• Your Heart’s Electrical System
• How a Pacemaker Can Help Your Heart
• Living With Your Pacemaker
The reason for a Pacemaker?
Your doctor may have told you that you need a pacemaker –
to understand why you need a pacemaker you must understand the electrical
system of the heart and how it regulate your heart beat, it is too
slow or irregular. Problems with this electrical system can make
your heart’s pace slow or uneven, possible leaving you feeling
tired or even faint. A pacemaker is a small electronic device that
will regulate your electrical system, keeping the your heart beating
at the right pace.
Signs and Symptoms
of a Slow Heartbeat
Your heartbeat may be slow all the time or only every so often.
When your hearts’ pace is slow or uneven, you may feel one
or several of these symptoms:
• Shortness of breath
• Fainting spells
These symptoms are usually most noticeable when
you are trying to do something physical, such as walking or climbing
How and Who implants
Having a pacemaker implanted is a fairly simple surgical procedure,
but it does require a lifelong commitment, working with your Cardiologist.
This specially trained physician is called an Electrophysiologist.
This specialist’s job is to implant and oversee the function
of your pacemaker on a regular basis. With proper care, a pacemaker
can help keep you feeling good for many years to come.
How Your Heart’s
Electrical system Work
Your hearts’ job is to keep blood moving through your body.
To do this, your heart beats many times each minute. Signals from
your heart’s electrical system tell it when to beat. If there
is a problem with these signals, your heart may not beat when it
should. This doesn’t always mean you’ve had a heart
attack or have a problem with your blood vessels - it simply means
your heart’s not beating often enough.
Signals Tell your Heart
Your heart is divided into four chambers that hold blood as it moves
through the heart. The two upper chambers are the atria and the
two lower chambers are the ventricles. When the heart beats, the
atrial contract (squeeze) to move blood to the ventricles and the
ventricles contract to move blood out to the rest of the body. Certain
areas of the hearts’ electrical system, known as nodes, send
the signals that tell the chambers when to contract. When you’re
active, these signals speed up to move your blood faster. When you’re
resting, the signals return to a slower pace.
Problems with Your Signals
Sometimes your heart’s signals don’t work properly.
The signals from the SA node may be too slow (sinus bradycardia),
may alternate between being too fast and too slow (sick sinus syndrome),
or may occasionally stop (sinus pause). Or, signals may not be able
to leave the AV node or move along the pathways to the ventricles
(heartblock). These problems mean that the atria, the ventricles,
or both contract at too slow a pace – fewer times each minute
than they should.
What is a Pacemaker?
When there’s a problem with your heart’s electrical
system, a pacemaker can help. A pacemaker is a small, lightweight,
electronic device that’s placed inside your body. The pacemaker
keeps track of your heartbeat and, when necessary, generates electrical
signals similar to the heart’s natural signals. These signals
keep your heart beating at the right pace.
What a Pacemaker Does
A pacemaker helps to keep your heart from beating too slowly, but
it doesn’t stop your heart from beating on its own. The pacemaker
“listens” to your heart. When the hearts own electrical
system sends a signal and the heartbeats, the pacemaker waits and
does nothing. When the hearts’ system misses a signal, the
pacemaker sends a signal to replace it.
Types of Pacemakers
Your doctor will choose the type of pacemaker that’s best
for you. A pacemaker with one lead is called a single-chamber pacemaker.
A Pacemaker with two leads is called a dual-chamber pacemaker.
Implanting Your Pacemaker
Inserting the pacemaker into your body is called implantation. Pacemaker
implantation is not open-heart surgery. Rather, it is a minor procedure
that is done in an operating room or cardiac catheterization lab.
You will be given instructions on how to prepare for the procedure.
Pacemakers can be inserted near the right or left shoulder. If you
prefer to have it implanted on a particular side, discuss your preference
with your doctor.
Preparing for the Pacemaker
Ask your doctor whether you should stop taking aspirin or other
medication before your procedure. Unless instructed otherwise, don’t
eat or drink anything for six hours before the procedure. You’ll
probably be admitted to the hospital on the day of the procedure.
Before the procedure begins, you may be given some medication to
help you relax. The skin where the pacemaker is implanted may be
washed and shaved.
Implanting a pacemaker is a simple procedure involving little risk.
But, as with any other surgical procedure, there can be complications.
You will be asked to sign a consent form stating that you understand
the procedure, risks of implantation and give your permission to
perform the procedure. The possible risks of implanting a pacemaker
include the following:
• Bleeding or severe bruising
• Tearing of the vein or artery wall
• Clotting or air bubbles in the vein
• Puncture of the lung or heart muscle
• Infection or nerve damage at the incision site
During the Procedure
The most common method used to insert a pacemaker is call endocardial
(“inside the heart”) implantation. In many cases, this
procedure takes one to tow hours. You stay awake during the procedure.
If so, you’ll probably hear the surgical team talking. You
may be asked some questions or be asked to take some deep breaths
during the procedures by the your physician or the staff.
Implanting the Pacemaker
This a how endocardial implantation is commonly done:
• A local anesthetic is given by injection
to numb the area where the pacemaker will be inserted. This keeps
you from feeling pain during the procedure.
• An incision in made in your skin below your collarbone
to create a small “pocket”.
• The lead is threaded through the incision into the vein
in your upper chest. The lead is then guided into your heat’s
chambers using x-ray monitors. Electrical measurements are taken
to determine a good position for the lead in the heart. If there
is a second lead, this process in repeated.
• The pacemaker generator is attached to the lead or leads.
Then, the generator is placed in the pocket under your skin.
• The pacemaker’s settings are programmed to help
your heart beat at a rate that is right for you. The incision
is then closed and covered with a sterile dressing.
After Your Pacemaker
After your pacemaker is implanted, you’ll probably stay in
the hospital for a day or two to be sure that there are no further
heartbeat problems. When you go home you may be given instructions
on how to take care of the incision site as it heals. Your doctor
may also schedule some follow-up visits.
In the Hospital
During your stay in the hospital, your heart’s signals are
monitored to be sure the pacemaker is working correctly. A nurse
may take your pulse and blood pressure regularly and check your
incision for bleeding or swelling. To give the lead or leads a chance
to secure themselves inside the vein and your heart, it will be
recommended that you do not lift your arm above your shoulder on
the side where the pacemaker was implanted. It’s normal to
have some pain and stiffness in the area around your incision for
a week or so. Pain medication can help make you more comfortable.
Please remember to talk to your nurse if you feel any unusual symptoms
like hiccups that won’t go away, dizziness, chest pain, and
shortness of breath or difficulty taking deep breaths.
Once You are Home
A few days after leaving the hospital, you can go back to most of
your daily activities. But take it easy for a few weeks as to continue
the healing process inside your body and to insure that the leads
are kept in place once all daily activities resume. Be careful not
to hit or rub the insertion site. Also avoid activities like heavy
lifting, running, or contact sports. Every day, take your temperature
and check your incision for signs of infection. Ina week or two,
you may visit the doctor to have your sutures or staples removed,
if necessary, and to check how your incision is healing.
The Fist Few Months
After your Procedure
Your incision should heal completely within about a month after
the procedure. Continue to avoid letting anything rub or hit your
pacemaker. Don’t fiddle or play with the pacemaker under your
skin. Your may feel numbness or fullness in the area around the
pacemaker for a few months after the implantation procedure. which
When to Call Your Doctor
• You have signs of an infection (a fever,
redness, swelling, or warmth at the incision site, drainage from
• You fell any of the symptoms you had before the pacemaker
How to Care for Your
To be sure your pacemaker is working correctly, you will be asked
to visit your doctor or pacemaker clinic several times a year. During
these visits, the pacemaker’s settings can be adjusted if
necessary. Your pacemaker can also be checked from your home. Pacemaker
batteries and leads occasionally need to be replaced – your
doctor will tell you when this needs to be done.
Regular visits to the doctor’s office, pacemaker clinic, or
hospital help make sure your pacemaker is working correctly. During
these visits, tests such as an electrocardiogram (EKG or ECG) are
performed. Your pacemaker’s battery level is also checked.
As the battery begins to run low, the pacemaker send a signal that
can be seen during routine tests, There’s still plenty of
time to replace the battery when the signal is sent, so you don’t
have to worry about the battery running dowm unexpectedly.
Making Pacemaker Adjustments
From time to time, the pacemaker’s setting may need to be
readjusted to better help your heart. For most pacemakers, adjustments
can be done from outside the body, so surgery is not required. Your
doctor will determine whether your pacemaker’s settings need
adjusting and can make there adjustments during a follow-up visit.
A computer device is used outside the body, and without cutting
the skin, to acquire pacemaker function information as well as changing
the settings to make your pacemaker function at the best possible
Checking Your Pacemaker
You may occasionally be asked to help check your pacemaker by sending
signals to your doctor or pacemaker clinic by phone, or by checking
• If your doctor recommends that you
send signals by phone, your doctor will arrange for the telephone
monitoring service. This service allows you to use a special transmitter
to send your pacemaker signals over the phone lines. A doctor
or specially trained technician will analyze the recorded signals
and checks that everything is running smoothly. Your doctor will
tell you how often you need to use this service.
• Checking your pulse regularly is not necessary, but you
may be asked to check if from time o time. Your nurse or doctor
can show you how to do it correctly.
Replacing the Battery
Pacemaker batteries usually last for about 5 to 10 years before
they need to be replaced. Because the battery is sealed inside the
generator, replacing a battery requires replacing the entire generator.
This procedure is usually simpler and shorter than the initial implantation.
To replace the generator, the pacemaker pocket is opened, the old
generator, is detached from the leads, the leads are tested, the
new generator is attached to the leads, and the pocket is closed.
If a new lead is added, the procedure will most likely be similar
to your original implantation. Occasionally, the leads wear out
and need to be replaced. In this case, replacing the leads may require
a more complicated and riskier procedure.
When to Call Your Doctor
• Dizziness, lightheadedness, lack of
energy, or fainting spells-symptoms you had before the pacemaker
• Fever and chills.
• Rapid or pounding heartbeat or shortness of breath.
• Pain in the area around your pacemaker.
• Swelling on the arm closest to the incision site.
Living With Your Pacemaker
It is not difficult to live with a pacemaker. You can usually do
almost everything you did before you got your pacemaker, since you
probably feel better, you may even do more. One of the things you
might do is exercise, which is a great way to improve your health.
Also, see your doctor regularly to help ensure that you remain healthy
and feeling good.
Remember to Always
Carry Your Pacemaker ID Card
When you first get your pacemaker, you will be given a card to carry.
This ID card contains important information about your pacemaker.
Show it to any doctor, dentist, or other medical professional you
visit. Also, because pacemakers tend to set off security devices
like those found in airports, libraries, department and grocery
stores, you may need to show your card to security personnel.
Exercise is usually good for you and your heart. It can help make
you healthier and help you feel your best. Ask your doctor whether
exercise is right for you and, if it is, to recommend an exercise
program for you. This program may include activities such as swimming,
walking, bicycling, jogging, tennis, or another activity you enjoy.
Certain activates, like racquetball or contact sports, probably
should be avoided because they may cause your pacemaker to get bumped.
You do not have to worry about most outside signals. Modern pacemakers
are well protested from outside signals, so there are very few things
that can interfere with your pacemaker. But if you ever feel symptoms
that make you think that a device is disrupting your pacemaker’s
signals, turn the device off or move away. Your symptoms should
stop and your pacemaker should not be damaged. To be safe, check
with your doctor should that situation occur.
Microwave ovens and other appliances that are in good repair will
not interfere with your pacemaker. Things like computers, hair dryers,
power tools, radios, television, stereos, electric blankets, vacuum
cleaners, heating pads, and cars are all OK to use.
• Stay In touch with your Doctor
• Follow all recommendations about caring for your pacemaker
• Take medications as prescribed
• Call your physician should you have any symptoms as described
in this information.
• Discuss any concerns you may have regarding your health.