Pacemaker

A pacemaker is a small, lightweight electronic device that is prescribed for people whose hearts are beating too slowly. It is implanted into the body, usually in the upper chest, near the shoulder.

The pacemaker keeps track of the heart’s electrical activity. If the pacemaker senses that the heart is beating too slowly or is pausing too long between beats, it delivers electrical impulses that pace (stimulate) the heart and keeps it beating at the proper speed.

A Pacemaker consists of two main parts: a pulse generator and either one or two leads.

The Pulse Generator is a small, lightweight metal case with a battery and circuitry. The battery supplies the electrical energy. The produces electrical impulses and controls how often and when these impulses are delivered to the heart.

The leads connect to the pulse generator. A lead is an insulated and flexible wire. It is threaded through a vein and placed in the heart. The lead carries electrical impulses from the pacemaker to the heart.  It also relays information about the electrical activity of the heart back to the pacemaker.  One or more leads may be used, depending on the type of pacemaker that is implanted.

When a Pacemaker is used

  • Bradycardia with significant symptoms, such as dizziness, fainting spells, tiredness, confusion, or shortness or breath.
  • Bradycardia with a very slow heart rate or long pauses between beats, even without symptoms.
  • Arrhythmias where the heart alternates between beating too fast and too slowly.
  • Arrhythmias and other medical conditions that require medications that cause bradycardia.
  • Recurring syncope that is caused, at lest in part, by significant slowing of the heartbeat.
  • Severe bradycardia caused by heart surgery or catheter ablation.

 Preparation for the Procedure

  • Do not eat or drink anything for 6 to 8 hours before the procedure. You may have small sips or water to take your medications.
  • If you take medications, tell your doctor several days before the pacemaker is to be implanted. You may be asked to stop some medications (such as aspirin) for 2 or 3 days before the procedure.
  • Bring a list of the names and dosages of all the medications you are taking.
  • Ask someone to drive you to and from hospital. You will not be permitted to drive home after the procedure, since you may be sedated.
  • Pack a small bag for your hospital stay. Take with you a robe, slippers, pajamas or nightgown, and toiletries.
  • Tell the doctor or nurse if you have had any allergic reactions to medications or x-ray dye (contrast), iodine or seafood, or if you have a history of bleeding problems.
  • Pacemakers can be placed near the right or left shoulder. If you prefer a particular side, let the doctor know.
  • Empty your bladder before the procedure starts.

Is Implanting a Pacemaker Safe?

Implanting a pacemaker is a simple procedure with little risk. Possible complications include bleeding at the incision or pocket site. Blood collects under the skin, resulting in local swelling and/or a bruise.

In rare cases, the procedure may lead to more serious complications, including damage to the heart and blood vessels, a punctured lung, infection, and blood clots. Death is very rare.

After the Procedure

After the pacemaker is implanted, you will be taken to the recovery area or to your room. A nurse will take your pulse and blood pressure and will also check the incision for bleeding or swelling.

It is normal to have some pain and stiffness around the incision site for a few days. You doctor will prescribe pain medication if needed. Don’t raise the arm on the side of the incision above shoulder level.

Most patients stay in hospital overnight; some will stay as extra day. Before you go home, you will be given instructions about caring for the incision, physical activity, and medications. When it is time to leave, have a friend or family member drive you.

Recovering at Home

A few days after you leave the hospital, you will most likely be able to go back to your usual daily activities. However, it may take a few weeks before the incision is completely healed. For a few weeks you may feel numbness or fullness in the area around the pacemaker, which is normal.

The First Few Weeks

  • For about 2 weeks, do not raise the arm on the pacemaker side above shoulder level.
  • Follow your doctor’s instructions regarding activity, exercise, and returning to work.
  • Keep the incision site completely dry for a week or so, to help prevent infection.
  • Do not lift anything heavier than 10 to 15 pounds. Also, avoid too much pushing, pulling, or twisting.
  • Call your doctor if the incision site shows signs of infection (pain, redness, swelling), there is drainage from the incision, or you develop a temperature over 100° F.
  • Call your doctor if you have twitching chest muscles, hiccups that will not stop, or a swollen arm on the side of the incision.
  • Call your doctor if the symptoms you had before come back, or if you have dizziness, chest pain, or shortness of breath.
  • Be sure to check with your doctor or nurse about medications. – which ones to keep taking and which ones to stop.
  • Tell any doctors and medical personnel you see that you have a pacemaker.

 Follow–Up Visits

A typical follow-up visit takes about 30 minutes. You will have to check your pacemaker several times during the first year, and then once or twice a year after that.

 Telephone Monitoring

Telephone monitoring allows you to send your ECG by the phone. If your doctor recommends telephone monitoring, you can subscribe to a service. You will be given a special transmitter that allows you to record and transmit your ECG over the phone line.

When you transmit your ECG, a receiving device in the monitoring office records the signals and prints a tracing. The tracing is analyzed by a technician and the information is sent to your doctor.

 Replacing the Battery

Pacemakers are powered by long-lasing lithium batteries. In general, a battery lasts 5 to 8 years.

Since the battery is sealed inside the pulse generator, the entire pulse generator must be replaced when the battery wears out. In most cases, the original leads will not need to ne replaced.

 Pacemaker Identification Card.

You will receive a wallet card with information about your pacemaker. It will also include your doctor’s name and phone number.

 

IMPORTANT!

You must carry your card with you all the times! Show it to any health care provider you visit.

Also, because your pacemaker may set off security devices, you may need to show your card to security personnel.

 

Call Your Doctor If:

  • You have questions about your pacemaker, medications, or activities.
  • You are going to have a medical procedure, especially if it involves surgery.
  • You experience any of the symptoms you had before the pacemaker was implanted
  • You have symptoms such as lightheadedness, fainting spells, palpitations, shortness of breath, chest pain, or lack of energy.
  • You have twitching chest muscles or hiccups that will not stop.

 

Avoid Interference!

Things that use magnets or electricity have magnetic fields around them. These fields are usually weak and will not affect your pacemaker. However, strong magnetic fields can interfere with your pacemaker and may temporarily affect the way it works.

 

Safe Items:

Microwave ovens, blenders,  electric can openers, and toasters,.

Radio, Televisions, CD/DVD players, pagers, remote controls, garage door openers

Hair dryers,  shavers ( avoid holding against the implant site)

Refrigerators, washers, dryers, and electric stoves.

Electric blankets and heating pads, personal computers, printers, fax machines, and copy machines.

 

Items that can be used but should remain at least 12 inches away from the implant site:

Slot machines, stereo speakers; Battery-powered, cordless power tools such as screwdrivers and drills

Lawn mowers, leaf blowers; Shop tools, such as corded drills and table saws

 

Avoid:

Large generators, electric motors, arc welders, and other large industrial equipment, maintaining or repairing any electrical or gasoline-powered appliances; Radio transmitters, high-voltage power lines

Leaning over the open hood of a running car; Magnetic therapy products, such as mattress pads, pillows, and massagers

If you have questions about the safety of a particular appliance, tool, or activity, check with your doctor or nurse or call the company that makes the pacemaker.

Medical Procedures:

Some procedures produce strong magnetic fields and should usually be avoided ( talk to your doctor first). These include:

Magnetic resonance imaging (MRI), electrocautery, diathermy, lithotripsy, transcutaneous electrical nerve stimulation (TENS), and radiation therapy.

Always tell any doctors or other medical personnel that you have a pacemaker.

Cell Phones:

A cell phone can affect your pacemaker if the phone it held to close to it.  This effect is temporary. You can move the phone away form the pacemaker and the pacemaker will work properly again.

When using a cell phone, hold it to the ear farthest from your pacemaker. Do not carry the phone in a breast pocket or on a belt within 6 inches of where the pacemaker is implanted.