Pacemaker

What is a Pacemaker?

A pacemaker is a small device that sends electrical impulses to the cardiac muscle. This helps to regulate a normal heart rate and rhythm.

Insertion of a pacemaker is known as implantation. A pacemaker is placed just below the skin near your heart to help regulate the heart beat.

Lead Implant Walkthrough

Who needs it?

A pacemaker is used to treat patients with:

  • Slow Atrial Fibrillation
  • Bradycardia (slow heart rate)
  • Heart Block (electrical impulses not continuing throughout pathway correctly)
  • Sick sinus syndrome (alternating slow and fast rhythms of the heart)
  • Congestive heart failure

How a normal heart beats

In a normal heart, the muscles and chambers within the heart synchronize in a regulated type of harmony together. This occurs only when the electrical impulses are conducted properly through the heart.

If the heart is beating too slow or too fast, a sufficient amount of blood is unable to flow throughout the body. When this happens, patients may get symptoms of arrhythmia. These symptoms include fatigue, shortness of breath, fainting, or loss of consciousness.

The electrical signals of the heart follow through a conduction pathway. The origin of this pathway is from the Sinoatrial node, the natural pacemaker of the heart. The impulses are transmitted throughout the heart keeping it beating in sync in rate and rhythm.

What does a pacemaker do?

When the Sinoatrial node is not functioning properly, a pacemaker is needed to help initiate the correct electrical impulses. The pacemaker acts by mimicking the Sinoatrial node, generating a normal heart rate and rhythm.

  • Battery: the pacemaker battery supplies the power to the pacemaker. This is a small, sealed, lithium battery that can lasts for years. Battery life usually lasts 5-10 years depending on how active your pacemaker is.A pacemaker consists of:
  • Computerized generator: this is a miniature computer inside the pacemaker. The battery transmits electrical impulses that go through this generator to stimulate the heart to beat.

  • Case: the battery and computer generator are sealed inside a metal casing.

  • Leads: are flexible wires connecting the generator to the walls of the heart.

Pacemakers not only monitor your heartbeat but also your body motion and breathing pattern. This can signal the pacemaker to increase during times of exercise.

What are the different types of pacemakers?

Depending on the condition of the heart, Dr. Jamnadas will determine the number of chambers in your heart that need to be placed.
Pacemakers can be implanted temporarily or permanently.

The different types of pacemakers are:

  • Single Chamber Pacemakers: this uses one lead which connects either to the right atrium or ventricle.
  • Dual Chamber Pacemakers: this uses two leads with one connecting to the right atrium and the second connecting to the right ventricle to make the heart beat more efficiently.
  • Biventricular pacemakers: this uses 3 leads, one in the right atrium, and one in each ventricle. This treatment resets the ventricular pumping system and is referred to as Cardiac Resynchronization Therapy (CRT).
  • Leadless pacemakers: this has no leads and is implanted directly into the right ventricle.

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

  • Allergy: may produce an allergic reaction to the dye.
  • Swelling, bruising or bleeding at or around the implantation site.
  • Formation of a clot (hematoma).
  • Infection: can occur where their pacemaker was implanted.
  • Damage to blood vessels or nerves around pacemaker site
  • Collapsed lung

How is this diagnosed?

Dr. Jamnadas will discuss with you about your history and symptoms.

Following this, a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done to find out the cause of irregular heartbeats including:

  • Electrocardiogram (EKG) – a simple,non-invasive test that records the electrical activity of the heart and its beating pattern.
  • Holter monitor- records the electrical events of the heart during your normal daily activities. It is important to accurately record your activities and symptoms so Dr. Jamnadas can compare them to the Holter monitor findings. If symptoms do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days.
  • Echocardiogram (ECHO) – shows images of the heart determining the size and shape of the heart, and shows whether the heart walls and pumping activity are normal or performing weakly.
  • Stress test- helps access the blood flow to the heart at rest and during stress. Will detect if any areas receiving less blood flow.

What to expect

Before the procedure:

Today pacemaker devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

A pacemaker is usually implanted just beneath the skin of your chest, below the collarbone.

Pacemakers are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay overnight in the hospital.

You will need to arrange for someone to pick you up and drop you off.

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an I.V. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the pacemaker will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the pacemaker leads will be threaded through the vein and fixed to the wall of the right atrium or ventricle or both, depending on your pacemaker.

The other end of the lead will be secured to the generator box.

The pacemaker settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the pacemaker underneath the skin of the chest.

After the pacemaker is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

After the procedure:

After the procedure, you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks.

On the side of the incision, Do NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your pacemaker affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you and when it is best to start.

Make sure to:

  • Change your dressing as often as instructed and avoid getting the area wet for about a week.
  • Take your temperature and check the incision every day for signs of infection like redness, discharge, or a local rise in temperature.
  • Learn how to take your own pulse and keep a record of it.
  • Avoid putting direct pressure on your pacemaker. For example, do not lie on your chest while sleeping at night.
  • Let your primary health care provider or any other healthcare providers, as well as the dentist, know about your pacemaker before receiving any treatment.
  • Carry an ID card that contains information about your pacemaker. Your pacemaker may set off a metal detector while going through security. You may need to show this card to security personnel.
  • Keep your cellular phone away from your pacemaker. Do not carry your phone in your shirt pocket, even when it is turned off.
  • Avoid strong magnets including MRI scans and hand-held security wands.
  • Avoid strong electrical fields such as those made by radio transmitting towers, ham radios, and heavy duty electrical equipment.
  • Avoid leaning over the open hood of a running car. A running engine creates an electrical field.

Keep all follow-up appointments to check your pacemaker and lead. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

Follow-up appointments will be scheduled for you in the initial one month, and then the following 2 months, then every 3 months to get your device checked.

What can I use?

The following items are all ok to use:

  • Microwave ovens
  • Computers
  • Hair dryers
  • Power tools
  • Radios
  • Televisions
  • Stereos
  • Electric blankets
  • Vacuum cleaners
  • Heating pads
  • Cars

Call Dr. Jamnadas if you experience any symptoms of:

  • Dizziness
  • Palpitations
  • Shortness of breath
  • Fatigue
  • Fainting spells
  • Twitching chest muscles
  • Chest pain or pain at pacemaker site
  • Fever
  • Hiccups that won’t stop