What is a Pacemaker?

A pacemaker is a small device that sends electrical impulses to the heart muscle to maintain an acceptable heart rate.  They are normally used to treat slow heart rhythms (bradyarrhythmias).

Electrical wires called leads connect the pacemaker to your heart. The pacemaker continuously monitors your heart’s rhythm and adjusts your heart rate according to the demands of your body.  Special biventricular (left and right lower chamber) pacemakers may be used to improve symptoms of heart failure.

There are different types of pacemakers. Some have one lead, pacing only the ventricles or the atria; others have two leads, pacing both chambers.

What is a Pacemaker Used For?

A pacemaker is used to help control your abnormal heart rate or rhythm. Pacemakers are used most commonly for:

• Bradyarrythmias: Slow heart rhythms which may arise from disease in the heart's conduction system (such as the SA node, AV node or HIS-Purkinje system. A minimum heart rate is programmed into the pacemaker and when your heart rate drops below the set rate, the pacemaker generates (fires) an impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heart beat.
• Heart failure
• Hypertrophic cardiomyopathy

How Should I Prepare for an Ablation Procedure?

• Your doctor may ask you to stop certain medications one to five days before your test (such as aspirin products). If you are diabetic, ask your doctor how you should adjust your diabetic medications.
• DO NOT eat or drink anything after midnight the evening before your test. If you must take medications, drink only with a sip of water.
• Wear comfortable clothes. You will change into a hospital gown for the procedure.
• You will lie on a bed and the nurse will start an intravenous line (IV) into your arm or hand to provide medications and fluids during the procedure.  You will be given a medication through your IV to relax you and make you drowsy, but it will not put your to sleep.
• The nurse will connect you to several monitors. The monitors allow the doctor and nurse to check your heart rhythm, blood pressure and other measurements during the pacemaker implant.
• Your left or right side of your chest will be shaved and cleansed with a special soap. Sterile drapes are used to cover you from your neck to your feet. A strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

What Happens During a Pacemaker Implant Procedure?

The pacemaker implant takes about two to five hours to perform. There are two ways pacemakers can be implanted:

Endocardial (transvenous approach): Most common
A lead is placed into a vein, then guided to your heart. The lead tip attaches to your heart muscle. The other end of the lead is attached to the pulse generator, which is placed under the skin in your upper chest. This approach is done under local anesthetic (you will not be asleep).

Epicardial approach: Less common in adults, more common in children
The lead tip is attached to the outside of the heart. The other end of the lead is attached to the pulse generator, which is placed under the skin in your abdomen. This approach is done under general anesthesia (you will be asleep) by a surgeon.

• The doctor will numb your skin by injecting a local numbing medication. You will feel a pinching or burning feeling at first. Then, it will become numb.
• Once this occurs, an incision will be made to insert the pacemaker and leads. You may feel a pulling as the doctor makes a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse.
• After the pocket is made, the doctor will insert the leads into a vein and guide them into position using the fluoroscopy machine.
• After the leads are in place, their function is tested to make sure they can increase your heart rate. This is called "pacing" and involves delivering small amounts of energy through the leads into the heart muscle. This causes the heart to contract. When your heart rate increases, you may feel your heart is racing or beating faster. It is very important to tell your doctor or nurse any symptoms you feel. Any pain should be reported immediately.
• After the leads are tested the doctor will connect them to your pacemaker. Your doctor will determine the rate of your pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a "programmer."

After the Procedure

• You will be admitted to the hospital overnight. The nurses will monitor your heart rate and rhythm. The morning after your implant, you will have a chest x-ray to ensure the leads and pacemaker is in the proper position.
• Keep your wound clean and dry. After five days, you may take a shower. Look at your wound every day to make sure it is healing.
• Call your doctor if you experience:
  • Redness
  • Swelling
  • Drainage
  • Fever
  • Chills

Pacemaker Identification
Your pacemaker settings will be checked before you leave the hospital. You will be given information about:

• The type of pacemaker and leads you have
• The date of implant
• The doctor who implanted them. In about three months you will receive a permanent card from the company. It is important that you carry this card at all times in case you need medical attention.

Activity

• You may move your arm normally.
• You do not need to restrict arm motion during normal activities.
• Avoid extreme pulling or lifting motions
• Avoid activities such as golf, tennis and swimming for six weeks.
• Ask your doctor when you can resume more strenuous activities

Electrical Interference
Most electrical devices, such as microwave ovens, do not interfere with pacemaker function. You need to avoid strong electric or magnetic fields such as:

• Some industrial equipment, high output ham radios, high intensity radiowaves (found near large electrical generators, power plants or radiofrequency transmission towers), and arc or resistance welders
• Cellular phones should not be placed directly against the chest or on the same side as your pacemaker.
• Do not undergo any tests that require magnetic resonance imaging (MRI).
• If you have concerns about your job or activities, ask your doctor.

Follow-Up

A complete pacemaker check should be done one to two weeks after your pacemaker is implanted. Then your pacemaker should be checked every three months on the telephone to evaluate battery function. When the battery function becomes low, it will be necessary to change your pacemaker (pacemakers usually last about four to eight years). Your nurse will explain how to check your pacemaker using the telephone transmitter. Every six to 12 months, you will need a more complete exam at a hospital or doctor's office.