A Pacemaker is a small device that is implanted under the skin in the chest which monitors the heartbeat & controls the heart rhythm.
A pacemaker has two parts:
1. The pulse generator- This is small metal container that houses the battery & the electrical circuit that regulates the rate of electrical pulses sent to the heart.
2. Electrodes or leads- They are insulated wires placed in the heart chambers which delivers electrical pulses to adjust the heart rate.
Types of Pacemakers
There are three types of Pacemakers:
- Single Chamber Pacemaker- They carry electrical impulses from the generator to the right ventricle of the heart.
- Dual Chamber Pacemaker- They carry electrical impulses from the generator to the right atrium & right ventricle, both.
- Biventricular Pacemaker- They simulate the right & left ventricles both, so that the heart beats more efficiently. It is a treatment option for people suffering from heart failure.
Indications for Pacemaker
Pacemakers are used to treat the following:
- Heart failure
- Slow heart rhythms also known as bradyarrythmia.
Tests done before Pacemaker Implantation
Following are the major tests needed before Pacemaker Implantation:
- Electrocardiogram: In this, electrodes are placed on chest or the limbs to record heart’s electrical impulses
- Holter Monitoring: It is also known as ambulatory monitor in which the heart rhythms are recorded for entire 24 hours
- Echocardiogram: This non-invasive test in which sound waves allows the doctor to see the heart without making an incision
- Stress Test: In this test an electrocardiogram is taken before and immediately after walking on a treadmill.
Pacemaker Implantation procedure
Before the procedure
- Do not eat or drink anything after midnight the evening before the procedure.
- Stop taking certain medications like diabetes 1 to 5 days before the procedure.
During the Procedure
Pacemakers are implanted in 2 ways:
- Endocardial approach- This approach is commonly used for pacemaker implantation. In this approach, local anaesthesia is administered to numb the area where an incision is made. Through an incision the lead is inserted into a vein, then advanced to the heart with the help of the x-ray machine. One end of the lead is attached to the heart muscle, while the other end of the lead is attached to the pulse generator, which is placed in a pocket created under the skin in the upper chest.
- Epicardial approach- This approach is commonly used in children. In this approach, general anaesthesia is administered. One end of the lead is attached to the heart muscle, while the other end of the lead is attached to the pulse generator, which is placed in a pocket created under the skin in the abdomen.
After the procedure
- The patient stays in the hospital for one day after having a pacemaker implanted.
- Before the patient leaves the hospital, the pacemaker is programmed to fit the particular pacing needs.
- Avoid vigorous exercise or heavy lifting for about a month, after the procedure.
- Avoid placing the cell phone directly over the pacemaker implantation site when the phone is turned on.
- Avoid leaning against a metal-detection system.
- If a doctor is considering any medical procedure that involves intensive exposure to electromagnetic energy like magnetic resonance imaging, therapeutic radiation for cancer treatment, tell him /her about the pacemaker implanted.
- Stand at least 2 feet from welding equipment, high-voltage transformers or motor-generator systems.
1. What is the recovery time for a pacemaker surgery?
The recovery time for a pacemaker surgery is 3-4 weeks.
2. Do cell phones interfere with pacemakers?
It is safe to use a mobile phone, but make sure it is kept at a distance of more than 6 inches from the pacemaker.
3. For how long do the pacemaker batteries last?
Most pacemaker batteries last for 6 to 10 years.
4. How often will the patient need follow-up appointments?
- The follow- up appointments may be every 3 to 12 months, depending on the type of pacemaker you have and how well it works