A pacemaker is a compact battery-operated device that helps your heart to beat in its natural rhythm. The doctor will surgically implant it underneath the skin of the patient’s chest if they have an arrhythmia. It is a health condition in which your heartbeats are irregular. It can be either too slow (more common) or too fast.
What are the different types of pacemakers?
There are three types of pacemakers. It includes the following –
- Single-chamber pacemaker – This model directs electrical impulses to the lower right chamber of the heart (right ventricle or RV).
- Dual-chamber pacemaker – It directs electrical impulses to the lower (RV) and the upper (right atrium or RA) right chamber of the heart. It aids in controlling the timing of the movement (contractions) of your heart muscles between the two compartments.
- Biventricular pacemaker – Biventricular pacing, also called cardiac resynchronization therapy, is for people with heart failure with abnormal electrical systems. This type of pacemaker stimulates the lower chambers of the heart (the right and left ventricles) to make the heart beat more efficiently.
Why does a doctor suggest a pacemaker?
The fundamental role of a pacemaker is to help regulate your heart’s functioning by controlling the heartbeat. Your doctor can either implant it temporarily or permanently, depending on the severity of your condition and treatment needs.
- If your heart is beating slowly, following a heart attack, medication overdose, or surgery, your doctor will suggest a temporary pacemaker.
- In cases with heart failure and irregular (mainly slow) heartbeat, a doctor is more likely to permanently implant a pacemaker.
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Your heart – how does it beat?
Your heart is a fist-sized, muscular, and hollow organ that sits at the center of your circulatory system. It has four chambers –
The upper two chambers include –
- Right atrium
- Left atrium
The lower two chambers include –
- Right ventricle
- Left ventricle
All these chambers work together in coordination with the electrical system of your heart to allow it to beat appropriately. Your average heartbeat per minute, at rest, ranges from 60 to 100.
Your heart’s electrical system regulates your heartbeat and starts at the sinus node (your natural pacemaker) , spreading the electrical impulses to the bottom. It results in coordinated contractions in the muscles of your heart, leading to the pumping of blood.
However, due to aging, certain heart conditions such as heart attack, genetic defects, and medication, your heart may happen to beat abnormally. In such cases, your doctor may recommend a pacemaker.
A pacemaker – how does it work?
A pacemaker imitates the process of the natural electric system of your heart. It has two components –
- Pulse generator – It is a small metallic unit that comprises an electrical circuit and a battery. The pulse generator produces electrical impulses that regulate your heartbeats.
- Electrodes (leads) – These are insulated and flexible wires that your doctor implants into your heart muscle. You may need one to three of these leads, depending on your needs. These leads carry impulses from the generator to your cardiac (heart) muscle and sense the electrical activity of your heart, as well.
Some facts about pacemakers
- If you have a pacemaker, it will only work when you need it. If you have bradycardia (your heartbeat is slower than the normal), your pacemaker will send signals to your heart to maintain the right pace.
- The new-age pacemaking devices come with sensors. These sensors detect your breathing rate and flag your pacemaker to increase the pace of your heart as and when needed, especially while working out.
- An authorized body in the United States has given a green signal to two leadless pacemaker devices that directly go into your heart. Because these pacemakers do not have electrodes, these can help in a speedy recovery and minimize some health risks. Although these devices work safely and effectively, their long-term implications are yet to be studied.
Can there be complications with pacemakers?
Yex, complications with pacemakers are common. There are two basic categories of the same, i.e. –
Procedural complications
- Pocket hematoma or bleeding – In most people who undergo a pacemaker implant surgery, bleeding is common. However, the risk of hematoma (localized bleeding outside the blood vessels) is low. If you are on anticoagulant therapy, you might bleed a little more, but there is nothing to worry about it
- Hemothorax – It is one of the acute procedural complications of having a pacemaker. However, it is rare.
- Pneumothorax – Pneumothorax or collapsed lungs is a complication of having an artificial cardiac pacemaker. It occurs either during the procedure or within the first two days (48 hours) of the surgery.
General complications
- Deep vein thrombosis (DVT) and phlebitis – These conditions (blood clots in the veins) are quite prevalent with pacemaker insertion.
- Lead dislodgement – It is another complication of having a pacemaker that can add to your discomfort. Plus, it is likely to require reoperation to prevent the lead from migrating.
- Pacemaker malfunction – It arises when your pacemaker is not functioning as it is supposed to do. It can occur due to a plethora of reasons, starting from device failure to changes in your heart’s natural rhythm.
- Myocardial perforation – Although rare, myocardial perforation can lead to serious health complications. Shortness of breath and chest pain are some of the common symptoms.
- Tricuspid regurgitation – It is likely to occur due to damage to the tricuspid valve during the procedure.
- Pacemaker syndrome – If your symptoms tend to worsen after getting a pacemaker, and you gradually show the signs and symptoms of CHF (congestive heart failure), it is known as pacemaker syndrome. It primarily happens due to the loss of synchronization between the atria and ventricles (atrioventricular synchrony) of your heart.
How to prepare for a pacemaker insertion procedure?
There can be several reasons behind irregular heartbeat. Therefore, your doctor will perform a few tests to identify the underlying cause of your condition beforehand. The tests include the following –
- ECG or Electrocardiogram – It is a non-invasive procedure in which your doctor places sensor pads connected with wires on your limbs or chest to measure the electrical impulses of your heart.
- Echocardiogram – It is also a non-invasive procedure. It uses sound waves to monitor the functioning of your heart.
- Holter monitoring – It is a compact counterpart of an electrocardiogram. It helps in detecting unpredictable irregularities in the rhythm of your heart. You need to wear the monitoring device for a day or two and carry on with your regular activities. The device will record all electrical actions of your heart in the meantime.
- Stress test – Some heart conditions only surface when you exercise. In this test, your doctor will perform an electrocardiogram right before and after exercising, including riding an exercise bike or training on the treadmill.
What are the risks of getting a pacemaker?
Some of the common risks of getting a pacemaker to include –
- Infection at the site of pacemaker implantation
- Allergic reaction to anesthesia during the surgery
- Bruising or swelling at the site of the pulse generator implant
- Damage to local (near the implant) nerves and blood vessels
Pacemaker insertion Procedure – Before, During, and After
Before the procedure
A pacemaker insertion surgery takes a couple of hours to complete. Before the procedure, your doctor will clean your chest with a sterilizing agent . Then, he or she will anesthetize the site of incisions with the help of local anesthesia.
During the procedure
- During the surgery, your doctor will insert insulated wires (one or more) into a major vein located near or under your collarbone and lead it to the site of implantation with the help of X-ray imaging.
- Then your doctor will fix the terminal of each wire (with the other end of the wire secured to the pulse generator) to the right position in your heart.
After the surgery
- After your surgery is complete, you are most likely to stay in the healthcare facility for a day or two. Your doctor will tune/program your pacemaker according to your pacing requirements.
- Do not drive home on your own. Call a family member, friend, or driver for the same.
- Your doctor can monitor your pacemaker remotely.
- Your doctor is most likely to ask you to avoid lifting heavy items or doing strenuous exercises for a month or so.
- In case you experience pain or discomfort, get in touch with your doctor. He or she may recommend taking over-the-counter medications such as ibuprofen or acetaminophen.
What precautions should you take with a pacemaker?
Although your pacemaker is less likely to stop functioning owing to electrical interference(s), it is a good idea to be careful and take the necessary precautions. Take a look at the following precautions –
- Using a mobile phone – It is safe to use a cellphone when you have a pacemaker. However, make sure to keep it at a distance of at least 15 centimeters or 6 inches from the device. Also, make sure not to keep your phone in the pocket of your shirt. And hold the phone on the opposite side of your implant while talking.
- Going through a metal detector – Going for security checks through a metal detector at a shopping mall or airport will not intervene with your device. However, due to the metal components of your pacemaker, it might beep. One of the best things to avoid the possible issues is to carry along an identity card that reads you are wearing a pacemaker.
- Undergoing medical procedures – Ensure all your doctors, including your dentist, about your pacemaker. Some medical treatments and diagnostic procedures such as MRI, radiation, electrocautery, and CT scans can interfere with your device.
- Being near heavy-duty equipment – It is crucial to keep a distance of at least 2 feet from high-voltage transformers, welding apparatus, etc.
Be in touch with your doctor!
The battery of your pacemaker is likely to last for 5 to 15 years. Make sure to pay visits to your doctor at an interval of 3 to 6 months.
Frequently Asked Questions (FAQ)
- Will your pacemaker be visible through your cloth?
No, your pacemaker will not be visible because your doctor inserts it under the skin of your skin. However, you might feel a slight bump.
- Can you wear accessories around your neck?
Yes, of course, you can wear a necklace or any other accessory around your neck. It will not affect your pacemaker.
Call 1860-500-1066 to book an appointment
