What Is A Pacemaker?

What is a pacemaker? A pacemaker is an electronic medical device that is typically the size of a matchbox. It is implanted beneath the skin by a surgeon to help treat certain types of heart failure and irregular heartbeats known as arrhythmias. 

How do pacemakers work? 

What is a pacemaker and how does it work? An electrical signal that enables your heart to beat generally starts at the sinoatrial (SA) node, your heart’s natural pacemaker. Electrical signals produced by the SA node travel from the top of the heart to the bottom in a coordinated manner, generating a heartbeat. When there are problems with this electrical signaling, which can result in a heartbeat that is too fast (tachycardia), too slow (bradycardia), or otherwise irregular, a pacemaker provides electrical impulses that help your heart beat at a normal rate, rhythm, or both.

A pacemaker has flexible, insulated wires (leads) that are placed in one or more chambers of the heart. If your heartbeat is too slow, the pacemaker sends electrical signals to your heart to correct the beat. Some newer pacemakers also have sensors that detect body motion or breathing rate and signal the devices to increase heart rate during exercise, as needed. A pacemaker tells the heart to beat when the heartbeat is too slow or irregular. 

What are the variations?

• A single-lead pacemaker delivers electrical impulses to either the right atrium or right ventricle of your heart
• A dual-chamber pacemaker delivers electrical impulses to both the right atrium and right ventricle of your heart.
• Some people need a biventricular pacemaker, or “bivent,” which is a device with three leads that send electrical signals to the right atrium, right ventricle, and left ventricle.
• Also available are wireless pacemakers, which are often implanted in the right ventricle and consist of a single unit about the size of a tablet or capsule that combines the pulse generator and electrodes.
• An implantable cardioverter defibrillator (ICD) can also be used to stop life-threatening arrhythmias, especially those characterized by abnormally quick and irregular heartbeats. If an ICD detects these arrhythmias, it can deliver electric impulses to restore the heartbeat to normal; most recent ICDs also have a pacemaker function.
• Cardiac Resynchronization Therapy or CRT for heart failure patients in the biventricular pacemaker.

What are the risks associated with a pacemaker?

Every medical procedure carries some level of risk. The majority of pacemaker dangers are related to the implantation process and include:

• Bruising or bleeding
• Blood clots
• Damaged blood vessels or nerves
• An infection of the leads or the site of the incision
• Scar tissue accumulation around the pacemaker
• Pacemaker syndrome (when a pacemaker only stimulates one ventricle), which results in exhaustion, breathlessness, and low blood pressure
• Pacemaker-related cardiomyopathy
• A collapsed lung

Misplaced leads may also cause a perforated heart and fluid accumulation near the heart. However, life-altering consequences are rare, and the majority of difficulties are transient. A pacemaker could also malfunction or stop functioning properly. However, this is uncommon.

If you notice that your arrhythmia or heart failure symptoms are getting worse as a result of a pacemaker malfunction, you must make an appointment with your doctor or cardiologist so they can check to see if your pacemaker is working properly. 

How is a pacemaker implanted?

The procedure usually takes about an hour, but it may take longer if you’re having a biventricular pacemaker with 3 leads fitted or other heart surgery at the same time. You’ll usually need to stay in hospital overnight and have a day’s rest after the procedure.

Transvenous procedure

The majority of wired pacemakers are implanted using a transvenous procedure, which entails threading the leads and electrodes through your veins and into your heart. The pacemaker’s wires (pacing leads) are inserted into a vein just below the collarbone, typically on the left side of the chest. The pacing leads are then guided along the vein into the correct chamber of your heart using x-ray scans.

The time it takes to implant a pacemaker this way varies depending on the number of leads.

Epicardial approach

The epicardial approach, which needs general anesthesia, involves attaching the electrodes to the surface of the heart rather than inside the heart. It is the less common way to implant a pacemaker.

Wireless pacemakers are implanted using a tiny tube called a catheter, and an x-ray machine is used to guide the catheter and wireless pacemaker via a vein in the thigh to the heart. The procedure typically takes less than an hour.

Before you leave the hospital, the pacemaker will be properly programmed for your heart’s needs, and your doctor may also order a chest x-ray. At your follow-up appointments, your doctor can reprogramme the device as necessary.

Pacemaker After-care

After your treatment, you’ll likely experience some pain or discomfort. To lessen this, you may need to use over-the-counter medications. Ask your doctor about the safest painkillers for you.

Although it’s unusual, a pacemaker can send electrical impulses that you can feel. If you do, your doctor or cardiologist can change the pacemaker’s programming to reduce this. Additionally, because the pulse generator is implanted under the skin, you may feel it when you lie in certain postures.

In some cases, you might be able to go home the same day. However, you should refrain from strenuous activity for about 4 to 6 weeks after your pacemaker is implanted. After this, you should be able to participate in most activities and sports. 

Safety Precautions

You should be able to engage in most activities and sports after having a pacemaker fitted. But it’s important to avoid collisions if you play contact sports like football or rugby. You may want to wear a protective pad.

While modern pacemakers are less sensitive to electrical devices than older ones, some devices may still interfere with your pacemaker. If at all possible, try to keep at least 6 inches of space between your pacemaker and any devices that could cause interference.

Take consideration of the following which may affect your pacemaker:

• The use of a smartwatch
• Prolonged exposure to metal detectors, even handheld ones
• Proximity to theft deterrents like those found at department stores
• Electric fences
• High-voltage transformers
• Keeping a phone in your pocket while wearing a pacemaker
• Using a cell phone while your pacemaker is on the same side of your body as your ear
• Placing your headphones on or close to your chest.
• The majority of everyday appliances in homes and offices pose little to no risk to those who have pacemakers
• Electrolysis for hair removal
• Microwave diathermy is used in physical therapy
• Radiation therapy is used to cure cancer

Key Takeaways

A pacemaker can be used to help your heart beat at a normal rate or rhythm if you have a problem that affects your heartbeat. Not everyone who experiences these symptoms requires a pacemaker, although it can ease your symptoms and prevent complications. Your doctor can decide if a pacemaker is a good option for you after reviewing your medical history and doing a number of tests.

Learn more about Cardiovascular Issues here.