A pacemaker is a small electronic device that is implanted underneath the skin below your collarbone to treat irregular, interrupted, or slow heartbeats. The pacemaker system includes a pacemaker generator and one or several leads. The leads are thin wires (about the size of spaghetti noodles) that transmit electrical impulses from the pacemaker to the heart and send information about the heart’s activity back to the pacemaker.
Pacemakers monitor your heartbeat continuously and can speed up your heart rate by sending electrical signals to the heart if it beats too slowly. Pacemakers also have special sensors that detect your activity level and adjust the heart rate during exercise, mimicking the function of a normal heart.
Pacemaker Types
Permanent Pacemaker
The pacemaker can be connected to the heart through one (single chamber pacemaker), two (dual-chamber pacemaker), or three wires (biventricular pacemaker). These leads reach the heart muscle through a vein that runs below your collarbone.
Leadless Pacemakers
New-generation leadless pacemakers have recently become available for clinical use in the United States. The leadless pacemaker, a miniaturized device the size of a large vitamin capsule, is used to treat abnormal heart rhythms (arrhythmias).
Unlike a traditional pacemaker, the leadless device is implanted directly into the heart muscle through a vein in your leg, with the use of a minimally invasive procedure.
Smallest pacemaker - Micra is 93% smaller than conventional pacemakers, about the size of a large vitamin capsule.
Less invasive - The procedure requires no chest incision and, unlike conventional pacemakers, does not create a scar or bump under the skin.
Fewer restrictions - For most patients, the Micra design translates to fewer medical complications and fewer post-implant activity restrictions.
Who Needs a Pacemaker?
The pacemaker is used to treat arrhythmias such as bradycardia (slow heartbeat). The heart normally beats 60 to 100 times in a minute while you are resting. Bradycardia occurs when the heart beats fewer than 60 times in a minute.
At that rate, the heart cannot pump enough blood to the body to sustain regular activity or exercise. As a result, you may experience dizziness, fatigue, shortness of breath, or fainting spells during such an episode.
Treatment of bradycardia depends on the cause of this arrhythmia. Bradycardia can be caused by an underactive thyroid (hypothyroidism), an electrolyte imbalance, or medicines that you may be taking for certain conditions.
Using a new medication to treat your health condition or adjusting the doses of your current medications may restore your normal heartbeat.
If adjusting your treatment does not correct the arrhythmia, or damage to the heart’s electrical system causes your heart to beat too slowly, a pacemaker may be recommended.
Your doctor will explain the risks and possible complications of the procedure.
The pacemaker implantation procedure usually takes a few hours. After the medical staff prepares you for the procedure, you will be transferred to a room with special X-ray equipment, called an electrophysiology (EP) lab or catheterization (cath) lab.
For most pacemaker implantations, local anesthesia is used to numb the area of the incision and other medications are administered through your arm vein to help you relax. Your doctor will make a small incision in the upper part of your chest, below the collar bone, and will guide one or several leads (thin insulated wires) through a vein into the heart.
One end of each lead is connected to a certain area in your heart, while the other end is connected to the pacemaker generator. The pacemaker is inserted into a pouch underneath the skin. The incision is then closed and covered with a special dressing.
At the end of the procedure, the electrophysiologist (EP) will test the pacemaker to ensure that it is working correctly and will program it to meet your specific needs. After the procedure, you will typically spend one night in the hospital.
Before you leave the hospital
You will receive instructions about self-care after the procedure and about scheduling follow-up visits with your doctor.
You will receive a home monitoring device and will be instructed on how to set it up. The home monitoring device will communicate your pacemaker information to your doctor’s office, so that the doctor can monitor you remotely. Make sure that your home monitor is always working properly.
You will also receive a pacemaker wallet identification card, which contains essential information about your pacemaker. Always carry the card or a copy with you.
Follow your doctor’s instructions and contact the doctor’s office if you have any questions or concerns about your pacemaker.
Can You Have an MRI Test if You Have a Pacemaker?
Magnetic resonance imaging (MRI) utilizes a magnetic field and radio waves to obtain detailed images of the organs and tissues within the body.
Depending on the make and model, some pacemakers are safe to use in the MRI environment.
Before you schedule your MRI test, make sure to tell the staff at the MRI center about your cardiac device and show them your pacemaker identification card. The MRI staff will consult your doctor, directly or through you, to confirm that your pacemaker is working correctly and is safe to use during the MRI.
On the day of your MRI test, your pacemaker will be reprogrammed to ensure that it works appropriately in the MRI environment. After the MRI, your device will be restored to its original settings.
Living with a Pacemaker
Here are some general questions you may want to ask your doctor about how a pacemaker will affect your daily living:
Life with a pacemaker: Many people with pacemakers resume their normal daily activities after they recover from the implantation procedure. Your doctor may recommend avoiding certain situations. Discuss your activity and lifestyle goals with your doctor, who can help you develop a plan that works best for you.
Pacemaker ID card: You will receive a pacemaker wallet identification card (ID card). This card contains essential information about your pacemaker. Always carry the card or a copy with you.
Home monitoring: Ask your doctor to check whether your home monitoring system is active and functioning properly.
Pacemaker battery life and replacement: Pacemaker batteries may last between 5 and 15 years (6 to 7 years on average), depending on how often the device is being used to regulate your heart activity. Your electrophysiologist (EP) will replace the generator before the battery starts to run down.
Cell phones: Cell phones may interact with the function of your pacemaker. It is recommended to keep your cell phone at least 6 inches away from your pacemaker, hold the phone to the opposite ear from your pacemaker, and avoid carrying the cell phone in a pocket near your pacemaker.
Household appliances: Most household appliances, including microwave ovens, electric ovens, mixers, and other major appliances, will not interfere with the function of your pacemaker. Devices that contain magnets, such as magnetic therapy products, stereo speakers, and hand-held massagers, can temporarily affect the function of your pacemaker. It is recommended to keep items that contain magnets at least 6 inches away from your pacemaker. Talk to your doctor if you have any questions about the safety of using any tools or equipment at home while using a pacemaker.
Working with a pacemaker: It is critical to talk with your doctor about the type of tools, machinery, and equipment that you use or plan to use at work, because some of these may interact with your pacemaker. Keep at least 2 feet (60 centimeters) away from welding equipment, high-voltage transformers, and motor-generator systems. Talk to your doctor if you have any questions about the safety of using any tools or equipment at work. Travel and security screening: Passing through a metal detector in an airport will not interfere with your pacemaker but may trigger the detector alarm. Avoid standing close to or leaning against a metal-detection system.
To prevent potential problems, carry your pacemaker ID card to show that you have a pacemaker. If the security personnel insist on using a hand-held metal detector, ask them not to hold the device near your pacemaker any longer than necessary, or ask for an alternative form of body search.
Medical and dental procedures: If a doctor recommends a medical or dental procedure or test for you, let them know that you have a pacemaker. Before you undergo a procedure or test, discuss it with your cardiologist.
