Pacemakers

Why is the doctor performing this procedure?

When the sinoatrial (SA) node or sinus node (the body's natural pacemaker) becomes defective, the heart may beat too fast, too slow, or irregularly--all of which are referred to as arrhythmias. An artificial pacemaker is used to treat a dangerously slow heart rate, to help it beat at a more healthy rate.

What is a pacemaker?

A pacemaker is a small, artificial electrical device which assists, or in some cases, replaces the function of the (SA) node. Frequently, pacemakers are necessary following a heart attack or cardiac surgery. Without treatment, a slow or irregular heart rate can lead to weakness, confusion, dizziness, fainting, shortness of breath and even death.

There are two types of pacemakers: permanent (implantable) and temporary (external). Your doctor will advice you as to which device is most suitable depending upon your condition.

Most pacemakers are demand pacemakers. Demand pacemakers have a sensing device which paces the heart (turns the device off and on) as needed--off when the heart beat is too fast and on when it is too slow. Patients are usually completely unaware of when the device is pacing their heart.

What happens during a pacemaker procedure?

A pacemaker implantation is a minor procedure requiring only mild sedation and a local anesthetic (patients are generally not put to sleep). A small, approximately 2-inch incision is made parallel to and just below the collarbone. A thin flexible wire (called the lead) is inserted into a vein that lies just under the collarbone. The doctor advances the lead through that vein under fluoroscopic (x-ray like) guidance into the heart. Once the lead enters the heart, the doctor attaches it to the tissue inside the heart. At this point, the doctor will test the lead to see if it is in a suitable place for pacing. The testing is not painful. After the lead test, your doctor may decide to move the lead and perform the test again. Repositioning and retesting a pacing lead several times is not unusual during a pacemaker procedure.

The other end of the pacer wires are connected to a "generator" that is implanted under the skin beneath the collarbone. This generator is about half an inch deep and one and a half inches wide. The skin is then sutured closed and the patient leaves the hospital later that same day or the following day.

Do pacemaker batteries wear out?

The pacemaker contains batteries that will wear down over time, just like any electronic device. Most batteries last at least 5 years. Using a special analyzer, the doctor can detect the first warning that the batteries are running down. This can be done before you detect any changes yourself. A sudden major slowing down of your heart rate, which you may detect, indicates a more serious problem. If that occurs, call your doctor.

If I have a pacemaker, are there electrical devices to avoid?

Yes. Keep the following potential sources of strong electrical or magnetic fields at lease 30 cm (12 inches) away from your Pacemaker.

  • Large stereo speakers
  • Strong magnets
  • Magnetic bingo wands
  • Magnetic wands and detectors used in airport security
  • Industrial equipment like power generators / arc welders
  • Avoid leaning over running engines
  • Many amusement park rides have strong magnets and should be avoided.
  • Talk on your cell phone your ear opposite the pacemaker placement

Where is the test performed?

In the cardiac catherization lab.

How long does this test take?

Typically the procedure takes 1 - 2 hours to perform.