Doctors recommend pacemakers to patients for a number of reasons. The most common reason is when a patient's heart is beating too slow or there are long pauses between heartbeats.
A pacemaker may be helpful if:
To decide whether a pacemaker will benefit you, your doctor will consider any symptoms you have of an irregular heartbeat, such as dizziness, unexplained fainting, or shortness of breath. He or she also will consider whether you have a history of heart disease, what medicines you're currently taking, and the results of heart tests.
A pacemaker won't be recommended unless your heart tests show that you have irregular heartbeats.
A number of tests are used to detect an arrhythmia. Your doctor may recommend some or all of these tests.
This simple and painless test detects and records the electrical activity of the heart. An EKG shows how fast the heart is beating and the heart's rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through each part of the heart.
A Holter monitor, also called an ambulatory EKG, records the electrical signals of your heart for a full 24- or 48-hour period. You wear small patches called electrodes on your chest that are connected by wires to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
During the 24 or 48 hours, you do your usual daily activities and keep a notebook, noting any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.
The purpose of a Holter monitor is to record heart signals during typical daily activities and while sleeping, and to find heart problems that may occur for only a few minutes out of the day.
This test uses sound waves to create a moving picture of your heart. An echocardiogram shows the size and shape of your heart and how well your heart is pumping blood. The test can identify areas of heart muscle that aren't contracting normally or getting enough blood flow.
For an electrophysiology study, your doctor threads a small, flexible wire from a blood vessel in your arm or leg to your heart. The wire electrically stimulates your heart to see how your heart's electrical system responds. The electrical stimulation helps to find where the heart 's electrical system is damaged.
Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise to make your heart work harder and beat faster while heart tests, such as an EKG or echocardiogram, are performed.
A pacemaker consists of a battery, a computerized generator, and wires with electrodes on one end. The battery powers the generator, and a thin metal box surrounds both it and the generator. The wires connect the generator to the heart.
The pacemaker's generator sends the electrical pulses that correct or set your heart rhythm. A computer chip figures out what types of electrical pulses to send to the heart and when those pulses are needed. To do this, the computer chip uses the information it receives from the wires connected to the heart. It also may use information from sensors in the wires that detect your movement, blood temperature, breathing, or other factors that indicate your level of physical activity. That way, it can make your heart beat faster when you exercise.
The computer chip also records your heart's electrical activity and heart rhythms. Your doctor will use these recordings to set your pacemaker so it works better at making sure you have a normal heart rhythm. Your doctor can program the computer in the pacemaker without having to use needles or directly contacting the pacemaker.
The wires in your pacemaker send electrical pulses to and from your heart and the generator. Pacemakers have one to three wires that are each placed in different chambers of the heart.
There are two main types of programming for pacemakers—demand pacing and rate-responsive pacing.
A demand pacemaker monitors your heart rhythm. It only electrically stimulates your heart if it’s beating too slow or if it misses a beat.
A rate-responsive pacemaker will speed up or slow down your heart rate depending on how active you are. To do this, the rate-responsive pacemaker monitors your sinus node rate, breathing, blood temperature, or other factors to determine your activity level. Most people who need a pacemaker to continually set the pace of their heartbeat have rate-responsive pacemakers.
Placement of a pacemaker requires minor surgery, which is usually done in a hospital or special heart treatment laboratory. You will be given medicine right before the surgery that will help you relax and may make you fall nearly asleep. Your doctor will give you a local anesthetic so you won't feel anything in the area where he or she puts the pacemaker.
First, your doctor will place a needle in a large vein, usually near the shoulder opposite your dominant hand. The doctor will then use the needle to thread the pacemaker wires into a vein and to the correct location in your heart.
An x-ray "movie" of the wires as they pass through your vein and into your heart will help your doctor place the wires. Once the wires are in place, your doctor will make a small cut into the skin of your chest or abdomen. He or she will then slip the pacemaker generator/battery box through the cut, place it just under your skin, and connect it to the wires that lead to your heart.
Once the pacemaker is in place, your doctor will sew up the cut. The entire surgery takes a few hours.
Expect to stay in the hospital overnight so your heartbeat can be monitored and your doctor can make sure your pacemaker is working properly. You probably will have to arrange for a ride to and from the hospital because your doctor may not want you to drive yourself.
For a few days to weeks after surgery, you may have pain, swelling, or tenderness in the area where your pacemaker was placed. The pain is usually mild and often relieved by over-the-counter medicines. Consult with your doctor before taking any pain medicines.
Your doctor also may ask you to avoid any vigorous activities and heavy lifting for about a month. Most people return to normal activities within a few days of having pacemaker surgery.
Your chance of having any problems from pacemaker surgery is less than 5 percent. These problems may include:
Once you have a pacemaker, you have to avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields. Devices for which close and prolonged exposure can interfere with a pacemaker include:
These devices can disrupt the electrical signaling of your pacemaker and stop it from working properly. You may not be able to tell whether your pacemaker has been affected. How likely a device is to disrupt your pacemaker depends on how long you're exposed to it and how close it is to your pacemaker.
To be on the safe side, some experts recommend not putting your cell phone or iPod in a shirt pocket over your pacemaker (if they are turned on). You may want to hold the cell phone up to the ear that’s opposite the site where your pacemaker was implanted. If you strap your iPod to your arm while listening to it, put it on the arm farthest from your pacemaker.
You can still use household appliances, but avoid close and prolonged exposure, as it may interfere with your pacemaker.
You can walk through security system metal detectors at your normal pace. You also can be checked with a metal detector wand as long as it isn't held for too long over your pacemaker site. You should avoid sitting or standing close to a security system metal detector.
Stay at least 2 feet away from industrial welders or electrical generators.
You also need to avoid some medical procedures that can disrupt your pacemaker. These procedures include:
Let all of your doctors, dentists, and medical technicians know that you have a pacemaker. You also should notify airport screeners. Your doctor can give you a card that states what kind of pacemaker you have. Carry this card in your wallet.
In most cases, having a pacemaker won't limit you from doing sports and exercise, including strenuous activities. You may need to avoid full-contact sports, such as football. Such contact could damage your pacemaker or shake loose the wires in your heart. Ask your doctor how much and what kinds of physical activity are safe for you.
Your doctor will want to check your pacemaker regularly. Over time, a pacemaker can stop working properly because:
To check your pacemaker, your doctor may ask you to come in for an office visit several times a year. Some pacemaker functions can be checked remotely through a telephone call or a computer connection to the Internet. Your doctor also may ask you to have an EKG (electrocardiogram) to monitor changes in the electrical activity of your heart.
Pacemaker batteries last between 5 and 15 years, depending on how active the pacemaker is. Your doctor will replace the generator along with the battery before the battery begins to run down.
Replacement of the generator/battery is a less involved surgery than the original surgery to implant the pacemaker. The wires of your pacemaker also may need to be replaced eventually. Your doctor can tell you whether you need to replace your pacemaker or its wires.
National Institutes of Health (U.S. Department of Health and Human Services) www.nih.gov
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