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Devices: Pacemakers and Defibrillators

Tiny devices that help regulate the heart’s rhythm have been around since the first cardiac pacemaker was implanted in the late 1950s. Implantable cardioverter defibrillators, or ICDs, came along in 1980.

Pacemakers and ICDs are both battery-powered devices that are implanted below the skin to keep track of an individual’s heart rate using thin wires, called leads, that connect to the heart. If an abnormal heart rhythm is detected, the devices automatically deliver an electric shock to restore a normal heartbeat. Although the devices work in similar ways, their duties are different. Think of it this way - every defibrillator is a pacemaker, but not every pacemaker is a defibrillator.

The pacemaker was designed to correct a heartbeat that is too slow. But because an arrhythmia diagnosis can include heartbeats that are too fast as well as too slow, the ICD was invented. “The defibrillator works like a pacemaker,” explains Boris Bogmilov, MD. “If your heart slows down, it will give it a small electrical jolt to get it going. If your heart goes fast and irregular — which is life-threatening — it can also give you a big electrical jolt and save your life."  Dr. Bogomilov specializes in electrophysiology, the branch of cardiology that focuses on electrical activity of the heart, offering diagnosis and treatment of heart rhythm disorders, or arrhythmia. Board-certified in both cardiology and electrophysiology, he works closely with other cardiologists to evaluate and treat patients who have arrhythmia.

Advancements in implantable cardiac devices have already provided lifesaving treatment for millions of people, and Bogomilov says the devices continue to improve. “Think about pacemakers and defibrillators as computers,” he says. “You can imagine what computers were in the 1980s and what they are right now, and pretty much the same is true in the field of electrophysiology. Devices are getting smaller, faster, more powerful. Much more information can be transmitted from them, and the transmission protocols are much more sophisticated.”

Micra transcatheter pacemakers are the latest advancement in heart rhythm regulators, Bogomilov says. Placed directly in the heart, they do not require leads. “They are absolutely the future,” he says. “They’ve only been recently introduced, and for certain patients they are very good options.”

As types of arrhythmias vary, so do symptoms. While some people may experience heart palpitations or a skipped beat, others feel a fluttering sensation in their chest or neck. When arrhythmia is untreated, these more serious symptoms can develop:

  • Fatigue or weakness
  • Dizziness or lightheadedness
  • Rapid heartbeat or pounding in the chest
  • Shortness of breath
  • Chest pain or pressure
  • Cardiac arrest

“If you have racing of your heart with dizzy spells or passing out, that’s when you should go to the emergency room,” Bogomilov says. “If you are having symptoms or just don’t feel comfortable, talk to your doctor and let him or her know there is a problem.”

To learn more or to make an appointment at Washington Regional Cardiovascular Clinic, part of the Walker Heart Institute, call 479.463.8740 or click here.