Pacemaker

A pacemaker is a device a healthcare provider places in your upper body to help your heart beat at a typical rate and rhythm. The device can stabilize abnormal heart rhythms and prevent problems that could disrupt or endanger your life.

Pacemakers use electrical impulses to correct problems with your heart’s electrical system. Typically, this system tells your heart’s chambers when it’s their turn to squeeze. When your heart’s electrical system doesn’t work right, your heart’s chambers may squeeze in the wrong order or too weakly. When this happens, they can’t provide enough blood to your body.

A cardiac pacemaker can sense when your heartbeat is too slow. Then, it delivers electrical impulses to control the rhythm of your heart. The device can sometimes help people with a fast or irregular heartbeat. But it can’t deliver a shock to correct the rhythm.

Talking to your healthcare provider about your concerns or symptoms is the first step to finding out if a pacemaker can help you. Pacemakers are common. They can treat problems with your heart’s electrical system, like certain arrhythmias (abnormal heart rhythms) or heart blocks. They also treat heart failure and heart palpitations (pounding in your chest). People may also need them if they’re short of breath or have unexplained dizziness or lightheadedness, nausea, confusion or fainting.

Types of pacemakers

Depending on the heart problem, your healthcare provider may suggest a specific type of cardiac pacemaker with one to three wires (called leads). Types of pacemakers include:

• Single-chamber pacemaker: This uses a single wire that attaches to one chamber of your heart.
• Dual-chamber pacemaker: This uses two wires that attach to two chambers of your heart.
• Biventricular pacemaker: This uses three wires, two of which attach to the lower chambers of your heart. A third wire connects to the right upper chamber of your heart. This is for cardiac resynchronization therapy (CRT).
• Leadless pacemaker: This is a small pacemaker (about the size of a large pill) a provider inserts using a catheter-based procedure. They attach this device to an inner wall of your heart, which means it doesn’t use any wires.

How should I prepare for pacemaker surgery?

Before your operation, you can expect to:

• Arrange for someone to drive you home
• Tell your healthcare team what medicines you take and what allergies you have
• Stop eating and drinking at a certain time before your procedure (your team will tell you when)
• Stop taking certain medicines (only if your team tells you to)

What happens during this procedure?

Depending on the type of cardiac pacemaker, you’ll have a catheter-based, vein-based or surgical-based operation. Approaches include:

• Catheter-based approach: For leadless pacemakers, a specialist inserts a catheter (tubelike device) into an artery (usually near your groin). They thread the catheter up to your heart. They guide the pacemaker inside the bottom right chamber of your heart and secure it to heart muscle.
• Transvenous (through a vein) approach: A specialist makes a small incision to access a vein near your heart (most commonly in your upper chest). Using a type of X-ray to see, the specialist threads the lead or leads (wires) through the vein and attaches them to a point on your heart.
• Surgical-based (epicardial) approach: A surgeon creates a small cut in your chest and inserts the lead(s) through that cut, and then attaches the lead(s) to your heart.

If the pacemaker has one or more leads, your provider will attach them to the pacemaker device. Then, they’ll place the device into a small “pocket” they make from tissue under the skin in your upper chest or abdomen. After testing the device, your provider will close the cut they made for the pocket.

How long does this procedure take?

Catheter-based procedures usually take about an hour or less. The transvenous and surgical-based approaches take between two and five hours. Your healthcare provider will explain which is best for you. The goal is to help you feel less pain, recover faster and get back to your life sooner.

What are the potential benefits and risks of this procedure?

Pacemakers can improve your quality of life and prevent disruptions from heart problems. Benefits include:

• Saving your life by preventing your heart from stopping
• Improving many of the symptoms of heart rhythm problems
• Preventing dangerous symptoms like fainting because of arrhythmias
• Helping people with advanced heart failure feel better and live longer

Pacemaker procedures tend to have few complications, but the following are possible:

• Allergic reactions: These may happen because of a medication you receive or one of the materials in the pacemaker itself. Your healthcare team may check for allergies in advance.
• Blood clots: Your healthcare provider may prescribe blood-thinning medications to reduce the risk of developing a blood clot.
• Infection: Around 1% of people may develop an infection. Your healthcare team will take steps to try to prevent this and keep a close eye out for any signs of infection during follow-up visits. Medications can treat an infection, but your provider may need to replace the pacemaker.
• Injury to your lung: There’s a very small risk of injury to the lung, leading to an air leak (pneumothorax) during pacemaker placement. This may require your provider to observe you in the hospital for longer. You may need a special drain in your chest.
• Device malfunctions: In some cases, a pacemaker lead may get out of position or break free. Your healthcare provider will recommend limiting your activity for a while after your procedure to avoid this.
• Malfunctions from sources outside of your body: Your healthcare provider will give you instructions on devices or machines to avoid so they don’t cause problems. These situations aren’t common.
• Unexpected heart rhythm problems: Rarely, some people develop heart rhythm problems because of the pacemaker. Your healthcare provider can talk to you about these risks and help you avoid them.

What happens after this procedure?

You might need to spend one night at the hospital, or you may go home after only a few hours. You may have an X-ray to make sure the device and wires are staying put. And your healthcare team will check your device to be sure it’s working right.

Before you go home, you’ll get a card to carry with details about your device. You’ll receive information about what can interfere with your pacemaker. For example, you should avoid spending much time near a metal detector or a store’s theft detector. Also, keep cell phones and headphones 6 inches away from your pacemaker. Some medical tests (like MRIs) and treatments may also cause issues with pacemakers.

What is the recovery time?

You can most likely get back to your normal routine a few days after pacemaker surgery. It can take several weeks to fully recover after a pacemaker procedure. During that time:

• Don’t lift anything heavier than 10 pounds (like a cat or a light bowling ball).
• Don’t push, pull or twist your upper body.
• Don’t lift your arm above your shoulder on the side where the pacemaker is.
• Don’t press on or let clothes rub against the area where your pacemaker sits.

You can shower four or five days after you get your pacemaker.

Follow-up visits

Your healthcare provider will schedule follow-up visits once or twice a year to check your pacemaker’s battery level. Replacing the battery is usually a simpler process than implanting the device. Pacemaker batteries can last 10 to 15 years.

Follow-up visits also let your provider see how you’re doing and how well your pacemaker is working.

The life expectancy of a person who has a pacemaker depends on several factors. Your age and medical conditions when you receive it are two of these factors. People who have fewer or less severe health concerns tend to live longer and are more likely to have a normal or near-normal life expectancy.

When should I call my healthcare provider?

If you have a pacemaker, it’s best to manage your health and be aware of how you feel. Your healthcare provider may prescribe medicines that are meant to work along with your pacemaker. Be sure you understand how you’re supposed to take your medications and for how long.

If you have questions, be sure to ask them. Your provider is there to make sure you have the best possible outcome, and they know that’s more likely when you have the answers to all your questions.

Call your healthcare provider if you:

• Notice bruising, swelling or drainage from the pacemaker site
• Have any trouble breathing
• Unexpectedly gain weight, or you have swelling in your ankles and lower legs
• Have dizziness, fainting or bouts of confusion
• Notice symptoms like you had before you got a pacemaker
• Often have a pulse that’s too fast or too slow (based on the range your healthcare provider tells you)