyone with these symptoms needs a pacemaker, though.
A review of your medical history and several tests can help your doctor determine if a pacemaker is a good option for you.