Pacemaker

A pacemaker is a small, lightweight, electronic device that is used to pace the heart. People who have slow heartbeats would be likely candidates for a pacemaker. What Does it Do? A pacemaker monitors the heart's electrical activity. If the heart beats too slowly or is pausing between beats, the pacemaker will deliver electrical impulses to the heart to maintain proper heart rhythm. Why is it Important?  A patient with a slow heart rhythm will often have dizzy, fainting, or fatigue spells. A pacemaker can relieve these symptoms.

Why Have a Pacemaker?

A pacemaker can be used to treat bradycardia or slow heart rhythms, or Heart Block.

Sick Sinus Syndrome, SSS, is a form of bradycardia when the heart beats too slowly or pauses for too long between beats. Sometimes the heartbeat will alternate between the two.
Symptoms of SSS are: lightheadedness, fainting spells, fatigue, and palpitations.

Heart Block occurs when electrical impulses are delayed or stopped when creating a heartbeat. Second Degree Heart Block is when only some impulses are blocked and the heart beats too slowly or skips beats. Third Degree Heart Block, Complete Heart Block, is when impulses are totally blocked, which can create a very slow heartbeat.
Symptoms are: lightheadedness, fainting spells, confusion, or fatigue.

Understanding Pacemakers

A pacemaker is made of two general parts, a pulse generator and either one or two leads.
A pulse generator is a metal case that contains the battery and circuitry.
The leads are insulated, flexible wires that are placed in the heart. These wires carry electrical energy to the heart and send information about heart activity back to the pacemaker.

How Does a Pacemaker Work?
A pacemaker tracks the heart's natural electrical activity. It sends electrical impulses to the heart to make the heart beat regularly. Sensing and pacing aspects of the pacemaker can be reprogrammed by the doctor to meet your particular needs.

Types of Pacemakers:
A single chamber pacer has one lead that is placed where the signal problem is in the heart, often the right atrium or right ventricle. That chamber is stimulated to keep the heart beating.
A dual-chamber pacer has two leads that are placed in the right atrium and right ventricle. This pacer will allow the heart's upper and lower chambers to beat in succession so that the heart beats more efficiently.

Implanting a Pacemaker

A pacemaker implant is a minor surgical procedure.

To prepare for the implantation the doctor will run routine tests, including an electrocardiogram (ECG) and some blood tests, as well as perform a medical history examination prior to scheduled procedure.

Before the Procedure:

• Do not eat or drink anything for 6 to 8 hours before procedure.
• Ask the doctor several days before the procedure if the patient needs to stop taking certain medications.
  Do not cease medication without doctor authorization.
• Make arrangements for someone to drive to and from the hospital.
• Bring list of current medications.
• Inform doctors or nurses of any allergic reactions to certain medications.

During the Procedure:
The pacemaker is implanted under the skin in the upper chest, near the right or left shoulder. Another possible location would be near the abdomen. After the lead is in place within the heart, the pacemaker is tested to see if it senses heart signals clearly. The procedure takes 1 to 2 hours.

After the Procedure:
The patient will be taken to the recovery room where heart rhythm will be monitored. The patient may have a chest x-ray performed to confirm stable lead position.

Instructions:
Before going home instructions on how to care for the incision, physical activity, and medications will be provided.

The First Few Weeks:

• Follow any instructions that the doctor gives.
• Keep the incision completely dry.
• Avoid lifting heavy objects.
• Do not raise arm near the incision above shoulder level.
• Call doctor if there is any sign of infection or developed a fever.
• Call doctor if chest muscles are twitching, hiccupping that will not stop, or a swollen arm on the side of incision.
• Call doctor if recurring symptoms, lightheartedness, chest pain, or shortness of breath reappear.
• Check with a doctor or nurse regarding what medications to continue or stop taking. 

Caring for a Pacemaker

It is important to have follow up visits to ensure that the pacemaker is working properly. The doctor will also check the settings on the pacemaker, how it is interacting with the heart, and the battery status. Some doctors will use a magnet to check the status on the pacemaker and battery.

Adjusting the Pacemaker:
To adjust the pacemaker the doctor will use a programmer, which is a device that can communicate with the pacemaker. If the patient's medical conditioin changes, the pacemaker's settings are adjusted to better treat slow heart rhythm.

Replacing Battery and Leads:
The pacemaker is powered by long lasting lithium batteries. But, it is possible that a pacemaker will need to be replaced within 6 to 10 years. To replace a battery requires replacing the entire generator because it is sealed in the pacemaker. Leads may also need to be changed sometimes.