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Pacemakers

Definition

photo of man on a treadmill

An implantable pacemaker (or artificial pacemaker) is a small, battery-operated device that uses electrical impulses to regulate the heart rhythm or reproduce the rhythm.

The permanent pacemaker is implanted in the chest, under the skin. A pacemaker generally has two parts:

  • Generator -- contains the battery and the information to control the heartbeat, typically weighs less than an ounce
  • Leads -- wires used to connect the heart to the generator and send the electrical impulses to the heart to tell it to beat

Pacemakers are externally programmable and allow the cardiologist to select the optimum pacing modes for individual patients. Pacemaker devices may have multiple electrodes stimulating differing positions within the heart to improve synchronization of the lower chambers of the heart.

For patients that require it, a combination of a pacemaker and implantable defibrillator is available in a single implantation device.

Parts of the Body Involved

  • Heart
  • Upper chest

Reasons for the Procedure

The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart's natural pacemaker is not fast enough, or there is a block in the heart's electrical conduction system.

Single-Chamber Cardiac Pacemakers may be implanted in people who have:

  • various types of second-degree and complete heart block
  • sinus bradycardia with significant symptoms
  • sinus node dysfunction
  • bradycardia associated with atrial fibrillation or atrial flutter
  • recurrent and refractory ventricular tachycardia

Dual-Chamber Cardiac Pacemakers may be implanted in people who have:

  • prior experience with pacemaker syndrome
  • difficulty tolerating a single-chamber pacemaker
  • severe heart failure

Risk Factors for Complications During the Procedure

  • Abnormal heart rhythms
  • History of smoking
  • Obesity
  • History of excess drinking
  • Bleeding or blood-clotting irregularities
  • Infection

Prior to Procedure

The following tests may be conducted prior to your procedure:

  • Chest x-ray--a test that uses radiation to take a picture of structures inside the body, especially bones
  • Electrocardiogram--a test that records the heart’s activity by measuring electrical currents through the heart muscle
  • Electrophysiology study--a test that measures the condition of the heart’s electrical system by electrodes placed on the heart through blood vessels

In the days leading up to your procedure:

  • Talk to your physician about the medications you are taking. Prescriptions may need to be altered prior to your procedure.

The day before and the day of your procedure:

  • The night before, eat a light meal and do not eat or drink anything after midnight.
  • If you must take medications (which have been approved by your doctor), do so only with small sips of water.

Anesthesia

For the implantation of the pacemaker, light sedation and local anesthesia are generally used.

Description of the Procedure

photo of doctors in surgery

A pacemaker must be implanted under the skin. A small cut is made, usually on the left side of the chest. The physician uses x-rays to place the wires (leads) in the heart. After the leads are in place, they are connected to the pacemaker (generator). The pacemaker is placed into the chest area and the skin around it is closed with stitches. Most patients go home within 1 day of the procedure.

Possible Complications

  • Puncture of the heart or lung tissue
  • Damage to the blood vessel
  • Infection
  • Bleeding
  • Bruising
  • Device recall or safety alert

Average Hospital Stay

1-2 days

Postoperative Care

Wound Care and Follow-Up Instructions for All Device Patients:

  1. Leave the wound dry (do not shower) for 5 days. Do NOT remove steri-strips or suture.
  2. Avoid raising the affected arm above your head for 3 weeks.
  3. Do not life greater than 10 pounds with the affected arm for three weeks.
  4. No driving in the first 24 hours, while using narcotic pain medication, or while the pain persists
    • If you have passed out in the past 6 months, Alaska state law may prohibit you from legally driving.
    • As your physician whether you are cleared for driving.
  5. Call if you develop wound drainage, worsening pain or fever.
  6. Your first follow-up visit is for a wound check, and in some cases, removal of sutures. Please go to the Alaska Heart Institute (AHI) Cardiac Device Clinic one week after your device was implanted for your first check. Call (907) 561-3211 for a specific appointment time. If you live out of town, call the AHI Cardiac Device Clinic and they will help coordinate a follow-up visit where you live.
  7. The second follow-up visit should be performed at 6 weeks and is very important in terms of ensuring the longevity of your device. If your first follow-up visit is not with the AHI Cardiac Device Clinic, you will need to call (907) 561-3211 to schedule your second visit with the Cardiac Device Nurse.
  8. It is your responsibility to continue with device follow-up. If you somehow lose contact with the Cardiac Device Clinic, call (907) 561-3211 to arrange your next appointment.
  9. If you received a a biventricular pacemaker or defibrillator, your water pill (diuretic) medicine may become more effective as your heart function strengthens. If you develop lightheadedness or weakness with standing, this may be a sign that your medication requires adjustment. Please call the AHI Cardiac Device Clinic at (907) 561-3211 and arrange for a reevaluation of your medications.

Pacemaker Safety - American Heart Association Guidelines

Equipment and devices you come in contact with may interfere with the operation of your pacemaker. If you have questions regarding electromagnetic interference (EMI), consult the manufacturer's recommendations for your specific device.

General EMI information:

There are only a few devices in the environment today that can interfere with a pacemaker. Arc welding equipment and equipment with powerful magnets have the potential to interfere with the pace generator.

Cell phones in the U.S. do NOT interfere with pacemakers. However, you should still keep them away from the pacemaker area. For example, do not store your cell phone in your shirt pocket.

Most home appliances, such as a microwave, do NOT interfere with a pacemaker.

The American Heart Association recommends that people with a pacemaker pay close attention to their surroundings to make sure there are not any devices that may interfere.