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Heart Pacemakers

Pacemakers are very small computers about the size of a coin. They are usually implanted just underneath the skin in the chest area. A pacemaker monitors the heart’s rate (how fast it beats) and rhythm (the pattern in which it beats) and provides electrical stimulation when the heart does not beat or beats too slowly. To provide support, the pacemaker sends a tiny electrical pulse down a wire or wires into your heart, stimulating the heart to beat. The pacemaker also stores information about your heart, which can be retrieved by your doctor. This helps your doctor to program the settings of the pacemaker to provide you with the best therapy for your needs. Pacemakers cannot be damaged by properly operating household appliances, such as microwave ovens. Pacemakers can help to reduce symptoms of dizziness and fatigue brought on by a slow heart rhythm, helping patients to enjoy a better quality of life.

Why do I need a pacemaker?

Your heart is a muscle about the size of your fist and has a complex electrical system. It generates its own electricity, which causes it to contract and relax in the proper timing sequence, pumping blood to the body. For the heart to work correctly, the chambers must beat in a coordinated manner at a resting heart rate between 60 and 100 beats per minute. Electrical signals can become blocked or irregular, causing the heart to beat too quickly (tachycardia) or too slowly (bradycardia).

There are two common causes of bradycardia: sick sinus syndrome, which is a disease of the sinoatrial (SA) node, the heart’s natural pacemaker and heart block, which occurs when the upper chambers (atria) and lower chambers (ventricles) are not coordinated, resulting in atrioventricular (AV) block (also commonly called heart block). These diseases can cause the heart to beat too slowly, either occasionally or all the time. In both cases, the heart might not pump enough blood to meet the body’s needs. As the heart rate declines, there might not be sufficient blood flow to the brain, causing lightheadedness and (sometimes) fainting. Pacemakers will protect you from these symptoms

What will the pacemaker do for you?

Pacemakers are  battery-powered small computers that are usually implanted just underneath the skin in the chest area. To provide electrical support, the device sends a tiny electrical pulse down a wire, called a lead, into your heart, which stimulates the heart to beat. These impulses are very tiny,and most people do not feel them at all. While the device is helping your heart to maintain its rhythm, it is also storing a lot of information about your heart. This information can be retrieved by your doctor, and it helps him or her to program your device in a way that provides you with the best therapy for your condition.

Can  pacemakers be suited for my lifestyle?

Today’s pacemakers have the capability for their settings to be adjusted by your physician in order to provide appropriate support for a wide range of lifestyles and activities. If you enjoy walking, playing golf, swimming or participating in most other activities, you need not worry. Your doctor can help provide you with a device that meets both your medical and lifestyle needs.

How is a pacemaker implanted?

Usually, surgery for an implanted cardiac device is not done under full anesthesia. It is generally implanted under what doctors call “conscious sedation.” You will be given medication to help you relax, but you will still be aware of your surroundings and able to hear and even talk with the medical team as the procedure is being conducted. Numbing medication will be given where the incision is to be made.

The doctor will first make a small cut in the upper chest and locate a vein. A small puncture is made in the vein, and the leads, long flexible wires, will be guided down the vein to the heart. The surgical team monitors the placement of the lead using a large overhead monitor called a fluoroscope. This is a kind of moving x-ray picture. The leads must be placed in exactly the right spot for best results, so this is often the most time-consuming part of the operation. Once that is done, the doctor will test the leads to make sure that they are in the best position to deliver energy to the heart. After the leads are in place, your doctor might ask you to go through some simple maneuvers, such as taking a deep breath or coughing vigorously, to help assess the stability of the lead. Then, he or she will make a “pocket” by separating the skin and underlying tissue from the muscle beneath the tissue. After the pulse generator is connected to the leads, it is placed in that pocket. Once the device is in place, the doctor will sew up the incision. Many people just notice a small scar and a small bump after the incision heals. However, in people who are very small or thin, the device might stick out more.

What problems are associated with having a pacemaker?

Implanting a pacemaker is considered minor surgery, but a small number of patients will develop complications because of the implant procedure. They may include infection, a reaction to a drug used during surgery or to the device itself and blood loss or damage to a blood vessel, the heart wall or other organs. These complications can usually be corrected or cured, but may require a repeat operation or a longer than normal hospital stay. After the surgery, you will feel some discomfort, and you will be tired. As you recover, you will feel better. However, some patients continue to feel some discomfort where the pacemaker is implanted. Always, remember these are man-made devices. It is important to monitor the device regularly with follow-up visits as often as your doctor recommends.

What happens after the surgery?

Right after the surgery, you will be taken to a recovery room. You may experience some tenderness at the implant site for a while. You may stay in the hospital several hours or several days.  In the period after surgery, follow all of your physician’s instructions carefully. Above all, be sure to report any redness, soreness or tenderness around the implant site. If you are already back home when you notice redness or soreness around your scar, call your doctor immediately—do not wait for your next appointment.

You will be asked to see your doctor regularly for routine checkups. Sometimes minor adjustments are required, which can be done painlessly in the doctor’s office using a tabletop computer called a programmer. Your doctor will also want to check the incision to see how it is healing. After that, your physician will want to see you for regular follow-up visits.  The follow-up is completely painless and usually takes less than half an hour. During this time, the doctor or nurse will put a wand over the spot where the device is implanted. The wand is about the size and shape of a television remote control device. The device tells the programmer about the battery status, performs other system checks and can report on your heart’s rhythms since your last follow-up.

What about the batteries?

Implantable devices are powered by special batteries that are made to last a long time. These batteries do not suddenly wear out, like flashlight batteries, but they give plenty of warning that they are reaching end of service. Your doctor will monitor the battery as part of your regular device check-up. Most device batteries last five to ten years although it depends on the device and how often it sends electrical impulses to the heart. When the device indicates a low battery, your physician will arrange for a replacement. Implantable devices are sealed shut, so the batteries are not replaceable. Instead, your doctor will implant a new device. Typically, this surgery does not last as long as your original device implant because your new device will simply be plugged into the leads that have already been placed in your heart.

Precautions for your pacemaker:

Implantable devices cannot be damaged by using properly operating household appliances, such as microwave ovens, electric blankets and most power tools. Using electric arc welders or working on automobile ignition systems also will not damage pacemakers; however, there is a possibility that they may briefly interfere with proper pacemaker operation. Some medical equipment also may interfere with the function of the pacemaker. If you become lightheaded or feel palpitations (rapid, irregular heartbeats), you should simply turn off the electrical equipment or walk away from it, and the implanted device should resume normal operation.

If you are going into a hospital or tell the hospital personnel that you have a pacemaker before you undergo any medical procedure, such as electrosurgery, electrocautery, external defibrillation, lithotripsy or radiation therapy, or a dental procedure or test. Do not enter areas that have a “no pacer” symbol posted.

Cellular phones, which send electromagnetic signals, can interfere with proper device operation. However, simple precautions—such as not carrying the phone in a breast pocket over the pacemaker and holding it to the ear that is farthest from the pacemaker—minimize the risk.

Though many patients worry about airport security systems, there is really no need for concern. It is true that airport security has been tightened, but this does not place an added burden on you in terms of your implanted device. The best thing to do when you reach airport security is to walk through the metal detector at a normal pace. If the alarm sounds (it may or may not), it only means that the system detected the metal in your device. Simply show your identification card. Ask for a hand pat-down search. Security personnel may perform a search with a handheld wand. If so, it is important to tell them that the search should be done quickly and that they should avoid holding the wand over your implanted device for more than a second.




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