A pacemaker is a small device that's placed under the skin in your chest to help control your heartbeat. It's used to help your heart beat more regularly if you have an irregular heartbeat (arrhythmia), particularly a slow one. Implanting a pacemaker in your chest requires a surgical procedure.
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Pacemakers generally treat two types of arrhythmias:
. Tachycardia, a heartbeat that’s too fast
. Bradycardia, a heartbeat that’s too slow
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Why it's done
Why do I need a pacemaker?
You need a pacemaker if your heart is pumping too quickly or slowly. In either case, your body doesn’t get enough blood. This can cause:
. Fainting or lightheadedness
. Shortness of breath
. Damage to vital organs
. Eventual death
A pacemaker regulates your body’s electrical system, which controls your heart rhythm. With each heartbeat, an electrical impulse travels from the top of your heart to the bottom, signaling your heart’s muscles to contract.
A pacemaker can also track and record your heartbeat. A record can help your doctor better understand your arrhythmia.
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.
Your doctor or cardiologist will test you to see if you’re a good candidate for a pacemaker.
How your heart beats
The heart is a muscular, fist-sized pump with four chambers, two on the left side and two on the right. The upper chambers (right and left atria) and the lower chambers (right and left ventricles) work with your heart's electrical system to keep your heart beating at an appropriate rate — usually 60 to 100 beats a minute for adults at rest.
Your heart's electrical system controls your heartbeat, beginning in a group of cells at the top of the heart (sinus node) and spreading to the bottom, causing it to contract and pump blood. Aging, heart muscle damage from a heart attack, some medications and certain genetic defects can cause an abnormal heart rhythm.
What a pacemaker does
An implanted electronic pacemaker mimics the action of your natural electrical system. A pacemaker comprises two parts:
. Pulse generator. This small metal container houses a battery and the electrical circuitry that regulates the rate of electrical pulses sent to your heart.
. Leads (electrodes). One to three flexible, insulated wires are each placed in a chamber, or chambers, of your heart and deliver the electrical pulses to adjust your heart rate.
Pacemakers work only when needed. If your heartbeat is too slow (bradycardia), the pacemaker sends electrical signals to your heart to correct the beat.
Also, newer pacemakers have sensors that detect body motion or breathing rate, which signal the pacemakers to increase heart rate during exercise, as needed.
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How do I prepare for a pacemaker Surgery?
Before your doctor decides if you need a pacemaker, you'll have several tests done to find the cause of your irregular heartbeat. These could include:
. Electrocardiogram (ECG). In this noninvasive test, sensor pads with wires attached, called electrodes, are placed on your chest and sometimes your limbs to measure your heart's electrical impulses.
. Holter monitoring. This is a portable version of an ECG. It's especially useful in diagnosing rhythm disturbances that occur at unpredictable times. You wear the monitor, and it records information about the electrical activity of your heart as you go about your normal activities for a day or two.
Some personal devices, such as smartwatches, offer electrocardiogram monitoring. Ask your doctor if this is an option for you.
. Echocardiogram. This noninvasive test uses harmless sound waves that allow your doctor to see the action of your heart. A small instrument called a transducer is placed on your chest. It transmits the collected sound waves (echoes) from your heart to a machine that uses the sound wave patterns to compose images of your beating heart on a monitor.
. Stress test. Some heart problems occur only during exercise. For a stress test, an electrocardiogram is taken before and immediately after walking on a treadmill or riding a stationary bike. In some cases, an echocardiogram or nuclear imaging are done.
If a pacemaker is right for you, you’ll need to plan for the surgery. Your doctor will give you complete instructions on how to prepare.
. Don’t drink or eat anything after midnight the night before your surgery.
. Follow your doctor’s instructions about which medicines to stop taking.
. If your doctor prescribes medicines for you to take before the test, take them.
. Shower and shampoo well. Your doctor may want you to use a special soap. This reduces your chances of developing a potentially serious infection.
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What are the Risks and complications associated with a pacemaker?
Every medical procedure has some risks. Most risks associated with a pacemaker are from the surgical installation. They include:
. Allergic reaction to the dye or anesthesia used during your procedure
. Damaged nerves or blood vessels
. An infection at the site of the incision
. A collapsed lung, which is rare
. A punctured heart, which is also rare
Most complications are temporary. Life-altering complications are rare.
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Types of pacemakers
Depending on your condition, you might have one of the following types of pacemakers.
. Single chamber pacemaker. This type usually carries electrical impulses to the right ventricle of your heart.
. Dual chamber pacemaker. This type carries electrical impulses to the right ventricle and the right atrium of your heart to help control the timing of contractions between the two chambers.
. 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.
During the procedure
How is pacemaker surgery performed?
Implanting a pacemaker typically takes one to two hours. You’ll 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 near your shoulder. They’ll guide a small wire through the incision into a major vein near your collarbone. Then the surgeon will lead the wire through your vein to your heart. An X-ray machine will help guide your surgeon through the process.
Using the wire, your surgeon will attach an electrode to your heart’s right ventricle. The ventricle is the lower chamber of the heart. The other end of the wire attaches to a pulse generator. This contains the battery and electrical circuits.
Typically, your surgeon will implant the generator under your skin near your collarbone.
If you’re getting a biventricular pacemaker, your surgeon will attach a second lead to your heart’s right atrium, and a third lead to the left ventricle. The atrium is the upper chamber of the heart.
At the end, your surgeon will close your incision with stitches.
After Heart Pacemakers Surgery
After the procedure
You'll likely stay in the hospital for a day after having a pacemaker implanted. Your pacemaker will be programmed to fit your pacing needs. Arrange to have someone drive you home when you're discharged.
Most pacemakers can be checked remotely. Your pacemaker transmits to and receives information from your doctor's office, including your heart rate and rhythm, how your pacemaker is functioning, and its remaining battery life.
Your doctor might recommend that you avoid vigorous exercise or heavy lifting for about a month. Avoid putting pressure on the area where the pacemaker was implanted. If you have pain in that area, ask your doctor about taking over-the-counter medicines, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).
It's unlikely that your pacemaker would stop working properly because of electrical interference. Still, you'll need to take a few precautions:
. Cellphones. It's safe to talk on a cellphone, but keep your cellphone at least 6 inches (15 centimeters) away from your pacemaker. Don't keep your phone in a shirt pocket. When talking on your phone, hold it to the ear opposite the side where your pacemaker was implanted.
. Security systems. Passing through an airport metal detector won't interfere with your pacemaker, although the metal in it could sound the alarm. But avoid lingering near or leaning against a metal-detection system.
To avoid potential problems, carry an ID card stating that you have a pacemaker.
. Medical equipment. Make sure all your doctors and dentists know you have a pacemaker. Certain medical procedures, such as magnetic resonance imaging, CT scans, cancer radiation treatment, electrocautery to control bleeding during surgery, and shock wave lithotripsy to break up large kidney stones or gallstones could interfere with your pacemaker.
. Power-generating equipment. Stand at least 2 feet (61 centimeters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, ask your doctor about arranging a test in your workplace to determine whether the equipment affects your pacemaker.
Devices that are unlikely to interfere with your pacemaker include microwave ovens, televisions and remote controls, radios, toasters, electric blankets, electric shavers, and electric drills.
Having a pacemaker should improve symptoms caused by slow heartbeat, such as fatigue, lightheadedness and fainting.
Your doctor should check your pacemaker every three to six months. Tell your doctor if you gain weight, if your legs or ankles get puffy, or if you faint or get dizzy.
Your pacemaker's battery should last five to 15 years. When the battery wears out, you'll need surgery to replace it. The procedure to change your pacemaker's battery is often quicker and requires less recovery time than the procedure to implant your pacemaker.
Because most of today's pacemakers automatically adjust your heart rate to match your level of physical activity, they can allow you to resume a more active lifestyle.