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Pacemakers
A pacemaker is a small device, about the size of a silver dollar, which is implanted inside your body where it continuously monitors your heart rate and rhythm. The pacemaker can detect when your heart is beating too slowly or pauses too long, and it then stimulates your heart with precisely timed electrical impulses to keep your heart beating at its proper rate. This is called "pacing."
While a pacemaker is not a cure for slow heart rate problems, it can relieve the symptoms of a slow heart rate, which can include dizziness, fainting or fatigue. The pacemaker allows you the freedom to participate in activities you enjoy.
An abnormally slow heart rate is called bradycardia and is a result of the heart's electrical system not working properly. Symptoms may include dizziness, fainting, confusion or fatigue. The pacemaker is used to treat the following types of bradycardia:
Sick Sinus Syndrome - When the sinus node fails to perform its role as your heart's natural pacemaker, it may not send signals often enough, may skip signals or possibly send too many signals all at one time. With sick sinus syndrome, your heart may beat too slowly (sinus bradycardia), pause too long between beats (sinus pause) or alternate between beating too slow and too fast (bradycardia - tachycardia).
Heart Block - Patients with heart block, or AV Block, experience a delay or stoppage of the electrical signal as it travels through the heart from the atria to the ventricles. In second degree heart block, no signal from the atria reaches the ventricles. This causes the heart to beat slowly or irregularly. In some cases this may progress to third degree heart block. In third degree heart block, the electrical signals from the atria to the ventricles are completely blocked, resulting in a very slow heart rate, light-headedness, fainting, confusion and fatigue.
The pacemaker device has two main parts, a pulse generator and electrical leads to the heart. The pulse generator is a lightweight metal case that houses a small computer and a battery. It continuously monitors your heart rhythm and is responsible for delivering the electrical pulses to your heart when needed. Your physician can adjust the pacemaker's functions to meet your individual needs.
The leads are insulated, flexible wires that are run from the generator to your heart. They carry the electrical signal from the pulse generator when needed and also send information about the heart's rhythm back to the generator. Depending on the type of pacemaker that is implanted, one or two leads may be used.
- Single Chamber Pacemaker - These pacemakers use one lead that is placed in either the right atrium or right ventricle, depending on the condition.
- Dual Chamber Pacemaker - These pacemakers have two leads, one in the right atrium and one in the right ventricle. This allows the pacemaker to control both chamber and make sure they are synchronized in their beating.
- Rate Responsive Pacemaker - These pacemakers, which can be either single or dual chamber devices, use special sensors that monitor body changes such as motion and rate of breathing. The pacemaker can then adjust the heart rate accordingly based on these reading. This makes for a more natural heart function and may allow you to live a more active lifestyle.
Implanting a Pacemaker
The process of implanting a pacemaker is a minor surgical procedure that is performed under local anesthetic at the hospital. You are usually admitted to the hospital on the day of the procedure. Before the process begins, several lab tests are performed and an EKG study done. Your physician will visit with you and obtain a medical history and perform an examination. He or she will also explain the procedure, its benefits and risks and allow you to ask questions or express concerns.
Before the surgery, an IV will be inserted into your arm to deliver medication. Sometime a sedative may be administered to help you relax.
Usually a pacemaker is implanted under the skin in your upper chest area. Occasionally it may be implanted in your abdomen. A small pocket is made for the pulse generator just under the skin. The leads are inserted into a vein in your chest and guided to your heart with the help of X-ray images. The leads are then tested and attached to the pulse generator.
The pulse generator is programmed to treat your specific rhythm problem and then is placed in the pocket in your chest. The device is tested, and then the incision is closed and covered with a sterile dressing. The entire procedure usually takes one to two hours.
Recovery
You will remain in the hospital for one to two days. During this time nurses will check your blood pressure, pulse and incision. Your physician will also monitor the pacemaker to ensure it is working properly. You may experience some pain and stiffness around the incision for about a week.
Your physician will give specific instructions to follow at home while you recover. Generally these include:
- Avoid any heavy lifting.
- Limit arm movements as directed by your doctor.
- Do not wear tight clothing over the pulse generator.
- Contact your doctor if any signs of infection at the incision site develop (redness, swelling, warmth).
- Contact your doctor if twitching, hiccups that won't stop or arm swelling on the side of the incision develop.
- Contact your doctor if a rapid heart rhythm, dizziness, chest pain or shortness of breath occur.
- Follow your doctor's recommendations for medications.
- Inform other physicians, dentists and emergency personnel of the pacemaker.
Follow-Up Visits
Your physician will monitor the pacemaker during follow-up visits, which are scheduled several times a year. Your visit schedule depends on the type of pacemaker you have. You can be seen at your doctor's office, clinic or hospital, and a routine visit lasts 15 to 20 minutes. The pacemaker may also be checked with telephone monitoring. During these visits, a special magnet is placed over the pacemaker that causes it to beat at a set rate. This allows your doctor to check the pacemaker's settings and battery status. Once or twice a year, a more thorough exam is necessary. Your doctor may use a special device called a programmer that "talks" to the pacemaker. If your medical condition changes, the programmer can also reprogram the pacemaker as necessary. If you have a rate-responsive pacemaker, some physical activity may be performed during the visit. Since the pacemaker runs on batteries, the pulse generator will need to be replaced eventually. In general, batteries last six to 10 years. Telephone Monitoring Telephone monitoring is a method of transferring an EKG by telephone and is especially convenient for patients who live long distances from the clinic or if traveling is difficult.
You will be given a special transmitter that allows you to record and send an EKG over the phone. In the clinic, a special receiving device records the signals from the phone and prints them out. Your physician then reviews the record.
Living with a Pacemaker Once you have recovered from the surgery, you can resume most normal activities. Always follow the advice given by your physician.
Driving can be resumed depending on your physician's recommendations and local laws.
Regular exercise is encouraged after recovery from surgery. You should consult with your physician prior to starting an exercise program. Good heart exercises include brisk walking, jogging, swimming, bicycling, tennis, aerobic workouts and dancing.
Traveling with a pacemaker is not a problem once you have recovered from surgery. If a longer trip is planned (longer than three months) your should bring a copy of your medical record with you and arrange with your doctor to see another specialists in the area to which you are traveling.
If you have a pacemaker, you will need to avoid some things. In particular, you should avoid strong magnetic fields as these can interrupt proper function of a pacemaker. The following are lists of safe items and things to avoid.
Things That Are Safe
- Kitchen appliances such as microwave ovens, toasters, blenders, electric can openers.
- Televisions, AM/FM radios, VCRs, CD and DVD players, remote controls, garage door openers.
- Handheld appliances such as hairdryers and shavers.
- Major appliances such as washers, dryers, electric stoves, and refrigerators.
- Electric blankets and heating pads.
- Spark-ignited internal combustion engines such as lawn mowers and leaf blowers.
- Personal computers, printers, fax machines, electric typewriters and copy machines.
- Machine shop tools like drills and table saws. Keep tools 12 inches from implant site.
- Airport security archways are safe, but they may detect the metal in the pacemaker. If this happens, show the security officer your pacemaker ID card in your wallet. If a search is necessary, insist on a hand search. Security wands may interfere with pacemaker devices.
- Theft-detection systems at the entrances of stores, libraries and public places are safe.
- Cellular phones are generally safe but should not be held close to a pacemaker. It is recommended that your hold the phone to the ear farthest from the pacemaker. Do not carry the phone in a shirt or jacket pocket close to the device. As a rule, they should be kept six inches away from the pacemaker.
- Indoor cordless phones are safe.
Things to Avoid
- Large generators, electric motors and other large industrial equipment such as arc welders.
- Strong magnets.
- Radio transmitters, ham radios.
- Large stereo speakers.
- Battery-powered cordless power tools such as screwdrivers and drills.
- Maintaining or repairing any electrical or gas-powered appliance.
- Leaning over the open hood of a running car.
Other Medical Procedures - With proper precautions, most medical procedures are unlikely to interfere with a pacemaker; however, certain procedures should be avoided. These include magnetic resonance imaging (MRI), electrosurgery, diathermy, lithotripsy and radiation therapy.
If you have any question regarding the safety of something or are planning any medical procedure, contact your physician.
"Living with Your Pacemaker," from the American Heart Association
"Implantable Cardioverter Defibrillators," from the American Heart Association
"Defibrillation," from the American Heart Association
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