What is a pacemaker?
A pacemaker, also called a cardiac pacing device, is a small electronic device used to regulate slow heart rhythms. A pacemaker and an implantable cardioverter defibrillator (ICD) are similar in that they are both electronic devices implanted with wires connected that send an electronic signal to your heart. However, a pacemaker is different than an ICD in that a pacemaker speeds up a heart rate that is too slow, while an ICD slows a too fast or stopped heart rate. An ICD can also speed up a slowed heart rate, but it is not specifically designed to do so.
There are three different types of pacemakers, which differ based on which portion of the heart it sends electrical signals to: single chamber, dual chamber and biventricular.
Generally speaking a pacemaker, regardless of type, is comprised of a pulse generator and leads.
Who needs a pacemaker?
Your doctor may recommend a pacemaker if your heart muscle is damaged and not sending proper signals, called impulses, through your heart chambers, telling it when to beat. Typically you need a pacemaker if you have a chronically slow heartbeat or heart failure. You may also need a pacemaker if you have bradycardia or a heart block in which the electrical signals are delayed or blocked. There are many different types of heart blocks.
What are the risks of a pacemaker?
There are several risks associated with inserting a pacemaker, although most are relatively minor. They include bleeding and/or bruising at the insertion site or infection. Damage to blood vessels or development of blood clots can occur. In rare cases, a lung can be punctured which causes air to be trapped in the pleural space. This could lead to a collapsed lung. You should always inform your doctor if you’re pregnant, plan to be pregnant or are breastfeeding prior to the procedure.
How do I prepare for a pacemaker placement?
Your doctor may recommend several tests prior to determining if a pacemaker is the best option for you. They could include an electrocardiogram (ECG) or echocardiogram, Holter monitor or stress or exercise tests. Your healthcare provider will ask you to fast for a period of time prior to the procedure. They may also instruct you on which medications to take or discontinue – you should always follow the guidance of your healthcare team before taking or discontinuing any OTC or prescription medications prior to any procedure. Be sure to tell your doctor if you’re pregnant, actively trying to get pregnant or breastfeeding.
Plan to wear comfortable clothing and leave any valuables such as jewelry at home. Be sure to have someone you trust accompany you to and from your appointment. Due to the sedation involved, you will not be able to drive and will need someone to escort you home after the procedure.
What should I expect after a pacemaker placement?
Upon your arrival you will be asked to change into a hospital gown and given an IV. Your healthcare team may administer a sedative through the IV to help you relax for the procedure. Your healthcare team will place several electrodes or sensors to areas of your body to monitor you during the procedure. You may receive anesthesia for the placement, although this procedure is often done while you are awake and sedated. You will be given a local anesthetic to help numb the area, then the doctor will make a small incision on your chest where the pacemaker will be inserted. They will lead a small plastic tube into a blood vessel, then wire leads will be led through the tube to the heart. One end of each wire will be attached to the heart, and the pacemaker device will be placed under the skin near your collarbone. There are some pacemakers that are wireless – if you are getting a leadless pacemaker, it will be a self-contained unit that is inserted through a catheter (often through your groin) and implanted into the area of the heart that needs assistance. Your healthcare team will monitor you closely throughout the procedure.
Once the device is in place, the doctor will test it out to ensure it is working properly. They will use a special camera called a fluoroscopy to ensure the device is positioned properly when placing it. The doctor will then remove the tubing and close the incision. You will be taken to recovery where you will be closely monitored. Once you are fully awake, you will be discharged with specific instructions although sometimes you may need to remain in the hospital for observation for a day or so, depending on your condition.
Your healthcare provider will give you specific instructions on what to do and not to do after having your pacemaker implanted. This will likely include avoiding heavy lifting or strenuous activity including exercise as well as instructions on when you can return to work and resume driving. Avoid putting pressure on the area in which the pacemaker was implanted.
You should always report any concerning symptoms to your healthcare provider. If you feel it is a life-threatening emergency, do not hesitate to call 9-1-1.
As with ICDs, it's important to note that the electrical signals can interfere with your pacemaker, such as cell phones, metal detectors, medical equipment, security systems, generators, chargers and/or magnets. You should always carry an ID card that states you have the device for use in situations such as building or airport security. Your doctor or healthcare team should instruct you on things to be aware of when you have a pacemaker device.
Ongoing monitoring – usually about every 3 to 6 months – will be required to check the health of your heart and the ensure the device is working properly. Your healthcare team will advise you how frequently your pacemaker battery will need to be replaced. Typically a pacemaker batter will last anywhere from 5 to 15 years.