If you have heart disease that leads to symptoms like an irregular heartbeat or heart rhythm, your cardiologist might recommend that you get a pacemaker implanted. “I just celebrated 27 years of living on pacemakers. It’s helped a lot,” wrote one MyHeartDiseaseTeam member. Another said, “I don’t yet have a pacemaker, but they said sooner or later I will need one.”
But what is a pacemaker, and how does this small device work? Should you get a pacemaker if you’re living with heart disease? Check out seven facts that can help you better understand how these devices work.
A pacemaker is a small electrical device that doctors implant under your skin to regulate your heart rate. They’re made of a pulse generator (with electrodes) and a lead or wire, and they’re usually inserted under your skin below your collarbone.
If your heart rate or rhythm fall off course, the pacemaker delivers an electrical impulse that prompts the organ to beat correctly. Although the process may sound dramatic, having the pacemaker switched on is painless, and you likely won’t even notice when it happens. The electrical pulse helps your heart chambers beat together in the right synchrony so the heart’s electrical system operates correctly.
Most pacemakers are two-lead devices. One lead is placed in the right atrium and the other goes in the right ventricle. Three-lead devices have a third lead that’s generally placed through a vein into an area near the left ventricle. These devices are designed to resynchronize the heart to simulate normal conduction — that is, how electrical impulses move through the heart, causing it to beat. There are also now leadless pacemakers that are placed directly into the right ventricle using a catheter.
Pacemakers are generally programmed to function when the recipients’ heart rate drops below a specific level. A few devices can treat atrial fibrillation (AFib), which is an irregular, often rapid heart rhythm. However, most devices treat slow heart rhythms.
A device called a defibrillator corrects abnormal heart rhythms by either pacing rapidly or delivering an electric shock. Although most defibrillators are pacemakers, not all pacemakers are defibrillators.
The success rate of general pacemaker implantations is more than 99 percent, and the success rate of a three-lead pacemaker system is about 97 percent. Every year, more than 1 million pacemakers are implanted across the globe.
There are many reasons why you and your health care team may decide that you may benefit from a pacemaker. Cardiac pacemakers can prevent an abnormal heart rate for people who have experienced heart failure or heart attack, or who have an arrhythmia (irregular heart rhythm) or AFib.
Additionally, some people are born with congenital heart defects that can cause a fast or slow heartbeat. Others have an enlarged or thicker heart muscle. Both of these types of heart problems can cause irregular heartbeats that require a pacemaker or defibrillator.
Some treatments can cause heart complications, such as beta-blockers, which can slow your heart rate. Other conditions that cause irregular heart rhythms can also be corrected or improved with pacemakers. Among them is sinus node dysfunction, which means the heart’s electrical signal from the sinoatrial node — where your heartbeat begins — slows or disappears. Additionally, atrioventricular block — also called AV block or heart block — can prevent your heartbeat from traveling from the top chamber of your heart all the way to the bottom.
Pacemaker implantation is a routine operation, with a success rate close to 100 percent and excellent recovery prospects. If you and your doctor have decided that you’d benefit from a pacemaker, it’s a good idea to get to know a few important facts before you go to the hospital:
Once you arrive for the procedure, the facility staff will bring you to the electrophysiology lab. Here, the nursing staff will sterilize the site where they’ll implant your pacemaker and attach some monitors.
The surgeon will make a small incision and create a pocket under the skin and soft tissue to insert the pacemaker and leads. Using an X-ray as a guide, the doctor will then put the pacemaker wires through a vein inside the chest and position it in your heart.
After your procedure, your doctor will want you to stay in the hospital overnight for monitoring to ensure the pacemaker works correctly.
Because pacemakers run on batteries, you’ll have to undergo a pacemaker battery-replacement procedure approximately 5 to 7 years from the date of the pacemaker implantation. The battery life depends on how often the device is used.
Airport screening equipment like metal detectors or body scanners will not damage your pacemaker. However, it is possible that the metal in the device could set off a metal detector. For this reason, the U.S. Transportation Security Administration (TSA) advises travelers with pacemakers, as well as other internal medical devices, not to go through metal detectors. Instead, the TSA asks travelers to inform agents that they have a pacemaker and recommends going through the body scanner. You should bring a pacemaker identification card to show security agents in case any questions arise.
Although going through a full-body scanner is safe for people with pacemakers, you may prefer a physical pat-down if you’re not comfortable with the scanner. If a security agent wants to use a metal-detecting wand, they should pass the wand over the pacemaker quickly and not leave it there for more than a couple of seconds.
Security processes for individuals with pacemakers may vary depending on where you’re traveling.
Several medical procedures can affect pacemaker function, and you should talk to your doctor or specialist before undergoing:
Always let your surgeon know you have a pacemaker before any operation.
Although a pacemaker is likely to improve your quality of life, it’s important to understand that there may also be drawbacks.
Some people living with pacemakers have trouble sleeping and report discomfort. This can be made worse when you’re staying somewhere new and sleeping in an unfamiliar bed. Sleeplessness or discomfort may mean that your pacemaker isn’t situated in quite the right spot. If you experience these symptoms, it’s a good idea to discuss having a pacemaker position correction procedure with your cardiologist.
Some people have reported feeling irritated and impatient after having their pacemaker implanted, which can make day-to-day life difficult. You should talk to your health care provider at follow-up visits if you feel this way after your procedure.
If you’re thinking about the pros and cons of getting a pacemaker, talk to your cardiologist. Your doctor knows your medical history, including other health conditions, and they’re aware of your lifestyle considerations, so they can help you make an informed decision.
Your cardiology team can also help you sort out all of these different types of pacemakers and choose the one that’s best for you so you make the best decision to improve your health and help you maintain your quality of life.
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Are you living with heart disease and either using a pacemaker or thinking about getting one? Share your experience in the comments below, or start a conversation by posting on your Activities page.