Cardiac Pacemakers

A cardiac pacemaker is a small, battery-powered device that supports a normal heart rhythm. Most pacemakers are surgically implanted under the skin near the collarbone and connected to the heart with wires (called leads).

Different types of pacemakers are used for different heart conditions. Types include:

• Single-chamber pacemaker: Sends electrical signals to the lower right chamber of the heart.
• Dual-chamber pacemaker: Sends electrical signals to the upper and lower right heart chambers.
• Biventricular pacemaker: Also called a cardiac resynchronization pacemaker, it’s designed for people who have heart failure and a slow heartbeat. It stimulates both lower heart chambers and helps improve the heart function.
• Leadless pacemaker: This type of pacemaker is attached to the inner wall of the heart and doesn’t use any leads. Leadless pacemakers can be single-chamber (sends electrical signals to either the right atrium or the right ventricle) or dual-chamber (stimulates the right atrium and the right ventricle).

Who Needs a Pacemaker?

Pacemakers treat certain heart rhythm disorders and related conditions, including:

• Slow heart rate (bradycardia), which occurs when a specialized part of the heart that regulates heartbeat, the sinus node, doesn’t function properly.
• Heart block, which occurs when the heartbeat signal can't travel from the upper chambers to the lower chambers of the heart.
• Heart failure, especially when due to a delay in contractions between the heart’s ventricles (lower chambers) or when it’s expected that pacing will be needed in the ventricles most of the time. Delivering pacing to both ventricles to restore normal heartbeat rhythm is called cardiac resynchronization therapy (CRT).
• Fainting spells (syncope) due to either sinus node dysfunction or heart block.

What to Expect Before, During and After Your Procedure

Before Surgery

Your healthcare provider will provide you with specific instructions prior to your pacemaker surgery, discussing risks such as infection, bleeding or adverse reaction to anesthesia. You should refrain from eating or drinking for eight hours prior to the procedure.

During Surgery

After you receive an IV, you’ll be taken to the electrophysiology laboratory. Most procedures are done under light sedation with local anesthesia. Depending on your condition and health, you may receive general anesthesia, which means you’ll be asleep throughout the procedure. The procedure typically takes a few hours.

To implant a pacemaker, your doctor will insert one or more leads into a major vein near the collarbone. Using X-ray imaging to guide the leads to your heart, one end of each lead is attached to the heart and the other to the pacemaker.

If you receive a leadless pacemaker, no incisions are made in the chest. Instead, the pacemaker(s) is inserted through a vein in the groin and guided to the heart.

After Surgery

Most patients can go home from the hospital within 24 to 48 hours. Before you leave, your pacemaker will be programmed for your heart rhythm needs. Arrange for someone to drive you home from the hospital.

You’ll be instructed not to do any heavy lifting or intense exercise for the first month after getting a pacemaker. Avoid putting pressure on the area where the pacemaker is located.

You will receive follow-up care in the Cardiac Device Clinic.

Benefits of Pacemakers

Pacemakers can improve your quality of life by:

• Relieving many symptoms caused by low heart rates, including chest pain, palpitations, decreased stamina or leg swelling.
• Preventing lightheadedness or fainting caused by a slow heartbeat.
• Improving heart failure symptoms if your device provides cardiac resynchronization.
• Potentially saving your life by preventing your heart from stopping.

Risks and Potential Complications of Pacemakers

Risks and potential complications of a pacemaker or pacemaker implantation surgery include:

• Swelling, bleeding or bruising, particularly if you take blood thinners.
• Blood clots forming near where the device is implanted.
• Infection near the site in the heart where the leads connect.
• Damage to blood vessels or nerves.
• Allergic reactions to a medication you’re given or to one of the materials used in the pacemaker itself.
• Collapsed lung (air leaking into the space between the lung and chest wall).
• Blood in the space between the lung and the chest wall.
• In rare instances, unexpected heart rhythm problems caused by the pacemaker.
• In some cases, a pacemaker lead can get dislodged. Your doctor will recommend limiting your activity for a period of time after getting your pacemaker to avoid this.

Follow-up Care

Your physician will check your pacemaker several times a year, in the office and remotely if your pacemaker has a remote monitor.

A pacemaker’s battery usually lasts 5 to 15 years. Surgery is required to replace the battery, which is a simpler procedure with a shorter recovery period than implantation surgery.

Lead Extraction

Pacemaker leads are designed to stay attached to the heart permanently, where they are held in place by scar tissue. However, leads must be removed under certain circumstances like infection or lead malfunction. The procedure to remove them is called lead extraction.