Heart Center

Technology & Procedures

Pacemakers

To understand why your doctor may have told you that you need a pacemaker, you need to know about your heart's electrical system. This electrical system helps it beat at a regular speed or pace. Problems with this electrical system can make your heart's pace slow or uneven, possibly leaving you feeling fun-down or even faint. A pacemaker is a small electronic device that helps your electrical system keep your heart beating at the right pace.

Symptoms of a slow heartbeat may include:

•   Dizziness
•   Lightheadedness
•   Shortness of breath
•   Fatigue
•   Confusion
•   Fainting Spells

These symptoms are usually most noticeable when you're trying to do something active, such as walking or climbing stairs.

Having a pacemaker implanted is a fairly simple surgical procedure, but it does require a lifelong commitment. Keep in mind that pacemakers have been around for more than 30 years. With proper care, a pacemaker can help keep you feeling good for many years to come. A pacemaker is a small, lightweight, electronic device that's placed inside your body. The pacemaker keeps track of your heartbeat and, when necessary, generates electrical signals similar to the heart's natural signals. These signals keep your heart beating at the right pace.

A pacemaker helps keep your heart from beating too slowly, but it doesn't stop your heart from beating on its own. The pacemaker "listens" to your heart. When the heart's own electrical system sends a signal and the heart beats, the pacemaker waits and does nothing. When the heart's system misses a signal, the pacemaker sends a signal to replace it.

When you're active, your heart beats at a faster pace or rate. Electrical system problems can sometimes keep your heart's rate from speeding up when you're active. Because of this, some pacemakers are also rate-adaptive. This means they can help change the rate of your heartbeat depending upon your activity level. So when you're dancing or doing similar activity, a rate-adaptive pacemaker helps your heart beat faster. And when you sit down to rest, the pacemaker lets your heart return to a slower rate.

Inserting the pacemaker into your body is called implantation. Pacemaker implantation is not open heart surgery. Rather, it's a minor procedure that's done in an operating room or cardiac catheterization lab. You'll be given instructions on how to prepare for the procedure. Pacemakers can be inserted near the right or left shoulder. If you prefer to have it implanted on a particular side, discuss your preference with your doctor.

Ask your doctor whether you should stop taking aspirin or other medications before your procedure. Unless instructed otherwise, don't eat or drink anything for six hours before the procedure. You'll probably be admitted to the hospital on the day of the procedure. Before the procedure begins, you may be given some medication to help you relax. The skin where the pacemaker is to be implanted will be washed and shaved.

The most common method used to insert a pacemaker is called endocardial ("inside the heart") implantation. This procedure may take 2 to 3 hours. You stay awake during the surgery, and you'll probably hear the surgical team talking. You may be asked some questions or be asked to take some deep breaths.

A local anesthetic is given by injection to numb the area where the pacemaker will be inserted. This keeps you from feeling pain during the procedure. An incision is made in your skin below your collarbone to create a small "pocket". The lead for the pacemaker is threaded through the incision into a vein in your upper chest.

The lead is then guided into your heart's chambers using x-ray monitors. Electrical measurements are taken to determine a good position for the lead in the heart. If there is a second lead, this process is repeated.

The pacemaker generator is attached to the lead or leads. Then, the generator is placed in the pocket under your skin. The pacemaker's settings are programmed to help your heart beat at a rate that's right for you. The incision is then closed and covered with a sterile dressing.

Your doctor may use an alternative method, called epicardial ("outside the heart") implantation. Epicardial implantation takes longer than endocardial implantation and requires more recovery time. An opening is made in the lower chest, and the lead is threaded up to the outside of the heart. The generator is attached to the leads and placed underneath the skin in the abdomen.

After your pacemaker is implanted, you'll probably stay in the hospital for a day or two to be sure that there are no problems. When you go home, you may be given instruction on how to take care of the incision site as it heals. Your doctor may also schedule some follow-up visits.

During your stay in the hospital, your heart's signals are monitored to be sure the pacemaker is working correctly. A nurse may take your pulse and blood pressure regularly and check your incision for bleeding or swelling. To give the lead or leads a chance to secure themselves inside the vein and your heart, don't lift your arm above your shoulder on the side where the pacemaker was implanted. It's normal to have some pain and stiffness in the area around the incision for a week or so. Pain medication can help make you more comfortable.

Be sure to tell your nurse or doctor about any unusual symptoms you might experience, like hiccups that won't go away, dizziness or chest pain.

A few days after you leave the hospital, you can go back to most of your daily activities. But take it easy for a few weeks to keep from pulling the leads out of place. Continue to avoid lifting your arms over your head for at least a week. Be careful not to hit or rub insertion site. Also avoid activities like heavy lifting, running or contact sports. Every day, take your temperature and check your incision for signs of infection. In a week or two, you may visit the doctor to have your sutures or staples removed, if necessary, and to check how your incision is healing.

Your incision should heal completely within about a month after the procedure. Continue to avoid letting anything hit or rub your pacemaker. Don't fiddle or play with the pacemaker under your skin. You may feel numbness or fullness in the area around the pacemaker for a few months after the implantation procedure - this is normal.

Be sure to call your doctor if:

•   You have signs of an infection (a fever; redness, swelling or warmth at the incision site; drainage from the incision).
•   You feel symptoms you had before the pacemaker was implanted.

To be sure your pacemaker is working correctly, you'll visit your doctor or pacemaker clinic several times a year. During these visits, the pacemaker's battery level and functions are checked and the pacemaker's settings can be adjusted. Your pacemaker can also be checked from your home. Pacemaker batteries and leads occasionally need to be replaced - your doctor will tell you when this is necessary.

If your doctor recommends it, subscribe to a telephone monitoring service. This service allows you to use a special transmitter to send your pacemaker signals over the phone lines. A doctor or technician then read the record of these signals and checks that everything is running smoothly. Your doctor will tell you how often you need to use this service.

Pacemaker batteries last about 5 to 10 years before they need to be replaced. Because the battery is sealed inside the generator, replacing a battery requires replacing the entire generator. This procedure is usually simpler and shorter than the initial implantation. To replace the generator, the pacemaker pocket is opened, the old generator is detached from the leads, the new generator is attached to the leads, and the pocket is closed. Occasionally, the leads wear out and need to be replaced. Replacing the leads require a procedure similar to your original implantation.

It isn't difficult to live with a pacemaker. You can usually do almost everything you did before you got your pacemaker, and since you will probably feel better, you may do even more! One of the things you might do is exercise, which is a great way to improve your health. Also, see your doctor regularly to help ensure that you remain healthy and feeling good.

When you first get your pacemaker, you'll be given an ID card to carry. This ID card contains important information about your pacemaker. Show it to any doctor, dentist, or other medical professional you visit. Also, because pacemaker tend to set off security devices like those found in airports and libraries, you may need to show your card to security personnel.

Modern pacemakers are well protected from outside signals, so there are very few things that can interfere with your pacemaker. But if you ever feel symptoms that make you think a device is disrupting your pacemaker's signals, turn the device off or move away from it. Your symptoms should stop and your pacemaker shouldn't be damaged. To be safe, check with your doctor.

Appliances which should be safe to use include:

•   Microwave ovens and other appliances in good repair
•   Computers
•   Hair Dryers
•   Power Tools
•   TV's and Radios
•   Stereos
•   Electric Blankets and Heating Pads
•   Vacuum Cleaners

There are a few things to avoid that might interfere with your pacemaker. These include very strong magnets (like those used for an MRI), radio transmitting tours, ham radios, certain surgical instruments and cellular phones. When using a cellular phone, hold it on the ear farthest away from your pacemaker. Don't carry it in your breast pocket, even when it's turned off. Also, a running car engine generates an electrical field, so avoid leaning directly over the open hood of a running car.

If you have any questions or concerns, please call your doctor. It's very important for you to keep your appointments with your doctor or pacemaker clinic. Follow your doctor's recommendations about caring for your pacemaker, taking medications or doing other things to care for your heart.