If you’ve been told you need a pacemaker, you probably have a lot of questions, perhaps starting with: How does it work?
It’s helpful to start with a quick lesson in anatomy: When your heart beats, the muscle contracts and pumps blood, delivering oxygen to the entire body. Each beat is generated by the heart’s electrical system: In the upper chamber of your heart, the sinus node sends an electric signal to start the contraction, and that signal is carried to the lower chamber by a network of cell pathways called the conduction system.
The sinus node is considered your body’s natural pacemaker because it ensures that this beat happens at the correct pace for your activity level.
For some people, this natural pacemaker or the conduction system stops working properly, causing your heart to beat too slowly.
“The upper chamber might become too slow, or the pathways may have wear and tear,” says UNC Health cardiac electrophysiologist Anil Gehi, MD. “It’s most common to see this degeneration due to age-related changes, but other conditions that lead to this include congestive heart failure or a heart attack.”
A slowed heart rate can cause lightheadedness, to the point of passing out, fatigue or a limited ability to exert yourself.
If your doctor has determined that there’s not a treatable cause for your slowed heartbeat, they may recommend a pacemaker, which will monitor your heart’s natural electrical system and step in to assist it when necessary by sending a signal to create a heartbeat.
Dr. Gehi explains what you need to know about this device and the implant procedure.
1. Pacemaker implantation is a minimally invasive procedure that doesn’t require major surgery.
When your doctor suggests a pacemaker, you might feel overwhelmed or fearful.
“People hear ‘pacemaker’ and think it will be a big heart surgery,” Dr. Gehi says. “It’s not an invasive, open chest procedure. We make a two-inch incision in the upper chest, and most people go home the same day.”
Dr. Gehi says that the most common pacemaker device has a pulse generator that’s slightly bigger and thicker than a half dollar, with two leads, or thin wires, that are attached to the chambers of the heart through the veins.
“The devices are much smaller than people expect,” Dr. Gehi says. “They’re almost invisible under the skin. You might feel it if you press on the chest, but most people don’t notice them.”
2. Pacemakers don’t shock the heart.
Dr. Gehi says that some people confuse a pacemaker with an internal defibrillator, which looks similar because it has a generator and leads, but that the devices treat different heart issues.
“The pacemaker is for slow heart rhythms, and if the heart goes too slow because the natural pacemaker or conduction system is not functioning properly, the device sends an electrical stimulation to the heart to make it go at a normal pace,” Dr. Gehi says. “The amount of energy needed is so low that you won’t feel it. A defibrillator device treats a fast rhythm, and if you go into cardiac arrest, it will act quickly by shocking the heart to resuscitate it.”
Most times, a defibrillator shock is noticeable and painful—a consequence of a life-saving intervention. However, when you have a pacemaker, you will mostly be unaware it is there, even when it is frequently pacing your heart.
3. Lifestyle limitations are minimal with a pacemaker.
After your pacemaker is placed, you’ll need to take it easy while your wound heals. But once your doctor gives the OK, you’re free to pursue an active life, including regular exercise.
People with pacemakers used to receive a long list of appliances that could potentially interfere with their pacemaker’s function, but Dr. Gehi says the devices have evolved so that most of those old precautions no longer apply.
“It used to be that you couldn’t stand near a microwave or have an MRI, but that’s changed, and now you don’t have to worry,” Dr. Gehi says. “It’s OK to hold a cell phone. There are some very minor precautions for situations that could produce electromagnetic interference, but it’s usually not an issue.”
For example, when you fly, you will need to alert security staff to the presence of your pacemaker, but it will be safe to go through detectors.
Your doctor will provide information specific to your pacemaker and tell you if anything should be avoided.
4. Your doctor will get a real-time view of your heart through your pacemaker.
Your pacemaker can communicate with your doctor, allowing them to check how your heart and the device are working. You’ll still see your doctor in person as recommended, but they will also monitor your heart function remotely.
“Alongside the basic pacing function, the pacemakers are also very sophisticated cardiac monitoring systems. Your device can communicate to your cardiac team through your cell phone or a console you can put next to the bed,” Dr. Gehi says. “That connects with the pacemaker and sends us information about any heart issues.”
That includes basic information about pacemaker function such as how often the pacemaker was required to prompt a beat, insight into other cardiac rhythm disturbances and the status of conditions such as congestive heart failure.
Pacemakers operate by battery, and the remote monitoring system will alert your physician if you need a battery replacement. There can sometimes be wear and tear on the leads, but most pacemaker systems last more than a decade.
Questions about heart health? Talk to your doctor. If you need a doctor, find one near you.The post 4 Things to Know About Pacemakers first appeared on UNC Health Talk.
