A pacemaker is an implantable electronic device that is used to manage heart diseases that affect the electrical rhythm of the heart, like atrial fibrillation or atrioventricular block.

A pacemaker can monitor your heart rate and trigger your heart to function properly if your heart rate is above or below normal values, preventing complications like cardiac arrest.

A pacemaker is surgically placed by a cardiologist or cardiac surgeon in the hospital. It can be temporary, and used for only for a specific period of time, or permanent, when needed to control chronic diseases.

What it's for

A cardiac pacemaker continuously monitors the heart and identifies irregular, slow or skipped heart beats.

When an irregularity is detected, the pacemaker sends an electrical stimulus to the heart, which regularizes electrical functioning of the heart and restores your heart rate.

Common uses

A pacemaker is recommended by a cardiologist when the patient has an illness that causes severe bradycardia, which is a decrease in heart rate of less than 40 beats per minute. Examples include:

Sinus node dysfunction
AV block
Bundle branch block
Neurocardiogenic syncope
Carotid sinus hypersensitivity
Hypertrophic cardiomyopathy
Serious congestive heart failure
Congenital heart disease

In addition, a pacemaker can also be recommended by a cardiologist following a heart attack, a heart transplant, to detect and manage tachycardia or treat a cardiac abnormality caused by medication or drug abuse.

How it works

A pacemaker continuously monitors the heart and identifies abnormal heart rates (like slow rates) or skipped beats. This device is stimulated when a cardiac abnormality occurs, and sends an electrical signal to the heart to reset its heart beats.

A pacemaker contains two parts: the generator (which contains the battery and the electronic circuitry to manage heart beats), and the electrodes (also known as the leads, which are the wires that connect the heart to the generator and conduct the electric impulses).

There are different types of pacemakers that can be used for the management of specific cardiac diseases. Dual-chamber pacemakers and bi-ventricular pacemakers, for example, are used for the treatment of severe congestive heart failure. These pacemakers consist of 3 parts: the generator, the electrodes and the programmer, which is a type of external computer that is used to adjust the pacemaker settings.

Pacemakers are powered by batteries that last on average for 5 to 15 years. However, there are some cases in which the batteries last for even less time. When batteries are close to running out of energy, they are swapped for fresh ones with a simple surgical procedure.

Types of pacemakers

The main types of pacemakers include:

1. Permanent pacemaker

This pacemaker is implanted in the chest for long-term use. The electrodes are attached to the atria and ventricles of the heart through surgery.

2. Temporary pacemaker

A temporary pacemaker is placed outside the body and fixed to the skin. One end of the device is connected to an electrode, and the other end is connected to the heart.

3. Transcutaneous or transthoracic pacemaker

This pacemaker consists of 2 electrodes that are placed over the skin, one on the chest and another on the back. They are connected to a defibrillator, which generates electrical charges to stimulate the heart to start beating again.

These are used in medical emergencies, like bradycardias or AV blocks.

4. Transvenous pacemaker

This pacemaker consist of a wire-electrode that is placed into the right ventricle through a cut in the jugular or subclavian artery. It is also used in medical emergencies, like the treatment of serious bradycardias.

Pacemakers that are used just for emergency situations are used temporarily, and removed once the imminent danger has resolved.

5. Endocardial pacemaker

An endocardial pacemaker is a type of permanent pacemaker with a low-energy system. Stimuli from this device are applied to the endocardium through an electrode positioned intravenously.

6. Epicardial pacemaker

An epicardial pacemaker is a type of permanent pacemaker in which the stimuli are applied to the heart through an electrode positioned directly over the epicardium.

This type of pacemaker is normally indicated for children with congenital heart disease, when the placement of an endocardial pacemaker is not indicated.

In addition, an epicardial pacemaker can be temporary to be used during heart surgery.

How to prepare for pacemaker surgery

There are some considerations to keep in mind to prepare for pacemaker surgery, like asking your cardiologist any questions you may have about the surgery and recovery, and being aware of how medication, vitamins and nutritional supplements that you already take may be affected. You should report any of these to your surgeon, as they can affect recovery, anesthesia, the risk of blood clots and the risk of hemorrhage. You should also report any allergies and other medical issues you may have.

In addition, you should also avoid smoking or drinking alcohol prior to surgery. Be sure to bathe with soap that is recommended by your doctor, and to avoid the use of moisturizers, lotions, perfume and deodorant. All jewelry and contact lenses should also be removed prior to surgery.

Patients should fast for at least 4 hours prior to the scheduled surgery time. Any necessary medications should only be taken with sips of water.

How the surgery is performed

A pacemaker insertion is performed by a cardiovascular surgeon and is a simple and quick procedure. It typically takes one or two hours.

To insert a permanent pacemaker, the doctor will typically use the following steps:

Start a normal saline IV and administer general anesthesia or light sedation;
Make a small incision in the skin near the shoulder, to reach the subclavian vein;
Insert a thin wire through the subclavian vein until it reaches the right ventricle of the heart, where the pacemaker electrode will be placed;
Place the pacemaker's electrical impulse generator on the skin near the collarbone in the shoulder, connected to the wire;
Close the incision with stitches and apply a dressing to the site.

Throughout the surgery, the doctor observes the insertion and position of the pacemaker through X-rays to confirm placement.

What recovery is like

Since it is a simple procedure, patients who receive a pacemaker are often discharged the day after surgery.

It is important for patients with a pacemaker to rest for the first month after surgery and to maintain all follow-up appointments as needed.

Surgery after-care

Because this is a simple procedure, patients are often discharged home the next day. However, it is important for post-op patients to rest for the first month after surgery and to attend all follow-ups with the cardiologist to monitor their general health status.

In addition, other necessary after-care considerations while recovering include:

Keep a pacemaker information card in your wallet, which outlines all your pacemaker settings as well as any emergency contacts
Take your medications at the right times, as prescribed by your doctor.
Avoid any brisk movements with the arm on the side of the pacemaker
Avoid any electric shocks or injuries to the pacemaker
Stay about 15 cm from any devices with a strong electromagnetic field
Avoid using your cellphone on the same side the pacemaker was inserted

In addition, the use of some equipment is contraindicated for patients with pacemakers, like an electric scalper and a defibrillator. You should inform your family, friends and health care professionals about your pacemaker so that your pacemaker is turned off before any kind of procedure that may cause interference.

What to avoid with a pacemaker

People with pacemakers can lead a normal life - they only need to avoid strenuous activity for the first 3 months after placement. Before starting to work out or attending physiotherapy, you should see your doctor to ensure your safety.

When starting to workout or exercise, you should ensure you are approved by your doctor to engage in physical activity. If you are participating in physiotherapy, you should advise any health care professionals that you have a pacemaker, as this device may be impacted with when near certain machines.

In addition, you should inform people in security areas, such as airports or banks, about your pacemaker, to avoid having to go through an X-ray machine.

For security reasons, it is recommended that people with a pacemaker to carry an information card that identifies the brand and type of pacemaker.

Possible complications

The main complications associated with pacemaker surgery are infection in the wound site, bleeding or bruising in the insertion area.

You should seek medical attention or proceed to the emergency room if your have a fever over 37.5ºC (or 99.5ºF), if you notice a blue color in your skin or nails, or if you experience shortness of breath or chest pain.