- What Is a Pacemaker and How Does It Work?
- When Is a Pacemaker Needed?
- How Do Pacemakers Regulate Heart Rhythm?
- Types of Pacemakers?
- What to Expect During Pacemaker Surgery
- What Happens If You Don’t Get a Pacemaker?
- Risks and Complications of Pacemaker Surgery
- Living Safely with a Pacemaker: Key Precautions
- Adapting to Life with a Pacemaker
- Pacemaker FAQs: Common Questions Answered
What Is a Pacemaker and How Does It Work?
A pacemaker is a small device that sends electrical impulses to regulate heart rhythm in cases of abnormal heartbeat. These signals ensure that the heart contracts regularly and effectively to maintain the blood circulation needed by the body. A pacemaker helps prevent problems such as fatigue, shortness of breath, dizziness, fainting, palpitations, and sudden cardiac arrest.
This device consists of a battery and electrodes. The battery unit serves as the power source and generates electrical signals. The electrodes are responsible for delivering these signals to the heart tissue. While some pacemakers can be used temporarily, they are primarily permanent implants.
When Is a Pacemaker Needed?
A pacemaker is implanted to ensure normal heart rhythm when the heartbeat is insufficient or irregular. For example, in bradycardia, where the heart rate becomes extremely slow, the body may not receive adequate blood flow, which can cause symptoms such as fatigue, dizziness, shortness of breath, and fainting (syncope). In conduction problems like heart block, heartbeats can become irregular.
Heart rate may slow down due to the side effects of medications used in conditions such as atrial fibrillation, which may necessitate a pacemaker. Additionally, temporary pacemakers can be used to regulate heart rhythm in acute conditions such as heart attacks or temporary conditions like drug toxicity.
How Do Pacemakers Regulate Heart Rhythm?
A pacemaker is a small electronic device designed to assist the heart’s natural electrical system. Normally, electrical signals that control heart function are produced by the sinus node, the heart’s natural “pacemaker,” and these signals cause the heart to contract and pump blood throughout the body. However, when this system malfunctions (for example, when signals slow down, become irregular, or stop completely), the pacemaker takes over.
Modern pacemakers can automatically adjust heart rate by adapting to the patient’s daily activities. They can increase heart rhythm during physical activity by detecting body movements and decrease it during rest. These features enable the pacemaker to support the patient’s quality of life and overall cardiac health.
Types of Pacemakers?
Pacemakers are divided into two main groups: permanent and temporary. Permanent pacemakers include different types that can function according to the patient’s needs. These types include VVI, DDD, CRT, ICD, CRT-D, and Leadless pacemakers. Temporary pacemakers are generally preferred for short-term use before surgery or in some temporary arrhythmias.
VVI Pacemakers (Single Chamber Pacemaker): VVI pacemakers are single-chamber devices that send electrical impulses to the heart’s lower right chamber (ventricle). They are simpler devices, used primarily in patients who have a slow heart rate (bradycardia) or who do not require atrial support. This type of pacemaker helps ensure the ventricles contract efficiently when the heart’s natural rhythm is insufficient.
DDD Pacemakers (Dual Chamber Pacemaker): DDD pacemakers stimulate both the upper (atrium) and lower (ventricle) chambers of the heart. By mimicking the heart’s natural electrical activity, they provide synchronized contraction between these chambers, improving cardiac output. This type is preferred in conditions such as atrioventricular (AV) block or other situations where coordination between the atria and ventricles is disrupted.
CRT Pacemakers (Cardiac Resynchronization Therapy): CRT pacemakers are specialized devices designed to synchronize the contractions of the left and right sides of the heart, particularly in patients with heart failure. These devices use three leads to stimulate the right atrium, right ventricle, and left ventricle. By restoring synchronized contraction, CRT pacemakers improve the efficiency of the heart’s pumping ability and alleviate symptoms of heart failure.
ICD (Implantable Cardioverter Defibrillator): ICDs are life-saving devices that detect and treat dangerous heart rhythms such as ventricular tachycardia and ventricular fibrillation. In the event of such arrhythmias, ICDs deliver a therapeutic shock to restore normal heart rhythm. They are typically used in patients at high risk of sudden cardiac death.
CRT-D (Cardiac Resynchronization Therapy-Defibrillator): This type of pacemaker combines the features of CRT and ICD devices. In addition to resynchronizing heart contractions, it can deliver shocks to prevent sudden cardiac death due to severe arrhythmias. CRT-D is used in patients who have both heart failure and a high risk of life-threatening arrhythmias.
Leadless Pacemakers: Leadless pacemakers are a new generation of devices that are implanted directly into the heart without the need for leads (wires). These devices are minimally invasive and are ideal for patients who are at high risk of infections or those with specific anatomical considerations that make traditional pacemakers challenging to implant.
What to Expect During Pacemaker Surgery
Pacemaker implantation is a minor surgical procedure typically performed under local anesthesia. The pacemaker is usually placed under the skin in the upper chest area and connected to the heart through thin wires (leads). Depending on the type of battery, it may contain one, two, or three electrodes. The procedure usually takes 1-2 hours. Most patients are discharged the same day or after one night in the hospital. After the procedure, daily wound dressing is applied, and showering is possible after a few days.
The stages of the procedure are:
- Preparation: Blood tests, ECG, and some imaging tests are performed.
- Incision: A small incision is made below the collarbone, and a pocket is created for the generator.
- Electrode Placement: Electrodes are guided to the heart through the vein.
- Generator Connection and Testing: Electrodes are connected to the generator, and the system’s operation is tested.
- Closure: The generator is placed, and the incision is closed.
The healing process typically takes 4-6 weeks. Mild pain and tenderness at the wound site are normal for the first few days. During this period, arm movements should be gradually increased while maintaining regular wound care and dressing. If unexpected pain, redness, or discharge occurs at the wound site, contact your doctor immediately.
What Happens If You Don’t Get a Pacemaker?
If a patient who requires a pacemaker doesn’t receive one, serious complications can develop. For instance, fainting episodes and syncope may become more frequent and can lead to severe consequences due to insufficient blood flow to the brain. While symptoms like chronic fatigue and weakness may occur, heart failure can develop in more severe cases. If arrhythmias remain untreated, there is a risk of sudden cardiac arrest and death.
Risks and Complications of Pacemaker Surgery
Like any surgical procedure, pacemaker implantation carries certain risks. These can be categorized as early and late complications.
Early Complications:
- Bleeding at the implant site.
- Infection around the device.
- Injury to the pleural space.
Late Complications:
- Lead displacement.
- Battery depletion.
- Device-related infection.
However, modern surgical techniques and experienced medical teams have significantly reduced these complication rates. Regular monitoring enables early detection and management of potential issues.
Living Safely with a Pacemaker: Key Precautions
Pacemakers are not affected by most household devices such as televisions, refrigerators, or hair dryers.
There are several important considerations regarding mobile phones. For example, some phone models contain internal magnets. These phone models should not be held close to the pacemaker. You shouldn’t place them in a pocket near the device. For instance, with ICD devices, keeping the phone close to the pacemaker can temporarily disable shock functions. When possible, it’s advisable to carry the phone on the opposite side of the pacemaker and use headphones.
While interactions between pacemakers and airport security detectors are rare, it’s recommended to carry your pacemaker card and request manual screening. There are also important considerations regarding medical procedures for pacemaker patients. Physical therapy treatments like TENS (Transcutaneous Electrical Nerve Stimulation), radiotherapy near the pacemaker site, MRI scans, or any surgery may interact with your device. Your cardiologist will provide specific recommendations for your situation.
After pacemaker implantation, it’s advised to avoid heavy activities with the arm on the implant side for several weeks. However, completely immobilizing that arm in daily life is not recommended. Use your arm for routine daily activities. Otherwise, a condition called frozen shoulder may develop, making arm movement difficult. This condition may then require additional treatment.
Adapting to Life with a Pacemaker
After pacemaker implantation, you may need to make some lifestyle changes to improve your quality of life. These changes will help improve your overall health:
- Exercise regularly with doctor’s approval.
- Follow a healthy and balanced diet.
- Limit salt consumption.
- Learn and practice stress-reducing techniques.
- Control high blood pressure, diabetes, and cholesterol levels.
- Avoid or limit alcohol.
- Don’t smoke.
- Maintain a regular sleep schedule.
- Avoid excessive caffeine consumption.
- Monitor weight regularly.
- Take medications consistently.
Pacemaker FAQs: Common Questions Answered
How should daily life be with a pacemaker?
After pacemaker implantation, patients typically return to their normal activities within 2-3 weeks. Regular walking and light exercises are permitted, and water activities like swimming can resume once the wound heals. There are no restrictions on sexual activity.
How long does a pacemaker last?
The average lifespan of a pacemaker is 7-10 years. This duration varies depending on usage frequency and energy consumption. More frequent heart stimulation results in shorter battery life.
Does a pacemaker extend life expectancy?
When implanted for appropriate indications, a pacemaker improves quality of life and can extend life expectancy in certain cases. It can be life-saving, particularly for patients with serious arrhythmias. Optimal benefits are achieved through regular check-ups and lifestyle modifications.
Can you feel when pacemakers work?
Under normal conditions, pacemaker operation is not perceptible. Only with shock-capable devices (ICDs) can you feel the shock delivery during a serious rhythm disturbance.
What happens if a pacemaker battery depletes?
Since pacemakers are monitored regularly, battery life status is tracked. More frequent checks are scheduled when the battery is low. Every pacemaker has an indicator signaling when battery replacement is needed, called ERI (Elective Replacement Interval). This signal appears during battery checks. After this signal, the battery continues functioning for a while, but replacement should be scheduled. Pacemaker replacement involves changing the generator without disturbing the leads. This procedure is shorter than the initial implantation.
Who needs a pacemaker?
Pacemakers are typically implanted in patients with very slow heart rates (bradycardia) or conduction problems between the upper and lower heart chambers.
Can I have an MRI with a pacemaker?
Most modern pacemakers are MRI-compatible. However, consult your doctor to verify that your specific model can safely undergo MRI. Pacemakers must be programmed into MRI-safe mode before scanning.
Can pacemakers be implanted at a young age?
While pacemakers are more commonly implanted in elderly patients, they can be appropriate for younger patients too. Depending on the underlying condition, shock devices, single-wire, two-wire, or three-wire pacemakers may be implanted in young people. You can read this article to learn about pacemaker types.
How is pacemaker monitoring performed?
After pacemaker implantation, regular monitoring is essential. Lead and battery measurements are taken. Normal pacemaker function is verified. If necessary, programming adjustments optimize the device’s operation mode and rate. The pacemaker also records any heart rhythm irregularities. During check-ups, these recordings are reviewed. If your doctor finds no abnormalities, they’ll schedule your next follow-up. Pacemakers can also be monitored at home using a programmer device for checks and adjustments.
Can People with Pacemakers Drive?
Patients with standard pacemakers (excluding ICDs) can usually resume driving after one to two weeks if they experience no dizziness or fainting. There are specific restrictions for ICD patients. Due to higher shock risk in the initial months, personal vehicle use is restricted for 6 months. Commercial driving is not recommended.
Reference: Pacemakers