What is a cardiac pacemaker?

What is a cardiac pacemaker?

Pacemakers are small devices used to treat heart blocks or pauses, severe rhythm disturbances and heart failure. Pacemakers detect the heartbeat and send signals to stimulate the heart when needed. They are usually placed in a pocket under the left collarbone. They are programmable devices.

Why is a pacemaker implanted?

Before moving on to the reasons for pacemaker implantation, it is necessary to mention the electrical system inside the heart tissue. This electrical system ensures that the atria and ventricles work in a coordinated manner. When the heart needs to pump more blood, the heart speeds up and slows down during sleep. All this is provided by the electrical system in the heart.

It is abnormal if the heart rate slows down too much, pauses or if the normal working order between the atria and ventricles is disturbed. These are called heart blocks or pauses. Dizziness, fainting or feeling as if you are about to faint may occur. In such cases, a pacemaker may be needed to enable the heart to function normally.

How is a pacemaker implanted?

After anaesthesia, a pocket is prepared under the left collarbone according to the size of the battery to be inserted. This pocket is opened just above the chest muscle. From the vein, 1, 2 or 3 battery cables (also called leads) are sent to the heart and inserted into the heart chambers. This is done in the angiography machine. The leads are then fixed so that they do not move and connected to the battery. The battery is placed in the prepared battery pocket. The battery pocket is closed according to surgical procedures (Figure 1). The pacemaker is not visible from the outside; depending on its size, its bulge may be noticeable.

Pacemakers can also be implanted on the right side more rarely. Especially if there is a dialysis fistula on the left side, if radiotherapy or radiation therapy has been performed in the left chest area, or if there is a condition affecting the lymph circulation in that area. The basic principles are similar.

There are also wireless pacemakers. These pacemakers are single-chamber pacemakers, but they can act like a two-chamber pacemaker by sensing the beats of the atria of the heart. A catheter is inserted through the veins in the groin into the heart, through which a wireless pacemaker is advanced into the right ventricle. The wireless pacemaker has small hooks at the end that hold it to the heart. After making sure that the pacemaker is attached to the heart with these hooks, the pacemaker is released and the procedure is completed. The battery here again listens to the heartbeat and activates to stimulate the heart when necessary. After the procedure is finished, there is no battery, cable, etc. outside.

Is a Pacemaker Implanted at a Young Age?

Although pacemakers are mostly implanted in elderly patients, they can also be implanted in young patients. Depending on the disease requiring pacemaker implantation, shock devices, single-wire, two-wire or 3-wire pacemakers can also be implanted in young people.

How Long Does Pacemaker Surgery Take?

Pacemaker surgery takes between 30 minutes and 1 hour on average. However, as in every surgical procedure, the duration may vary depending on the anatomical structure of the person, the abnormality in the heart and how many wires the pacemaker has.

Is Hospitalization Required After Pacemaker Implantation?

The day after the pacemaker is implanted, the pacemaker values are measured again and the wound site is checked. If the measurements are normal and the wound site is normal, the patient is discharged that day or 1 day later.

How to Check a Pacemaker?

Once a pacemaker has been implanted, it is necessary to check it at regular intervals. This includes checking how long the battery life is. Measurements of the cables and the battery are taken. The pacemaker is checked for normal functioning. If necessary, various programming is done to regulate the way the pacemaker works and its speed. Pacemakers also record any rhythm disturbances in the heart. During the check-up, it is also checked whether there is a rhythm disorder. If your doctor does not see any abnormalities, they will inform you about the next check.

How to Check a Pacemaker at Home?

A pacemaker can also be checked at home. A device called a programmer is used to control the pacemaker at home and make the necessary adjustments.

How Long is the Battery Life on a Pacemaker?

The average lifetime of a pacemaker is 5-10 years. This period depends on the energy used by the pacemaker to stimulate the heart and how long it works. Pacemakers are designed to be activated when they are needed. The less often the pacemaker is activated and the less energy it uses to stimulate the heart, the longer it will last.

The lifetime of shock devices is similar. This is longer if the patient does not need to be shocked. If the patient receives too many shocks, the battery life is shortened. Pacemaker brands are generally similar in terms of battery life, but with the recent development of battery technologies, batteries with longer life than standard batteries have started to be used.

What Happens If the Pacemakers Battery Dies?

Since pacemakers are checked periodically, information about the life of the device is also obtained. If the battery is low, it is checked more frequently. Each pacemaker has a signal that indicates when it is time to replace the battery. This is called ERI (Elective replacement interval). After receiving this signal, the battery will last for a while, but it is time to replace the battery, the appropriate time is determined and the battery is replaced. Replacing the battery means dismantling the entire system except the cables and replacing it with a new system. Otherwise, there is no separate battery system in the battery generator that can be removed and replaced.

What to look for after pacemaker surgery

Pacemakers usually do not interact much with electrical devices in the home. In other words, devices such as televisions, refrigerators and hair dryers do not affect the pacemaker.

There are various points to be aware of regarding telephones. For example, some phone models have a magnet inside the phone. These phone models should not be kept close to the battery. You should not put it close to the battery in your pocket. For example, in shock batteries, if the phone is held close to the pacemaker, they can cause the shock features to be temporarily disabled. If possible, it is better to carry the phone on the opposite side of the battery and use it with headphones.

Interaction of pacemakers with security detectors at airports is rare, but it is recommended to carry your battery card with you and go through a manual check.

There are also important considerations regarding medical procedures for patients with a pacemaker. Therapeutic procedures such as TENS used in physical therapy, radiotherapy to the area where the pacemaker is located, MRI scans or procedures before and during surgery, if any surgery is required, may cause interference with your pacemaker. Your cardiologist will make specific recommendations for your case.

After a pacemaker is implanted, you may be advised not to do heavy work with the arm on that side for a few weeks. However, it is not right not to move that arm at all in your daily life. Use your arm for the tasks that your daily life requires. Otherwise, a condition called frozen shoulder will occur and you will have difficulty moving your arm. Then you will need treatment to correct this condition.

Can a Person with a Pacemaker Have an MRI?

Batteries and cables must be MR compatible. Most of the batteries installed today are MR compatible. However, if there are MR incompatible batteries or cables that are not connected to the battery, it prevents MRI. You should definitely get information about your condition from your physician.

MRI is not recommended for MR compatible batteries for a few months after they are first installed. If MRI is to be performed, the battery must be switched to MR mode. Special precautions are taken according to the patient. Planning should be made with your cardiologist.

Can People with Pacemakers Drive?

People with normal pacemakers (except shock pacemakers) can drive after a period of one or two weeks if they do not experience dizziness or fainting. There are various restrictions for shock pacemakers. Since the risk of shock is higher in the first months, personal driving is restricted for 6 months. Commercial driving is not suitable.

Pacemaker implantation
Figure 1: Implantation of a permanent pacemakers. Two battery lead are sent to the heart through the vein you see in dark color and you can see the battery.

Read the article on pacemakers lead extraction here.

Update: February 13, 2024

Reference: Pacemakers

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Picture of Prof. Dr. Taylan Akgün
Prof. Dr. Taylan Akgün

He is a cardiologist specialised in the diagnosis and treatment of heart rhythm problems (ablation), pacemaker procedures.
He works in Istanbul province.

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