Diseases & Conditions

Pacemakers are used to treat diseases like a slow heartbeat (bradycardia), fainting spells (syncope), and heart failure that are connected to heart rhythm issues.

Cardiomyopathy with hypertrophy

Our electrophysiologists are skilled at treating bradycardia with pacemakers. Normally, your heart beats 60 to 100 times in a minute. Your heart beats less frequently than 60 times per minute if you have bradycardia.

There are two types of bradycardia:

• Sinus node dysfunction - This form of bradycardia happens when the sinus atrial (SA) node's electrical signal slows or vanishes entirely and the SA node fails to generate adequate beats.

• AV block - Not all heartbeats can move from the top chamber to the bottom chamber of the heart in this form of bradycardia. An AV block can range in severity from low to high.

 

Diagnosis

Pacemakers only function when necessary. The pacemaker gives electrical instructions to your heart to adjust the beat if it beats too slowly (bradycardia).

A few more recent pacemakers also feature sensors that notice changes in breathing or body movements and alert the devices when it is necessary to raise heart rate during exercise.

A pacemaker has two parts:

• A generator of pulses. The electrical circuitry that regulates the frequency of electrical pulses delivered to the heart is housed in this tiny metal container together with a battery.

• Leads (electrodes). The electrical pulses necessary to modify heart rate are delivered by one to three flexible, insulated wires that are individually inserted into one or more heart chambers. Some more recent pacemakers, however, do not require leads. Direct implantation of these leadless pacemakers takes place within the cardiac muscle.

 

Treatments

How you prepare

A number of tests will be performed on you to determine the reason of your irregular heartbeat before your doctor decides if you need a pacemaker. Before getting a pacemaker, tests might be performed including:

• Electrocardiogram (ECG) (ECG or EKG). The electrical activity of the heart is measured by this rapid and totally painless examination. Electrodes are applied to the arms, legs, and occasionally the chest in the form of sticky patches. The electrodes are connected by wires to a computer, which shows the test findings. If the heart is beating very quickly, too slowly, or not at all, an ECG might reveal this.
• Holter tracking. The heart's rhythm is monitored using a tiny, wearable device called a Holter monitor. For one to two days, your doctor could ask you to wear a Holter monitor. All of your heartbeats are captured by the device during that time. Holter monitoring is particularly helpful in identifying irregular heartbeats that happen at unusual periods. Smartwatches and other personal electronics provide electrocardiogram monitoring. If this is an option for you, you should ask your doctor.
• Echocardiogram. Images of the size, composition, and velocity of the heart are created during this noninvasive test using sound waves.
• Test for stress. Some heart issues manifest during physical activity. An ECG is performed prior to and immediately following a treadmill or stationary bike test. Together with nuclear imaging or echocardiography, a stress test may occasionally be performed.

What you can expect

Before the procedure

During the several-hour procedure to implant the pacemaker, you'll probably be awake. A specialist would place an IV in your hand or forearm and administer a sedative to help you unwind. A specific soap is used to wash your chest after that.

Local anesthetic is frequently used to numb the site of the incisions during pacemaker implantations. However, the level of sedation required for the treatment will vary depending on your unique medical issues. You might be mildly drugged or fully awake, or you might need general anesthesia (fully asleep).

During the procedure

Using X-ray images, one or more wires are put into a significant vein under or close to your collarbone and led to your heart. The right location in your heart is where one end of each cable is fixed, and the other end is connected to the pulse generator, which is often implanted under the skin just below your collarbone.

A smaller, less intrusive surgery is often needed to implant a leadless pacemaker. One capsule houses both the pulse generator and other pacemaker components. A flexible sheath (catheter) is inserted by the physician into a vein in the groyne, and the single component pacemaker is then manoeuvred through the catheter to the desired location within the heart.

After the procedure

After getting a pacemaker implanted, you'll probably spend a day in the hospital. Your pacemaker would be set up to match your requirements for cardiac rhythm. You have to make arrangements for transportation home from the hospital.

After having your pacemaker implanted, you should refrain from demanding tasks for approximately 4 to 6 weeks. You should be able to participate in most activities and sports after this. However, if you participate in contact sports like football or rugby, you should try to prevent collisions. Consider donning a protective pad.

Your doctor might advise not engaging in strenuous activity or heavy lifting for roughly a month. Keep your hands off the place where the pacemaker was inserted. Ask your doctor if you can take over-the-counter medications like acetaminophen (Tylenol, among others) or ibuprofen if you experience discomfort there (Advil, Motrin IB, others).

Special precautions

It's unlikely that electrical interference would cause your pacemaker to stop functioning properly. However, there are a few safety measures you must take:

• Cellphones. The safest distance between your pacemaker and your telephone is at least 6 inches (15 centimetres). Keep your phone out of your shirt pocket. Hold your phone up to your ear while speaking on the line that isn't your pacemaker's side.

• Security measures Your pacemaker won't be affected by going through a metal detector at the airport, but the pacemaker's metal components can set off the alarm. However, avoid standing too close to or leaning against a metal-detection device.

To avoid potential problems, you should carry an ID card stating that you have a pacemaker.

• Medical supplies. Ensure that every dentist and medical professional is aware that you have a pacemaker. Your pacemaker may be affected by some medical treatments like magnetic resonance imaging, CT scans, cancer radiation therapy, electrocautery to control bleeding during surgery, and shock wave lithotripsy to disintegrate big kidneys or gallstones.
• Tools for generating electricity. Stand at least 2 feet (61 cm) away from motor-generator systems, high-voltage transformers, and welding equipment. If you use such equipment at work, talk to your doctor about setting up a test there to see if it affects your pacemaker.