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Heart pacemaker

Cardiac pacemaker implantation; Artificial pacemaker; Permanent pacemaker; Internal pacemaker; Cardiac resynchronization therapy; CRT; Biventricular pacemaker; Arrhythmia - pacemaker; Abnormal heart rhythm - pacemaker; Bradycardia - pacemaker; Heart block - pacemaker; Mobitz - pacemaker; Heart failure - pacemaker; HF - pacemaker; CHF- pacemaker

A pacemaker is a small, battery-operated device. This device senses when your heart is beating too slowly. It sends a signal to your heart that makes your heart beat at the correct pace.

Description

Newer pacemakers weigh as little as 1 ounce (28 grams). Most pacemakers have 2 parts:

  • The generator contains the battery and the information to control the heartbeat.
  • The leads which are wires that connect the heart to the generator and carry the electrical messages to the heart.

A pacemaker is implanted under the skin. This procedure takes about 1 hour in most cases. You will be given a sedative to help you relax. You will be awake during the procedure.

A small incision (cut) is made. Most often, the cut is on the left side (if you are right handed) of the chest below your collarbone. The pacemaker generator is then placed under the skin at this location. The generator may also be placed in the abdomen, but this is less common. A new "leadless" pacemaker is a self-contained unit that is implanted in the right ventricle of the heart.

Using live x-rays to see the area, the doctor puts the leads through the cut, into a vein, and then into the heart. The leads are connected to the generator. The skin is closed with stitches. Most people go home within 1 day of the procedure.

There are 2 kinds of pacemakers used only in medical emergencies. They are:

  • Transcutaneous pacemakers
  • Transvenous pacemakers

They are not permanent pacemakers.

Why the Procedure Is Performed

Pacemakers may be used for people who have heart problems that cause their heart to beat too slowly. A slow heartbeat is called bradycardia. Two common problems that cause a slow heartbeat are sinus node disease and heart block.

When your heart beats too slowly, your body and brain may not get enough oxygen. Symptoms may be

Some pacemakers can be used to stop a heart rate that is too fast (tachycardia) or that is irregular.

Other types of pacemakers can be used in severe heart failure. These are called biventricular pacemakers. They help coordinate the beating of the heart chambers.

Most biventricular pacemakers implanted today can also work as implantable cardioverter defibrillators (ICD). ICD restore a normal heartbeat by delivering a larger shock when a potentially deadly fast heart rhythm occurs.

Risks

Possible complications of pacemaker surgery are:

  • Abnormal heart rhythms
  • Bleeding
  • Punctured lung. This is rare.
  • Infection
  • Puncture of the heart, which can lead to bleeding around the heart. This is rare.

A pacemaker senses if the heartbeat is above a certain rate. When it is above that rate, the pacemaker will stop sending signals to the heart. The pacemaker can also sense when the heartbeat slows down too much. It will automatically start pacing the heart again.

Before the Procedure

Always tell your health care provider about all the drugs you are taking, even drugs or herbs you bought without a prescription.

The day before your surgery:

  • Shower and shampoo well.
  • You may be asked to wash your whole body below your neck with a special soap.

On the day of the surgery:

  • You may be asked not to drink or eat anything after midnight the night before your procedure. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
  • Take the drugs you have been told to take with a small sip of water.

Your provider will tell you when to arrive at the hospital.

After the Procedure

You will probably be able to go home after 1 day or even the same day in some cases. You should be able to return to your normal activity level quickly.

Ask your provider how much you can use the arm on the side of your body where the pacemaker was placed. You may be advised not to:

  • Lift anything heavier than 10 to 15 pounds (4.5 to 6.75 kilograms)
  • Push, pull, and twist your arm for 2 to 3 weeks.
  • Raise your arm above your shoulder for several weeks.

When you leave the hospital, you will be given a card to keep in your wallet. This card lists the details of your pacemaker and has contact information for emergencies. You should always carry this wallet card with you. You should try to remember the name of the pacemaker manufacturer if you can in case you lose your card.

Outlook (Prognosis)

Pacemakers can help keep your heart rhythm and heart rate at a safe level for you. The pacemaker battery lasts about 6 to 15 years. Your provider will check the battery regularly and replace it when necessary.

Open References

References

Chung MK, Daubert JP. Pacemakers and implantable cardioverter-defibrillators. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 69.

Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013;61(3):e6-e75. PMID: 23265327 pubmed.ncbi.nlm.nih.gov/23265327/.

Miller JM, Ellenbogen KA. Therapy for cardiac arrhythmias. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 64.

Pfaff JA, Gerhardt RT. Assessment of implantable devices. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 13.

  • Heartbeat

    Animation

    •  

    Heartbeat - Animation

    The heart has four chambers and four main blood vessels that either bring blood to the heart, or carry blood away. The four chambers are the right atrium and right ventricle and the left atrium and left ventricle. The blood vessels include the superior and inferior vena cava. These bring blood from the body to the right atrium. Next is the pulmonary artery that carries blood from the right ventricle to the lungs. The aorta is the body's largest artery. It carries oxygen-rich blood from the left ventricle to the rest of the body. Beneath the tough fibrous coating of the heart, you can see it beating. Inside the chambers are a series of one-way valves. These keep the blood flowing in one direction. Dye injected into the superior vena cava, will pass through all the heart's chambers during one cardiac cycle. Blood first enters the heart's right atrium. A muscle contraction forces the blood through the tricuspid valve into the right ventricle. When the right ventricle contracts, blood is forced through the pulmonary semilunar valve into the pulmonary artery. Then it travels to the lungs. In the lungs, the blood receives oxygen then leaves through the pulmonary veins. It returns to the heart and enters the left atrium. From there, blood is forced through the mitral valve into the left ventricle. This is the muscular pump that sends blood out to the rest of the body. When the left ventricle contracts, it forces blood through the aortic semilunar valve and into the aorta. The aorta and its branches carries the blood to all the body's tissues.

  • Pacemaker

    Pacemaker - illustration

    A pacemaker is a small, battery-operated electronic device which is inserted under the skin to help the heart beat regularly and at an appropriate rate. The pacemaker has leads that travel through a large vein to the heart, where the wires are anchored. The leads send the electrical impulses to the heart to tell it to beat.

    Pacemaker

    illustration

  • Heartbeat

    Animation

    •  

    Heartbeat - Animation

    The heart has four chambers and four main blood vessels that either bring blood to the heart, or carry blood away. The four chambers are the right atrium and right ventricle and the left atrium and left ventricle. The blood vessels include the superior and inferior vena cava. These bring blood from the body to the right atrium. Next is the pulmonary artery that carries blood from the right ventricle to the lungs. The aorta is the body's largest artery. It carries oxygen-rich blood from the left ventricle to the rest of the body. Beneath the tough fibrous coating of the heart, you can see it beating. Inside the chambers are a series of one-way valves. These keep the blood flowing in one direction. Dye injected into the superior vena cava, will pass through all the heart's chambers during one cardiac cycle. Blood first enters the heart's right atrium. A muscle contraction forces the blood through the tricuspid valve into the right ventricle. When the right ventricle contracts, blood is forced through the pulmonary semilunar valve into the pulmonary artery. Then it travels to the lungs. In the lungs, the blood receives oxygen then leaves through the pulmonary veins. It returns to the heart and enters the left atrium. From there, blood is forced through the mitral valve into the left ventricle. This is the muscular pump that sends blood out to the rest of the body. When the left ventricle contracts, it forces blood through the aortic semilunar valve and into the aorta. The aorta and its branches carries the blood to all the body's tissues.

  • Pacemaker

    Pacemaker - illustration

    A pacemaker is a small, battery-operated electronic device which is inserted under the skin to help the heart beat regularly and at an appropriate rate. The pacemaker has leads that travel through a large vein to the heart, where the wires are anchored. The leads send the electrical impulses to the heart to tell it to beat.

    Pacemaker

    illustration

 

Review Date: 10/5/2022

Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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