Pacemaker

What is it?

A pacemaker is a small electronic device used to treat abnormal heart rhythms. It does this by generating electrical impulses to the heart muscle so it will contract and efficiently pump blood to all body parts. The pacemaker also senses the heart’s natural electrical activity and adjusts its response based on this input.

The pacemaker system is composed of the following parts:

• • Pacing lead that both senses the heart’s natural electrical activity and delivers needed electrical impulses to the heart muscle. The lead is an insulated wire that originates in the pacemaker battery and makes contact with the heart muscle. Based on the patient’s condition, one or two pacing leads may be inserted.
• • Pacemaker battery is a small metal case that is often inserted in the upper chest under the collarbone. It contains a small sealed lithium battery that typically lasts for many years and a miniature computer that controls the timing and intensity of the electrical impulses that are sent to the heart.

Why are Pacemakers Inserted?

Pacemakers are needed when patients develop certain types of abnormal heart rhythms (arrhythmias) that cause serious symptoms. The most common reason is when the heart beats too slowly or irregularly. The patient often feels dizziness, extreme fatigue, shortness of breath or fainting spells. A pacemaker will either increase the heart rate to normal parameters or generate electrical impulses past “blocked” areas of the heart.

Types of Pacing

Depending on the patient’s arrhythmia, the doctor will select one of the following:

• • Single chamber pacing usually has one pacing lead to carry signals and impulses from the pacemaker to one chamber of the heart.
• • Dual chamber pacing is comprised of two pacing leads connected from the pacemaker to two separate heart chambers (the atrium and the ventricle). This type is often chosen when the two chambers can receive impulses and thereby contract in a coordinated fashion.
• • Rate-responsive pacing can be delivered through either a single or dual chamber pacemaker. It is used when the patient’s heart cannot adjust its own rate. The pacemaker uses special sensors to monitor the body’s needs and deliver the most appropriate rate of pacing for the patient’s activities.

Preparation for Pacemaker Implantation

The patient must stop all food, drink and some medications, six to eight hours before the procedure. The physician will discuss specific instructions during an office visit or by phone.

During the Pacemaker Implantation

The procedure is performed in either the electrophysiology laboratory or in an operating room. The patient is given a mild relaxing sedative while the upper chest area is cleansed and shaved to avoid infections.

An incision is made below the collarbone to create a small pocket for the pacemaker. The pacing leads are threaded through a large vein down to the heart while the physician monitors the placement with fluoroscopy.

After the pacing leads are connected to the pacemaker generator, the device is programmed and the incision is closed. The implantation generally takes one to two hours.

Post-implantation Care

The patient remains in the hospital for one to two days after the procedure while the heart is monitored and the pacemaker is checked for proper functioning. Antibiotics are administered intravenously. Pain medications can be given for the incisional discomfort that may be experienced. During this time, the patient should not raise his arm above his shoulder on the surgical side. Direct pressure should not be placed on the pacemaker while lying face down.

Post-discharge Care

The incision should be monitored daily for increasing redness, swelling, warmth or drainage. The physician should be notified if dizziness, fatigue, fainting spells, chest pain, shortness of breath, swelling of the legs or arms, or prolonged hiccoughing is experienced.

Activities are resumed gradually. Medications may be changed by the physician. Generally, the arm should not be raised above the shoulder for about two weeks and should not be used for heavy lifting during that time period.

Guidelines

Patients with pacemakers have very few limitations after the recovery phase. An identification card with the pacemaker’s information should be carried at all times and shown to all medical personnel caring for that patient.

The following circumstances are to be avoided:

• • Close proximity to powerful magnets that are used in junk yards, electronic equipment, amusement park rides, running auto engines, large generators or power plants
• • CB or Ham radio antennae
• • Placing a cellular phone near your pacemaker device (the other ear is acceptable)
• • Hand-held security wands
• • Tight clothing over the pacemaker site
• • MRIs
• • Lithotripsy procedures
• • Electrocautery
• • Electric arc welding equipment
• • Induction furnaces such as kilns
• • Large magnets that may be used in some stereo speakers

Other precautions may be added or deleted depending on the model and type of pacemaker implanted. Further details are found in the manufacturer’s “Patient Guide.”

Follow-Up Visits

Regularly scheduled visits are necessary to check the efficiency of the pacemaker and leads, including an electrocardiogram. At times, the pacemaker may require some reprogramming adjustments that are accomplished by computer in the office.

While healing, avoid contact sports and heavy lifting. Normal activities such as work, travel, exercise, sex and hobbies can be resumed gradually.