Pacemaker Implantation

A pacemaker is a small device that’s placed (implanted) in your chest to help control your heartbeat. It’s used to prevent your heart from beating too slowly. Implanting a pacemaker in your chest requires a surgical procedure.

A pacemaker is also called a cardiac pacing device.

Types

Depending on your condition, you might have one of the following types of pacemakers.

• Single chamber pacemaker. This type usually carries electrical impulses to the right ventricle of your heart.
• Dual chamber pacemaker. This type carries electrical impulses to the right ventricle and the right atrium of your heart to help control the timing of contractions between the two chambers.
• Biventricular pacemaker. Biventricular pacing, also called cardiac resynchronization therapy, is for people who have heart failure and heartbeat problems. This type of pacemaker stimulates both of the lower heart chambers (the right and left ventricles) to make the heart beat more efficiently.

Why it’s done

A pacemaker is implanted to help control your heartbeat. Your doctor may recommend a temporary pacemaker when you have a slow heartbeat (bradycardia) after a heart attack, surgery or medication overdose but your heartbeat is otherwise expected to recover. A pacemaker may be implanted permanently to correct a chronic slow or irregular heartbeat or to help treat heart failure.

How your heart beats

The heart is a muscular, fist-sized pump with four chambers, two on the left side and two on the right. The upper chambers (right and left atria) and the lower chambers (right and left ventricles) work with your heart’s electrical system to keep your heart beating at an appropriate rate — usually 60 to 100 beats a minute for adults at rest.

Your heart’s electrical system controls your heartbeat, beginning in a group of cells at the top of the heart (sinus node) and spreading to the bottom, causing it to contract and pump blood. Aging, heart muscle damage from a heart attack, some medications and certain genetic conditions can cause an abnormal heart rhythm.

What a pacemaker does

Pacemakers work only when needed. If your heartbeat is too slow (bradycardia), the pacemaker sends electrical signals to your heart to correct the beat.

Some newer pacemakers also have sensors that detect body motion or breathing rate and signal the devices to increase heart rate during exercise, as needed.

A pacemaker has two parts:

Pulse generator. This small metal container houses a battery and the electrical circuitry that controls the rate of electrical pulses sent to the heart.

Leads (electrodes). One to three flexible, insulated wires are each placed in one or more chambers of the heart and deliver the electrical pulses to adjust the heart rate. However, some newer pacemakers don’t require leads. These devices, called leadless pacemakers, are implanted directly into the heart muscle.

Risks

Complications related to pacemaker surgery or having a pacemaker are uncommon, but could include:

• Infection near the site in the heart where the device is implanted
• Swelling, bruising or bleeding at the pacemaker site, especially if you take blood thinners
• Blood clots (thromboembolism) near the pacemaker site
• Damage to blood vessels or nerves near the pacemaker
• Collapsed lung (pneumothorax)
• Blood in the space between the lung and chest wall (hemothorax)
• Movement (shifting) of the device or leads

How you prepare

Before your doctor decides if you need a pacemaker, you’ll have several tests done to find the cause of your irregular heartbeat. Tests done before you get a pacemaker could include:

Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. An ECG can show if the heart is beating too fast, too slow or not at all.

Holter monitoring. A Holter monitor is a small, wearable device that keeps track of the heart’s rhythm. Your doctor may want you to wear a Holter monitor for 1 to 2 days. During that time, the device records all of your heartbeats. Holter monitoring is especially useful in diagnosing heartbeat problems that occur at unpredictable times. Some personal devices, such as smartwatches, offer electrocardiogram monitoring. Ask your doctor if this is an option for you.

Echocardiogram. This noninvasive test uses sound waves to produce images of the heart’s size, structure and motion.

Stress test. Some heart problems occur only during exercise. For a stress test, an electrocardiogram is taken before and immediately after walking on a treadmill or riding a stationary bike. Sometimes, a stress test is done along with echocardiography or nuclear imaging.