What is a Pacemaker?

A pacemaker is a small electronic device, operated by a battery, that helps regulate the heart beat to stay in a regular rhythm. These devices are also called cardiac pacing devices.

pacemaker
Summary

Pacemakers typically have 3 parts;

  • a generator
  • wires (leads)
  • sensors (electrodes), however some newer versions are wireless

A surgeon implants the device under the skin in the chest area below the collarbone or sometimes in the stomach area. A pacemaker creates electrical pulses to manage irregular heart beats (arrhythmias) and can also be used for some types of heart failure.

A traditional pacemaker is connected to your heart by tiny wires (leads). The device sends pulses through the wires to your heart. There are sensors at the end of the wires to detect irregular heart beats so the device can return your heart to normal sinus rhythm.

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Common types of pacemakers?

There are different types available, each one is designed to address specific heart conditions and needs.

  • Single-Chamber: These pacemakers have one lead (wire) and are used to treat conditions where only one chamber of the heart requires stimulation. They are often used in cases of atrioventricular (AV) block, where the electrical signals between the atria and ventricles are disrupted.
  • Dual-Chamber: Dual-chamber pacemakers have two leads and are used when both the atria and ventricles need stimulation. They can coordinate the timing of electrical impulses between the two chambers, allowing for a more natural heartbeat. Dual-chamber pacemakers are commonly used in conditions such as sick sinus syndrome and certain types of heart block.
  • Bi-ventricular (Cardiac Re-synchronization Therapy – CRT): These pacemakers are used in patients with heart failure and electrical conduction abnormalities. They have three leads, with one placed in the right atrium, one in the right ventricle, and an additional lead in the left ventricle. Bi-ventricular pacemakers help synchronize the contraction of the ventricles, improving the heart’s pumping efficiency.
  • Lead-less: Unlike traditional pacemakers with leads, “lead-less” means they do not have leads and are self-contained devices placed directly inside the heart’s right ventricle. These devices are smaller than traditional ones as the pulse generator and the electrodes are all in one device. This is a minimally invasive procedure and means that you would not require surgery as you would with the traditional pacemakers. They are an alternative for patients who do not require atrial pacing and have specific conditions that may benefit from this type of technology.
How does our heart beat?

The sinus node is a small mass of specialized cells in the upper chamber of the heart (right atrium). It is the heart’s natural pacemaker and it produces electrical pulses causing your heart to beat. When an electrical pulse moves across a chamber of the heart, it contracts. The electrical signal must travel down a specific path to reach the lower chambers (ventricles) for the heart to beat properly.

When something is wrong with our natural pacemaker, the heart may beat too fast, too slow or can even be irregular. This can be due to a blockage or some abnormality of your heart’s electrical pathways.

 

Who needs a pacemaker?

You may need one if your heart has problems with electrical signaling, such as;

  • slow heart beat (bradycardia) or a heart beat that pauses
  • a fast heart beat (tachycardia)
  • irregular heart beat (arrhythmia
  • some types of heart failure
Reasons for needing a pacemaker?
  • Age related changes to heart tissue
  • damage to the heart from heart disease, a prior surgery or a previous heart attack
  • Certain medications can slow the heart such as beta blockers or calcium blockers
  • pericarditis (inflammation of heart tissue around the heart)
  • myocarditis (inflammation of the heart muscle)
  • cardiomyopathy (heart muscle not able to pump blood as it should)
  • systemic sclerosis (scarring of internal organs)
  • sarcoidosis (swollen areas of tissue appearing in the organs of the body)
  • hypothyroidism (thyroid produces too little thyroid hormone)

Possible signs you may have heart problems that require a pacemaker are;

  • tiredness, dizziness or nasea
  • chest pain (angina)
  • shortness of breath
  • feeling faint
  • fast heart rate (tachycardia – more than 100 beats per minute)
  • slow heart rate (bradycardia – less than 60 beats per minute)
  • swelling in your ankles, legs and abdomen
  • needing to urinate many times during the night
Temporary or Permanent

Most pacemakers are intended to be permanent but temporary ones can be used to control certain types of problems such as a medication overdose that can slow the heart. Other reasons for a temporary one may be after a heart surgery or after a heart attack.
Temporary pacemakers are normally inserted through a vein in your neck and remain outside of your body.

How does a demand pacemaker work?

Most pacemakers are demand pacemakers. This means that they only work when they are needed.

These devices have sensors which;

  • shuts the device off if the heart rate is above a certain number
  • turns the device on if the heart rate drops below a certain number of beats per minute.
  • turns on the device when the sensors (electrodes) at the end of the wires (leads) detect abnormal heartbeats and then promptly return your heart to it’s normal rhythm.
Other types?

A pacemaker delivers electrical pulses to control your heart rhythm but it is unable to deliver a shock to correct the arrhythmia.
There are medical devices called an implantable cardioverter defibrillator (ICD) that can be used to prevent uncontrollable arrhythmias, especially heat beats that are too fast and unstable. An ICD uses an electrical impulse (shock) to restore a normal heart rate and most newer ICDs also have a pacemaker function.

Types of surgery to implant a device?

Based on the type of pacemaker being used, you will either need a catheter-based, vein-based or surgical-based approach. These procedures are constantly being improved to help you feel less pain, recover faster and improve a patients quality of life.

Catheter-based approach:

This method is used with lead-less pacemakers, which only treat conditions involving a single chamber of your heart. A specialist inserts a catheter (a tube-like device) into an artery (usually near your groin) and threads it up to your heart. Once inside, it’s attached to the wall of your heart. This approach can take less than an hour.

Transvenous (through a vein) approach:

During this procedure, a specialist makes a small incision to access a vein near your heart. This is usually a vein that runs underneath your collarbone, to your arm or to your neck. Using fluoroscopy (a type of X-ray), the specialist threads the lead(s) (wires) through the vein and attaches them to a point on your heart. The lead(s) will then be attached to the pacemaker device itself, which is placed into a small “pocket” under the skin of your upper chest. This approach can take 2 to 5 hours.

Surgical-based (epicardial) approach:

A surgeon creates a small incision in your chest and inserts the lead(s) through that incision, and then attaches the lead(s) to your heart. The surgeon then connects the lead(s) to the pacemaker. The device is inserted into a “pocket” under the skin of your abdomen. This type of surgery can also take 2 to 5 hours.

How long do the batteries last?

While it depends on the specific model of pacemaker and how often it has to assist your heart, the batteries in the devices can last as long as 10 or 15 years. Your healthcare provider can tell you the average lifespan of the device you’ll receive, and will also schedule follow-up appointments to check your pacemaker’s battery level. It’s also usually a simpler process to replace a pacemaker battery than it was to implant the device in the first place.

Is it possible to take showers, baths or go swimming?
For the first 4 weeks, after being fitted with a pacemaker, the surgical site needs to be kept clean and dry. A shower should be allowed about 7 days after surgery. You should not engage in any activity that stress the area around the device.
After this time ends, keep in mind when swimming that there are certain swimming strokes that could damage or pinch the wires of the device. One of these is the butterfly stroke.
 
What are the possible risks or side effects?

Pacemaker procedures tend to have very few complications. In general, the following complications are possible however:

  • Allergic reactions: These may happen because of a medication you’re given or you may be allergic to one of the materials used in the device itself.
  • Blood clots: Your healthcare provider may prescribe blood-thinning medications to reduce the risk of developing a blood clot.
  • Malfunctions of the device or its leads: In some cases, a lead may get jostled out of position or might break free. Your healthcare provider will recommend limiting your activity for a while after your procedure to avoid this.
  • Malfunctions caused by sources outside of your body: Your healthcare provider will give you instructions on devices or machines to avoid so you don’t have problems caused by outside electrical interference.
  • Unexpected heart rhythm problems: Some people develop heart rhythm problems — in rare instances — because of the pacemaker.
  • Bleeding from the incision or catheter insertion site
  • Damage to a vessel at the catheter insertion site
  • Infection of the incision or catheter site
  • Pneumothorax. If the nearby lung is inadvertently punctured during the procedure, leaking air becomes trapped in the pleural space (outside the lung but within the chest wall); this can cause breathing difficulties and in extreme cases may cause the lung to collapse.
  • For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.
cell phone
Can I Use a Cell Phone?

Cell phones do give off electromagnetic waves so try to keep it about 6 inches away from your chest.

airplane
Can You Go Through Airport Security?

Yes, you certainly can go through security at an airport with a pacemaker. It’s best to let airport security know that you have a medical device before you even go through the airport security scanners, otherwise you can set off alarms or the scanner can interfere with your device.

Avoiding Electrical Interference

Spending time around devices that give off electromagnetic waves can cause problems.This could include but not limited to;

  • Jumper cables
  • Welding equipment
  • Gas-powered equipment
  • Ignition systems
  • Portable car battery starters
  • Workout equipment (certain types)
  • Magnets
  • Electric fences
  • Ham Radios / CBs

Many electronic devices are safe to use but be cautious of the devices that use magnetic chargers. The magnets can interfere with the operation of an ICD or a pacemaker if the magnets are strong enough and held close to your device.

Success rate of cardiac implantation devices?

The success rate of these devices depend on various factors, including the patient’s underlying heart condition and overall health. Pacemakers are generally considered safe and effective devices. Complications can occur, but they are relatively rare. Potential risks and complications associated could include infection at the implantation site, bleeding, allergic reactions to medication or anesthesia, damage to blood vessels or nerves, and device-related issues such as lead displacement or malfunction.

Pacemakers have greatly improved the quality of life for millions of people with heart rhythm disorders. The success rate of  in managing and treating these conditions is generally high, with a significant reduction in symptoms such as fatigue, shortness of breath, and fainting spells. However, the success rate can vary depending on individual factors and the specific heart condition being treated. It is essential to consult with a healthcare professional for a thorough evaluation and to discuss the potential benefits and risks of pacemaker implantation in each specific case.

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