Pacemakers

In contrast to ICDs, which are used to control tachycardias, pacemakers are used to control bradycardias.

What is a Pacemaker?

The pacemaker is essentially a small, lightweight, electronic device that delivers electrical impulse to the heart at a set rate. This electrical impulse enables the heart to beat.

A pacing system consists of two parts: a pacemaker, and a pacing lead.

The pacing lead is an insulated wire that carries the tiny electrical pulse from the pacemaker to the heart muscle. It can also relay information about the heart's activity back to the pacemaker.

Who Needs a Pacemaker?

When the normal electrical system in the heart is diseased, the heart may beat too slowly. This can lead to symptoms of weakness, fatigue, lightheadedness, dizziness, or fainting (syncope). In such cases, a pacemaker can be used to substitute for the natural pacemaker and make the heart to beat at an appropriate rate.

The two most common conditions that require treatment with a pacemaker are Sick Sinus Syndrome (where the SA node is inappropriately slow due to disease), and Heart Block (where there is a delay or stoppage of electrical transmission through the AV Node, the electrical "junction box" between the atria and the ventricles, due to disease in the wiring).

What are the Different Types of Pacemakers?

Pacemakers come in different shapes and sizes. They are all relatively small and lightweight (approximate weight 1-13/4 ounces or 22-50 grams.)

Depending upon the patient's heart condition, the physician will prescribe a single or dual chamber pacemaker.

A single-chamber pacemaker paces either the right atrium or, more commonly, the right ventricle with one electrode.

A dual-chamber pacemaker paces both the right atrium and right ventricle of the heart. This requires two pacing leads. A dual-chamber pacemaker is the most common type of pacemaker implanted today.

A rate-responsive pacemaker varies the heart rate depending upon the person's level of activity, respiration, or other factors, thereby simulating the natural pacemaker. Rate-responsive pacing can be part of single-chamber and dual-chamber pacing. Most pacemakers implanted today are rate-responsive.

How is the Pacemaker Implanted?

Pacemaker surgery is often done using a local anesthetic in an operating room under light sedation. The person usually returns home the next day. Occasionally, a patient who requires other surgery, such as a coronary bypass, will have the pacemaker implanted at the same time as the other surgery.

What Should You Expect During this Procedure?

Before the procedure:

The doctor will explain the procedure, including its potential benefits and risks, to you. This is a good time to ask any questions or share any concerns that you may have. You will then be asked to sign a consent form.
The night before surgery, your doctor will give specific instructions. Some of these instructions may include:
- Avoid eating any food or drinking any fluids after midnight.
- Advice on taking your medication. You may need to alter your medications, depending upon your condition.
Tests, including EKG, blood tests will be done a day or two prior to the procedure.
A small IV will be inserted in a vein in your arm.
Be sure to mention to the doctor (or nurse) if you have experienced any allergic reactions to any medications, or if you may be pregnant.
Pacemakers can be inserted near the right or left shoulder. If you prefer to have it implanted on a particular side, let your doctor know (e.g. if you use a gun).
Empty your bladder as completely as possible before the procedure starts.

During the Procedure:

You will be taken to the EP lab or operating room.
You will be sedated during the procedure. Be sure to let the staff know if you experience any discomfort.
A local anesthetic is used to numb the area where the pacemaker will be inserted.
An incision is made for the pacemaker and a "pocket" is created for the pulse generator to lay in.
The lead(s) are inserted into a vein and guided to the heart with the help of an x-ray camera.
The leads are connected to the pacemaker after they are positioned.
The pacemaker and leads are tested to make sure they work properly.
The wound is closed and covered with a sterile dressing.
The pacemaker is programmed (adjusted for low/high heart rates, etc).
The whole procedure usually takes 1-2 hours.

After the Procedure:

You may be taken to the recovery area or to your room.
Your heart will be monitored to make sure that your pacemaker is functioning properly.
You may feel mild discomfort from the incision. Tell your doctor or nurse if you feel a lot of discomfort.
Do not raise your arm on the side of the incision above shoulder level.
Before you leave the hospital, you will receive a temporary pacemaker identification (ID) card which identifies you as the wearer of an implanted device. The card has important information about your pacemaker and includes your doctor's phone number. A permanent card will be mailed to you in a few weeks. Keep this in your wallet/purse at all times.
You will also receive instructions regarding care of the incision, physical activity, do�s and do not�s, and medication prior to discharge.
When it is time to leave, have a friend or family member drive you.

The Recovery Period:

It takes a few weeks for most people to get back to normal after pacemaker implant.
Numbness or fullness in the area around the pacemaker for several days after the procedure is normal.
Avoid lifting anything heavier than 15 pounds. Also, avoid excessive pushing, pulling, or twisting.
Do not wear tight clothing or a bra around the pacemaker, as this may irritate your wound.
Call your doctor immediately if the incision site shows signs of infection (such as redness, swelling, or warmth), if there is drainage from the incision, or if you develop a fever over 100F.
Call your doctor if you experience dizziness, shortness of breath, or chest pain.
Carry your pacemaker identification card with you at all times.

return to top of page