What Is It?

A pacemaker is a small electronic device that helps your heart beat more regularly by producing a small electric stimulation that helps control your heartbeat. Your physician implants the pacemaker under the skin on your chest, or directly in your heart through a vein. People may need a pacemaker for a variety of reasons - mostly due to one of a group of conditions called arrhythmias, in which the heart's rhythm is abnormal.

Various types of pacemakers are offered at Washington Regional, including single chamber, dual chamber and biventricular (offered by Medtronic, St. Jude and Boston Scientific). Walker Heart Institute also offers the Micra™, a small, self-contained, less invasive option for patients needing a single chamber pacemaker. For more information about what type of pacemakers is right for you, please consult your doctor or make an appointment at Walker Heart by calling 479.463.8740.

Why Is It Done?

You may need a pacemaker to keep your heart contracting and pumping blood adequately. In this way your body gets the blood, oxygen and nutrients that it needs. Some people just need a pacemaker for a short time, such as after a heart attack, and may use a kind that's placed outside the skin. The battery unit for this type of pacemaker is worn on a belt.

To understand why your physician may recommend a pacemaker, you need to know about your heart's electrical system. This electrical system helps it beat at a regular speed or pace. Problems with this electrical system can make your heart's pace slow or uneven, possibly leaving you feeling fun-down or even faint. A pacemaker keeps your heart beating at the right pace.

Symptoms of a slow heartbeat may include:

• Dizziness
• Lightheadedness
• Shortness of breath
• Fatigue
• Confusion
• Fainting Spells

These symptoms are usually most noticeable when you're trying to do something active, such as walking or climbing stairs.

What to Expect

Having a pacemaker implanted is a simple surgical procedure, but it does require a lifelong commitment. With proper care, a pacemaker can help keep you feeling good for many years to come. A pacemaker helps keep your heart from beating too slowly, but it doesn't stop your heart from beating on its own. The pacemaker "listens" to your heart.  When the heart's own electrical system sends a signal and the heart beats, the pacemaker waits and does nothing. When the heart's system misses a signal, the pacemaker sends a signal to replace it.

When you're active, your heart beats at a faster pace or rate. Electrical system problems can sometimes keep your heart's rate from speeding up when you're active. Because of this, some pacemakers are also rate-adaptive and can help change the rate of your heartbeat depending upon your activity level. So, when you're dancing or doing a similar activity, a rate-adaptive pacemaker helps your heart beat faster. And when you sit down to rest, the pacemaker lets your heart return to a slower rate.

The Procedure

Inserting the pacemaker into your body is called implantation. Pacemaker implantation is not open-heart surgery. It's a minor procedure that's done in an operating room or cardiac catheterization lab. Your physician's office will provide instructions on how to prepare for the procedure. Pacemakers can be inserted near the right or left shoulder. If you prefer to have it implanted on a particular side, discuss your preference with your physician.

You will probably be admitted to the hospital on the day of the procedure. Before the procedure begins, you may be given some medication to help you relax. 

The most common method used to insert a pacemaker is called endocardial, or inside the heart, implantation. This procedure may take two to three hours and you will be awake during the surgery. Your physician may ask you some questions or ask you to take some deep breaths.

A local anesthetic is given by injection to numb the area where the pacemaker will be inserted to keep you from feeling pain during the procedure. An incision is made in your skin below your collarbone to create a small pocket. The lead for the pacemaker is threaded through the incision into a vein in your upper chest. The lead is then guided into your heart's chambers using x-ray monitors. Electrical measurements are taken to determine a good position for the lead in the heart. If there is a second lead, this process is repeated.

The pacemaker generator is attached to the lead or leads. Then, the generator is placed in the pocket under your skin. The pacemaker's settings are programmed to help your heart beat at a rate that's right for you. The incision is then closed and covered with a sterile dressing.

Your physician may elect to use an alternative method, called epicardial, or outside the heart, implantation. Epicardial implantation takes longer than endocardial implantation and requires more recovery time. An opening is made in the lower chest, and the lead is threaded up to the outside of the heart. The generator is attached to the leads and placed underneath the skin in the abdomen.

After the Procedure

After your pacemaker is implanted, you'll probably stay in the hospital for a day or two to be sure that there are no problems. When you go home, you may be given instructions on how to take care of the incision site as it heals. Your physician may also schedule some follow-up visits.

To be sure your pacemaker is working correctly, you'll probably need to visit your physician or pacemaker clinic several times a year. During these visits, the pacemaker's battery level and functions are checked and the pacemaker's settings can be adjusted. Your pacemaker can also be checked from your home. 

Once your pacemaker is implanted, it should last five to 10 years, which is the average battery life. When a pacemaker's battery wears out, the entire pacemaker's pulse generator is replaced, and you'll need another procedure to fix your device. The leads of your pacemaker can be left in place, and the procedure to change your pacemaker's battery is often quicker and requires less recovery time than the procedure to first implant your pacemaker.

Living with a pacemaker requires some lifestyle adjustments, but isn't difficult. You can usually do almost everything you did before you got your pacemaker. And, since you will probably feel better, you may be able to do even more, including regular exercise. See your physician regularly to help ensure that you remain healthy and feeling good.

Special Instructions

When you first get your pacemaker, you'll be given an ID card to carry. This ID card contains important information about your pacemaker. Show it to any physician, dentist, or other medical professional you visit. Also, because pacemakers tend to set off security devices like those found in airports and libraries, you may need to show your card to security personnel.

Modern pacemakers are well protected from outside signals, so there are very few things that can interfere with your pacemaker. But if you ever feel symptoms that make you think a device is disrupting your pacemaker's signals, turn the device off or move away from it. Your symptoms should stop and your pacemaker shouldn't be damaged. To be safe, check with your physician.

Appliances which should be safe to use include:

• Microwave ovens and other appliances in good repair
• Computers
• Hair dryers
• Power tools
• TVs and radios
• Stereos
• Electric blankets and heating pads
• Vacuum cleaners

There are a few things to avoid that might interfere with your pacemaker. These include very strong magnets (like those used for an MRI), radio transmitting tours, ham radios, certain surgical instruments and cellular phones. When using a cellular phone, hold it on the ear farthest away from your pacemaker. Don't carry it in your breast pocket, even when it's turned off.  Also, a running car engine generates an electrical field, so avoid leaning directly over the open hood of a running car.

If you have any questions or concerns, please call your physician. It's very important for you to keep your appointments with your physician or pacemaker clinic. Follow your physician's recommendations about caring for your pacemaker, taking medications or doing other things to care for your heart.