A pacemaker insertion is the implantation of a small electronic device in the chest (just below the collarbone) to help regulate electrical problems with the heart. When a problem develops, such as a slow heart rate, a pacemaker may be recommended to ensure that the heartbeat does not slow to a dangerously low rate.
The heart is basically a pump made up of muscle tissue that is stimulated by electrical currents, which normally follow a specific circuit within the heart.
This normal electrical circuit begins in the sinus or sinoatrial (SA) node, which is a small mass of specialized tissue located in the right atrium (upper chamber) of the heart. The SA node generates an electrical stimulus at 60 to 100 times per minute (for adults) under normal conditions; this electrical impulse from the SA node starts the heartbeat.
The electrical impulse travels from the SA node to the atrioventricular (AV) node in the bottom of the right atrium. From there the impulse continues down an electrical conduction pathway called the Bundle of His and then on through the "His-Purkinje" system into the ventricles (lower chambers) of the heart. When the electrical stimulus occurs it causes the muscle to contract and pump blood to the rest of the body. This process of electrical stimulation followed by muscle contraction is what makes the heart beat.
A pacemaker may be needed when problems occur with the electrical conduction system of the heart. When the timing of the electrical stimulation of the heart to the heart muscle and the subsequent response of the heart's pumping chambers is altered, a pacemaker may help.
A pacemaker is a life-saving medical device composed of three parts: a pulse generator, one or more leads, and an electrode on each lead. A pacemaker signals the heart to beat when the heartbeat is too slow or irregular.
A pulse generator is a small metal case that contains electronic circuitry with a small computer and a battery that regulate the impulses sent to the heart.
The lead (or leads) is an insulated wire that is connected to the pulse generator on one end, with the other end placed inside one of the heart's chambers. The lead is almost always placed so that it runs through a large vein in the chest leading directly to the heart. The electrode on the end of a lead touches the heart wall. The lead delivers the electrical impulses to the heart. It also senses the heart's electrical activity and relays this information back to the pulse generator. Pacemaker leads may be positioned in the atrium (upper chamber) or ventricle (lower chamber) or both, depending on the medical condition.
If the heart's rate is slower than the programmed limit, an electrical impulse is sent through the lead to the electrode and causes the heart to beat at a faster rate.
When the heart beats at a rate faster than the programmed limit, the pacemaker generally monitors the heart rate and will not pace. Modern pacemakers are programmed to work on demand only, so they do not compete with natural heartbeats. Generally, no electrical impulses will be sent to the heart unless the heart's natural rate falls below the pacemaker's lower limit.
A newer type of pacemaker, called a biventricular pacemaker, is currently used in the treatment of specific types of heart failure. Sometimes in heart failure, the two ventricles do not pump in a normal manner. Ventricular dyschrony is a common term used to describe this abnormal pumping pattern. When this happens, less blood is pumped by the heart. A biventricular pacemaker paces both ventricles at the same time, increasing the amount of blood pumped by the heart. This type of treatment is called cardiac resynchronization therapy or CRT.
After a pacemaker insertion, regularly scheduled appointments will be made to ensure the pacemaker is functioning properly. The doctor uses a special computer, called a programmer, to review the pacemaker's activity and adjust the settings when needed.
Other related procedures that may be used to assess the heart include resting and exercise electrocardiogram (ECG), Holter monitor, signal-averaged ECG, cardiac catheterization, chest X-ray, computed tomography (CT scan) of the chest, echocardiography, electrophysiology studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and cardiac CT scan. Please see these procedures for additional information. Note that although an MRI is a very safe procedure, a person with a pacemaker generally should not undergo MRI, as the magnetic fields used by the MRI scanner may interfere with the pacemaker's function. Any patient with a pacemaker should always speak with his or her cardiologist before undergoing an MRI.
A pacemaker may be inserted in order to provide stimulation for a faster heart rate when the heart is beating too slowly, and when other treatment methods, such as medication, have not improved the heart rate.
Problems with the heart rhythm may cause difficulties because the heart is unable to pump an adequate amount of blood to the body. If the heart rate is too slow, the blood is pumped too slowly. If the heart rate is too fast or too irregular, the heart chambers are unable to fill up with enough blood to pump out with each beat. When the body does not receive enough blood, symptoms such as fatigue, dizziness, fainting, and/or chest pain may occur.
Some examples of heart rate and rhythm problems for which a pacemaker might be inserted include:
There may be other reasons for your doctor to recommend a pacemaker insertion.
Possible risks of pacemaker include, but are not limited to, the following:
If you are pregnant or suspect that you may be pregnant, you should notify your health care provider. If you are breastfeeding, you should notify your health care provider.
Patients who are allergic to or sensitive to medications or latex should notify their doctor.
For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
A pacemaker may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, a pacemaker insertion follows this process:
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. A nurse will monitor your vital signs.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain at the incision site.
After the period of bed rest has been completed, you may get out of bed with assistance. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the period of bedrest.
You will be able to eat or drink once you are completely awake.
The insertion site may be sore or painful. Pain medication may be administered if needed.
Your doctor will visit with you in your room while you are recovering. The doctor will give you specific instructions and answer any questions you may have.
Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged home.
If the procedure is performed on an outpatient basis, you may be allowed to leave after you have completed the recovery process. However, it is common to spend at least one night in the hospital after pacemaker implantation for observation.
You should arrange to have someone drive you home from the hospital following your procedure.
You should be able to return to your daily routine within a few days. Your doctor will tell you if you will need to take more time in returning to your normal activities. You should not do any lifting or pulling on anything for a few weeks. You may be instructed to limit movement of the arm on the side that the pacemaker was placed, based on your doctor's preferences.
You will most likely be able to resume your usual diet, unless your doctor instructs you differently.
It will be important to keep the insertion site clean and dry. You will be given instructions about bathing and showering.
Your doctor will give you specific instructions about driving.
Ask your doctor when you will be able to return to work. The nature of your occupation, your overall health status, and your progress will determine how soon you may return to work.
Notify your doctor to report any of the following:
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
The following precautions should always be considered. Discuss the following in detail with your doctor, or call the company that made your device:
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