During an average lifetime, the heart beats more than 2 billion times.
To you, it might just be a steady “lub-dub” that speeds up under pressure and slows as you drift to sleep. But behind that rhythm is a carefully orchestrated system: The heart chambers open and close rhythmically, electrical impulses fire off and blood flows with precision. Over time, though, the pattern can falter. The heart may beat too slowly or irregularly, and that’s where a pacemaker comes in, helping to restore the heart rhythm and keep it on track.
Read on to learn more about pacemaker surgery, types of pacemakers and how a pacemaker can improve your heart health.
[Read: Best Heart-Healthy Foods]
What Is a Pacemaker?
Traditional pacemakers are silver dollar-sized battery-powered devices surgically implanted under the skin in the upper chest. Pacemakers fit in a surgically created pocket, which may create a slight visible bulge beneath the skin. Leadless pacemakers are implanted directly into the heart.
A pacemaker helps the heart beat in rhythm by sending electrical impulses to the heart. Different types of pacemakers may deliver these electrical impulses in various ways.
Over the years, pacemaker technology has advanced, says Dr. Edward T. A. Fry, a cardiologist based in Indianapolis and chair of the Ascension National Cardiovascular Service Line.
“Over the years, pacemakers have become smaller in size, have a longer battery life and have improved MRI compatibility,” he explains.
They also have a lower risk of infection and are less invasive, he adds.
The heart has its own natural pacemaker, called the sinoatrial node, located in the upper right chamber of the heart. The SA node is composed of specialized cardiac cells that generate their own electrical impulses, enabling the SA node to regulate the heart’s rhythm. Whether the problem with the heart is coming from the SA node or not, the goal of a pacemaker is to take over or support the heart’s natural rhythm when the heart is unable to do so on its own.
[READ: Heart Palpitations After Eating: When to Be Concerned.]
Who needs a pacemaker?
You may need a pacemaker if:
— Your heart beats too slowly (or bradycardia). A dangerously low heart rate is when your heart beats less than 50 beats per minute, especially when the slow heart rate causes other symptoms, such as dizziness or fainting. “Pacemakers are typically implanted because the heart rate is too slow,” Fry says.
— Your heart beats too fast (or tachycardia). A dangerously fast heart rate is when your heart beats over 100 beats per minute at rest.
— You have a weak heart, which could be caused by a heart attack or heart failure.
— Your heart beats in an abnormal pattern, such as a heart block. This is when there is a delay or block in the electrical signals in the heart.
[READ: Broken Heart Syndrome: Symptoms, Causes and Treatments]
How a Pacemaker Works
All pacemakers contain a pulse generator, which is the battery component of a pacemaker. A pulse generator contains the electrical circuitry and a lithium battery that creates the impulses that stimulate the heart.
There are a few options for the pacemaker system:
— Transvenous. Thin, flexible wires, called leads, are threaded through a vein into the heart. There, they deliver electrical impulses.
— Epicardial. These leads are attached to the outer surface of the heart. This system is much less common than the transvenous option.
— Leadless. This newer system is where the pacemaker can be implanted directly into the heart. This system combines the pulse generator and electrodes into one.
Types of Pacemakers
The types of pacemakers include:
— Single-chamber pacemaker. This system sends the signals to either the heart’s upper or lower chamber.
— Dual-chamber pacemaker. This system uses two leads, one for the upper chamber and one for the lower chamber.
— Biventricular pacemaker. This system paces both the lower heart chambers and is primarily for those with heart failure.
— Automated implantable cardioverter-defibrillators. AICDs combine a pacemaker and a defibrillator. The defibrillator portion will provide a sudden jolt of electricity if the heart’s rhythm becomes dangerous. “Defibrillators have pacing capability, but not all pacemakers are defibrillators,” Fry says.
Depending on the type of pacemaker, it may last between five and 15 years before some or all of the device needs to be replaced.
Pacemaker Surgery: What to Expect
Is placing a pacemaker a major surgery? A pacemaker surgery takes less than a couple of hours. During the surgery, you’ll receive local anesthesia. This means you will be very relaxed and will be unable to feel the surgery, but you will still be conscious and able to respond. Sometimes this is called twilight sedation.
Who is not a good candidate for a pacemaker? Those with severe dementia, individuals who have limited life expectancy or those with increased risk of infection are less likely to be pacemaker candidates, says Dr. Srihari S. Naidu, a triple board-certified physician in internal medicine, cardiology and interventional cardiology. He is also a professor of medicine at New York Medical College in New York City and president of the Society for Cardiovascular Angiography & Interventions.
Before the procedure
Prior to the surgery, Naidu recommends that you plan your recovery time. You will be unable to use the full range of motion in your arm where the pacemaker is placed. Additionally, he recommends you schedule your first postoperative appointment before you have the surgery, so you don’t have to worry about making the appointment later.
Before surgery, you’ll:
— Receive medical clearance from a surgeon, cardiologist and a primary care provider
— Fill out a surgical consent form, agreeing to the surgery after a medical provider has explained what to expect
— Undergo a few preoperative procedures on the day of, including having the surgical site shaved, getting an IV and being hooked up to cardiac and vital sign monitors
During the procedure
The pacemaker procedure follows three key steps:
1. After anesthesia sets in, the surgeon begins the procedure by making an incision or inserting a catheter. For a traditional pacemaker, the incision is near the collarbone, usually on the left side. For leadless pacemakers, a catheter is inserted through the femoral vein in the groin. Using imaging to guide the placement, the surgeon will implant the pacemaker device or position the leads.
2. If this is a pacemaker with leads, the leads are positioned and connected to the pulse generator, which is implanted under the skin near the collarbone. If leadless, the entire system, including the pulse generator and electrodes, is directly implanted into the right lower chamber of the heart.
3. The medical team tests the pacemaker. Finally, the incision or catheter insertion site is closed, and the surgery is complete.
After the procedure and living with a pacemaker
After the surgery, make sure you:
— Attend your postoperative appointments. This is to assess for infection, bleeding and proper pacemaker function. Settings often need to be adjusted after the first visit, Naidu says.
— Allow your arm to fully heal before using its full range of motion. “This gives time for the pacemaker to heal and the leads to settle,” Naidu says. “Too much movement can dislodge or damage the leads.”
— Tell your doctor about any concerns. “If you are still feeling similar symptoms as before you had a pacemaker placed, such as dizziness or fainting, let your doctor know so they can adjust the pacemaker,” Naidu says.
What you shouldn’t do with a pacemaker device:
— Increase your physical activity too quickly. “This can be a psychological hurdle that is hard for some people,” Fry says. However, “modern pacemakers include rate-responsive algorithms that adjust pacing based on physical activity, better replicating what your body would normally do when exercising,” Fry says. Your provider will advise you on exercise intensity and amount. Usually, light to moderate exercise is encouraged.
— Be in close proximity with strong magnetic fields and electronic devices. Keep electronics 6 inches away, Naidu recommends.
— Forget your pacemaker ID. “Tell people during security checks if you have a pacemaker,” Naidu says.
— Neglect infection risk, as a pacemaker is a foreign body and prone to infection. “Keep up with your dental appointments and minimize the risk of other infections,” Naidu says. In addition, avoid close contact with individuals who are sick.
After the procedure, you’ll likely return to regular activity within four to six weeks.
Risks and Benefits of Pacemaker Surgery
Pacemaker surgery, though generally safe, has some risks, as all procedures do, says Dr. Leonard Ganz, Los Angeles-based divisional vice president of medical affairs and chief medical officer at Abbott’s cardiac rhythm management business.
“Both traditional and leadless pacemakers have some potential for early complications, such as infection, post-implant. Chronic complications seem more common with the traditional pacing systems,” he notes.
The benefits of a pacemaker vary between individuals, adds Dr. Mohanakrishnan Sathyamoorthy, a cardiologist, cardiac surgeon and medical device expert on pacemakers and pacemaker surgery. He is the chair of internal medicine at Burnett School of Medicine at Texas Christian University in Fort Worth, Texas.
“We keep in mind that the earlier in a patient’s life that we implant, the more times we will have to change out the generator as the battery depletes, which is all a part of our decision-making process,” he explains.
Survival rates
What is the life expectancy of a person with a pacemaker? Life expectancy after a pacemaker depends on a few factors, such as your age and your overall health.
There is limited data on the survival rates of pacemaker recipients from the last decade, and many advancements in pacemaker technology have been made since then. A 2015 study in the International Journal of Cardiology concluded that the life expectancy of pacemaker recipients without significant health issues was similar to that of the general population. In another study published in Europace, researchers concluded that more than 80% of pacemaker recipients were alive after about four years.
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Pacemakers: Surgery, Types and How They Work for Heart Health originally appeared on usnews.com
