Download A manual for pacemaker patients

Cardiac Rhythm Therapy // Patient Manual
All About Your Pacemaker
A manual for pacemaker patients
Content
Introduction.......................................................... 1
Questions and answers about
your pacemaker.................................................... 4
Why do I need a pacemaker?...................................5
The heart is a pump. How can it have
an electrical problem?.............................................6
What kind of problems can affect the heart’s
electrical system?.....................................................9
What causes bradycardia?.....................................11
Are there different types of heart block?..............12
How do I know what kind of arrhythmia
I have?......................................................................14
What if it seems like my heart beats
too quickly?.............................................................14
What are some kinds of atrial tachycardias?.......16
i
Does a pacemaker help me if I have atrial
fibrillation?..............................................................19
What about high ventricular rates?.......................20
Will my arrhythmias ever go away
on their own?..........................................................20
Why can’t I just take a medicine to treat
my arrhythmia?.......................................................21
Do I still need to take my heart medications
even if I have a pacemaker?...................................21
Can I have an arrhythmia without
any symptoms?.......................................................22
Will my symptoms go away with
my pacemaker?......................................................23
How can the doctor adjust the pacemaker
once it is implanted in my body?...........................23
How does a pacemaker know when to
pace and how fast to pace?....................................25
ii
If my heart is beating fast enough on
its own, does the pacemaker still pace?...............26
Does the pacemaker sense and pace in
the upper or lower chambers of the heart?.........27
How do I know what kind of pacemaker
I have?......................................................................30
Are there different types of leads?........................30
What is pacemaker surgery like?..........................31
How long does pacemaker surgery take?............32
Is it painful to be awake during the surgery?.......32
What will go on during pacemaker surgery?.......33
How do they actually perform the
implant surgery?.....................................................34
How long is the recovery time after
pacemaker surgery?..............................................36
What should I do right after surgery?...................37
iii
What should I do in the recovery period?..............38
What activities might I need to give up
now that I have a pacemaker?...............................39
How long does this battery-operated
device last?..............................................................41
Is there any warning before the battery
runs out?.................................................................42
What is a replacement?.........................................42
Why can’t they just replace the battery?...............43
Is it safe to be around a microwave oven?............43
Can I still use a computer?....................................43
What about cell phones?........................................43
Can I go through airport security or
other checkpoints?.................................................44
iv
Why do I need to keep seeing my doctor
after the pacemaker is implanted and
seems to be working fine?.....................................45
What should I tell my doctor during
my routine checkup?..............................................46
What should I tell my family about my
pacemaker?............................................................46
BIOTRONIK Home Monitoring®.......................... 48
Resources .......................................................... 51
Websites..................................................................51
BIOTRONIK..........................................................51
HRSOnline...........................................................52
FDA.......................................................................52
Pacemaker Club.................................................53
Support groups.......................................................54
v
Important information........................................ 55
Contraindications...................................................55
Risks, warnings and precautions..........................56
Risks........................................................................56
Precautions.............................................................62
Cell phones..........................................................62
Electromagnetic interference............................63
Other healthcare providers................................67
Changes in your health and condition...............76
Glossary.............................................................. 77
Index................................................................... 87
vi
Introduction
This booklet was prepared for you by BIOTRONIK
to help you better understand your pacemaker.
The best source of information for your health
questions is your physician, since every person
is unique and many factors affect your overall
health. It is our goal at BIOTRONIK to give you a
good overview of pacemakers and share with
you what we have found to be the general
experiences of most patients.
We have divided this booklet into four main
sections:
1. Questions and answers about your
pacemaker
2. BIOTRONIK Home Monitoring®
3. Resources
4. Important information
The “Important information” section tells you
some of the information that the U.S. Food and
1
Drug Administration wants you to know about
your pacemaker.
The section called “Questions and answers
about your pacemaker” tells you about how
pacemakers work, why you need a pacemaker
and how a pacemaker will affect your life. We
compiled this information based on questions
that people frequently ask about their
pacemakers and how they work. This is
probably the most interesting portion of the
booklet if this is your first pacemaker and you
do not know what to expect.
Many BIOTRONIK pacemakers offer Home
Monitoring®. To learn what this is and how
important it can be in your overall care, refer to
the Home Monitoring® section. If you are not
sure whether or not your pacemaker has Home
Monitoring®, ask your doctor.
2
The “Resources” section shares with you some
sources of information that can help you learn
more about pacemakers.
Throughout the booklet, we have sometimes
used medical terms. These terms can be long
and confusing, but it is important for you to
know the right medical words for certain
procedures and conditions. You will notice a
shaded box with these words defined in ordinary
language near where the words appear in the
text. You can also look up these words in the
“Glossary” section at the end of this book.
3
Questions and answers
about your pacemaker
If you have just learned that you need a
pacemaker, or have just had your pacemaker
implanted, you probably have many questions
and a lot of different emotions. Many people who
get a pacemaker get the news suddenly that they
need a pacemaker, before they ever realized they
had any kind of heart problem. You may not know
anyone else with a pacemaker. This can be a
confusing time, but let’s look at a few facts you
may not know about pacemakers.
Pacemakers have been around for more than
50 years. While they may seem like modern
marvels, these devices have proven themselves
over decades of service.
More than a million people all over the world
have a pacemaker right now. You are joining a
very large group of people with pacemakers.
4
People of all ages get pacemakers; they are
implanted in newborns and senior citizens.
BIOTRONIK has been at work for more than a
half a century making pacemakers, and we have
gathered some of the most common questions to
help you better understand your new pacemaker.
Why do I need a pacemaker?
You need a pacemaker because your physician
has determined that you have an electrical
problem in your heart that keeps it from
functioning properly. This electrical problem can
cause your heart to beat too slowly, too rapidly or
in a disorganized rhythm. When your heart does
not beat properly, you may not get proper blood
circulation to your body – particularly your brain.
This can result in feelings of fatigue, dizziness,
lightheadedness and even fainting.
5
The heart is a pump. How can it have
an electrical problem?
Your heart is a pump, but this pump relies on
electrical pulses generated by a small area of
tissue called the sinoatrial node
(SA or sinus node) to know when to pump.
Sinoatrial node
Also called the sinus node, the sinus or SA
node. This is an area of highly specialized
tissue on the upper area of the right side of
your heart (the so-called “high right atrium”).
The sinoatrial node generates electrical
pulses and drives the heart rate. In fact, the
sinoatrial node is nicknamed the “heart’s
natural pacemaker.”
In the healthy heart, the SA node generates a
small amount of electricity that travels across
6
the upper chambers of the heart (the atria),
down to the center of the heart to the
atrioventricular node or AV node, and then
continues down to the two larger lower
chambers of the heart (the ventricles).
Atrioventricular node
Also called the AV node. Located in about the
middle of the heart, below the upper
chambers and above the lower chambers, the
atrio-ventricular node is an important stop on
the electrical conduction pathway through the
heart. In the healthy heart, the
atrioventricular node slows the electrical
pulse slightly (fractions of a second) so that
the upper chambers can fully pump and relax
before the lower chambers pump.
In the healthy heart, the upper chambers (atria)
contract first, then there is a slight pause,
7
followed by the contraction of the lower chambers
(ventricles). Thus, there is one atrial beat for each
and every ventricular beat. This healthy heart
rhythm is called one-to-one AV synchrony, and it
allows your heart to work effectively.
Lung
Body
Oxygen-enriched blood
Oxygen-depleted blood
A healthy heart in the center of the bloodstream
8
One-to-one av synchrony
Also written 1:1 AV synchrony. The healthy
heart rhythm in which there is one atrial
contraction or beat for every ventricular beat.
However, sometimes problems can occur in the
heart’s electrical system.
What kind of problems can affect the
heart’s electrical system?
An arrhythmia can occur, which means that
there is an abnormal heart rate or rhythm or
both. The heart rate is how many times per
minute your heart beats; the heart rhythm is
the pattern of your heart’s activity, such as
problems that disrupt 1:1 AV synchrony. An
arrhythmia can involve your heart rate, your
heart rhythm, or both.
9
Arrhythmia
Any type of abnormal heart rhythm and / or
rate. Other terms for this are dysrhythmia
and rhythm disorder.
A common type of arrhythmia is bradycardia,
which means the heart beats too slowly.
Bradycardia
Any heart rate that is too slow to support the
person’s activity. Another term for bradycardia
is bradyarrhythmia.
People with bradycardia may feel overly tired, be
short of breath, or have other symptoms because
the heart does not beat fast enough to pump
enough blood to meet their needs.
10
What causes bradycardia?
There are a couple of different ways in which
bradycardia can occur. You might have
bradycardia because your SA node fires too
slowly or does not fire regularly. This is
sometimes called sinus bradycardia because it
is caused by the sinus node (SA node).
Sinus bradycardia
A type of too-slow heart rate that occurs
because the SA node does not fire quickly
enough or because it is erratic or unreliable.
Another type of bradycardia occurs when the
electrical pulse traveling through the heart
travels too slowly or is somehow delayed or even
blocked along its pathways through the heart.
This is called heart block. The SA node may
function perfectly well, but the electrical energy
does not travel reliably through the heart.
11
Heart block
A type of too-slow heart rate that occurs
because the electrical pulses from the SA node
are delayed or even blocked at the AV node.
Are there different types of heart block?
There are three main types of heart block that
are identified by degrees. In first-degree heart
block, the electrical pulse from the SA node is
delayed at the AV node in such a way that you
lose 1:1 AV synchrony and your heart rate is too
slow. First-degree heart block may be mild and
cause you few or no symptoms. In many cases,
first-degree heart block may be intermittent.
12
Intermittent
A medical term that describes a condition
that comes and goes. A person with
intermittent AV block experiences it some of
the time but not continually.
Second-degree heart block is more severe. In
this case, some (but not all) of the impulses from
the SA node are blocked at the AV node. This
results in a too-slow heart rate and a loss of AV
synchrony. People with second-degree heart
block may have symptoms that include dizziness,
lightheadedness, shortness of breath, and a
feeling of being unwell; they can even faint.
Third-degree heart block is also called complete
heart block. In this case, all of the electrical
impulses from the SA node are blocked
completely at the AV node. The lower chambers
13
of the heart continue to beat on their own, but
they beat at a much slower rate. People with
third-degree heart block have a very slow heart
rate and a loss of 1:1 AV synchrony. They can
have severe symptoms.
How do I know what kind of arrhythmia
I have?
Ask your doctor about the type of arrhythmia that
you have. It is not unusual for a person with one
arrhythmia to develop another arrhythmia over
time or to have more than one kind of
arrhythmia. Your doctor may ask you to undergo
some testing or monitoring to determine the
exact type of arrhythmia that you have.
What if it seems like my heart beats
too quickly?
Some people have tachycardia or a heart that
beats too rapidly.
14
Tachycardia
Also called a tachyarrhythmia. Any heart
rate that is too fast for the person’s activity.
People with tachycardia may feel like their heart
is racing or pounding; they may experience
dizziness, lightheadedness or feeling faint.
Tachycardia may also cause a person to feel
clammy or unwell. It is possible for a person with
a tachycardia to pass out.
Tachycardias are described by the chamber of
the heart where they start. An atrial tachycardia
starts in the upper chambers, or atria, while a
ventricular tachycardia starts in the lower
chambers, or ventricles.
15
What are some kinds of atrial
tachycardias?
There are two main types of atrial tachycardia.
The first is atrial flutter, sometimes called atrial
tachycardia, and the second is atrial fibrillation,
sometimes nicknamed A-fib or abbreviated AF.
Atrial flutter
A tachycardia that originates in the heart’s
upper chambers, or atria, and causes a rapid
atrial rate. The ventricles, or lower chambers,
try to keep up with the atria and also beat too
quickly, but without 1:1 AV synchrony. This
causes the heart to pump inefficiently.
16
Atrial flutter is often intermittent, which means it
may come and go for no apparent reason. People
with atrial flutter may experience the sensation
of a racing or pounding heart, palpitations,
clamminess, fatigue or a feeling of being unwell.
17
Atrial fibrillation
Also called A-fib or AF. A very rapid atrial rate
(300 beats per minute or higher) that causes a
loss of 1:1 AV synchrony. The ventricles try to
keep up with the atria and end up beating too
fast as well, but their rate is erratic. Atrial
fibrillation may stop and start suddenly, or it
may be longer lasting – even permanent.
Atrial fibrillation causes the upper chambers of
the heart to beat so fast (300 to 400 beats a
minute) that they cannot actually contract and
relax. They are trying to pump and relax about 5
or 6 times per second. That means instead of
pumping, the atria quiver and blood is not
effectively pumped out. Atrial fibrillation keeps
the heart from pumping blood efficiently and can
cause symptoms of a pounding or racing heart,
fatigue, dizziness, shortness of breath,
18
palpitations, a feeling of being unwell, and pain
or discomfort in the chest. A big concern with
atrial fibrillation is the risk of stroke. Since the
upper chambers do not pump efficiently, blood
collects in the upper chambers where it may clot.
If a clot breaks free, it can cause a stroke.
Does a pacemaker help me if I have atrial
fibrillation?
Atrial fibrillation can be a challenging arrhythmia
to treat. Your pacemaker does not specifically
treat atrial fibrillation, but it may help you if you
have atrial fibrillation. BIOTRONIK pacemakers
allow the pacemaker to monitor the heart and
can alert your doctor if it sees evidence that you
have atrial fibrillation. Your doctor can then
adjust your pacemaker and prescribe
medications to help with the atrial fibrillation.
19
What about high ventricular rates?
High ventricular rates, known as ventricular
tachycardia or ventricular fibrillation, can
occur, but pacemakers do not treat these
arrhythmias. However, some people who have
a pacemaker have an arrhythmia called bradytachy syndrome.
Brady-tachy syndrome
Also called tachy-brady syndrome. An
arrhythmia in which the heart alternately
beats too slowly and then too rapidly.
Will my arrhythmias ever go away on
their own?
While some health problems can clear up on
their own, it is unlikely that your arrhythmia will
go away. In fact, most arrhythmias become
progressively worse over time. The reason is that
20
an arrhythmia is caused by some kind of
irregularity in your heart’s electrical system,
which cannot repair itself. Pacemakers can be
the best possible treatment for certain types
of arrhythmias.
Why can’t I just take a medicine to treat
my arrhythmia?
While there are some heart drugs that treat
arrhythmias, these drugs are not right for
everybody. They may interact with other drugs
you take and may have certain risks and side
effects. Ask your doctor about the risks and
benefits of drug therapy.
Do I still need to take my heart
medications even if I have a pacemaker?
That depends. It is not unusual for pacemaker
patients to continue to take heart medications.
These medications may help the heart in other
21
ways or may be necessary to allow your heart
to work as efficiently as possible. If you have
questions about your medications, talk to
your doctor.
Can I have an arrhythmia without any
symptoms?
Yes. The symptoms you experience do not always
match up with your arrhythmia; that is, you may
have severe symptoms and a mild arrhythmia or
mild symptoms with a severe arrhythmia. Some
people have symptoms caused by their
arrhythmia that they attribute to something else.
For example, a person with an arrhythmia may
feel tired and out of breath, but just think he or
she is out of shape.
22
Will my symptoms go away with my
pacemaker?
If your symptoms were caused by the arrhythmia
that is being corrected by your pacemaker, you
should see those symptoms lessen or even
disappear completely. This sometimes happens
very quickly, even just a few days after
pacemaker surgery. If you still have symptoms or
if your symptoms get worse, talk to your doctor
as soon as you can. There may be ways to adjust
the pacemaker to provide better relief. Some
symptoms may not be caused by the arrhythmia,
and therefore will not change with a pacemaker.
How can the doctor adjust the pacemaker
once it is implanted in my body?
The clinical team (doctors, nurses) can
communicate with the pacemaker by using a
special device called a programmer. A
programmer is a computer that uses special
23
radio waves to share information back and forth
with the implanted pacemaker. Communicating
with the device is a simple and painless
procedure. With the programmer, your clinician
can get information stored in the pacemaker and
also change how the device is set. For example, it
is possible to change the pacemaker’s rate using
the programmer.
24
How does a pacemaker know when to
pace and how fast to pace?
The pacemaker system consists of a pacemaker
(running on a battery) plus one or more wires
called leads. The lead is plugged into the
pacemaker at one end and the other end is
maneuvered into the heart. Once inside the
heart, an electrode on the end of the lead picks
up signals from the heart. This allows the
pacemaker to “know” what your heart is doing in
a process called sensing.
Sensing
The ability of a pacemaker to pick up
electrical signals from within the heart and
interpret them – that is, to know how rapidly
the heart is beating.
The pacemaker senses your heart’s activity, so
when your heart is beating properly, the
25
pacemaker is on standby and does nothing but
observe. However, if the pacemaker senses that
your heart has not beat and it is time for it to
beat, it will fire a small electrical pulse that will
cause the heart muscle to contract. This is
pacing. All pacemakers sense and pace.
Pacing
The ability of a pacemaker system to generate
and deliver a small electrical output pulse to
the heart that causes it to beat.
If my heart is beating fast enough on its
own, does the pacemaker still pace?
No. The pacemaker senses 100 % of the time,
but it only paces when necessary.
26
Does the pacemaker sense and pace in
the upper or lower chambers of the heart?
That depends on what kind of pacemaker you
have. A single-chamber pacemaker is a pulse
generator plus one wire or lead that is attached
to the inside of the heart to one chamber, either
the right atrium or right ventricle.
Lead
Also called pacing wire or wire. A thin flexible
insulated wire with one or more electrodes at
the end. One end of the lead is plugged into
the pacemaker and the other end (with the
electrode) is attached to the inside of the heart.
Electrical pulses from the pacemaker travel
via the lead into the heart to pace; electrical
energy from the heart travels via the lead into
the pacemaker to sense.
27
Single-chamber pacemaker
Single-chamber pacemaker
A pulse generator with one wire or lead
attached to the inside of the heart so that it
can pace and sense in either chamber.
A dual-chamber pacemaker is a pulse generator
plus two leads, one of which is secured to the
inside of the right ventricle and the other to the
inside of the right atrium (upper chamber).
28
Dual-chamber pacemaker
A pulse generator that paces and senses in
the atrium (via a lead in the right atrium) and
paces and senses in the ventricle (via a lead
in the right ventricle).
29
How do I know what kind of pacemaker
I have?
Ask your heart doctor about whether you have a
single-chamber or a dual-chamber pacemaker.
The decision about what kind of device you
should have is based on your arrhythmia. In
general, if your heart doctor thinks you will only
ever need ventricular pacing, you will get a
single-chamber pacemaker. If the doctor thinks
that both atrial and ventricular pacing will be
necessary for you, you will receive a dualchamber pacemaker. There are many factors
that might affect this decision, so discuss this
with your doctor.
Are there different types of leads?
Yes, there are many types of leads. Some leads
are specifically designed for the ventricles,
others for the atria. Some leads have a small
amount of steroid medication at the tip to help
30
them function better in the first weeks after
implant surgery. Leads may also vary in their
internal designs, or the type of electrodes they
have. Your heart doctor will pick the leads that
are best suited for you.
What is pacemaker surgery like?
In pacemaker surgery, the heart doctor will
implant the pacemaker in your upper chest, and
then make a small cut in a nearby vein and
maneuver one or more leads gently into your
heart. The lead is attached inside the heart,
plugged into the pacemaker, and the area where
the pacemaker is implanted is sewn up. This
procedure is often done under local anesthetic.
You will be given some medication to relax you,
and your chest area will be numbed, but you will
be awake during the procedure.
31
How long does pacemaker surgery take?
While that depends on your particular case, it
generally lasts about an hour, or, in some cases,
less than that.
Is it painful to be awake during the
surgery?
You will be given some medication to numb the
area where the pacemaker is implanted. If you do
feel pain or even discomfort, tell the clinical team
at once. They can adjust your medication so that
you are not in any pain or discomfort, although
you may feel some pressure at times. You will be
draped so you cannot see what the clinicians are
doing. However, you will likely be aware of what is
going on around you.
32
What will go on during pacemaker
surgery?
You may be surprised that several clinicians are
in the room. There is one doctor who performs
the surgery, but another doctor may be present
to assist. There will likely be at least one nurse in
the room. A technician may be present to operate
some of the monitors and technical equipment.
During the procedure, these clinicians talk to
each other, and you may hear some loud voices
around you. Do not be alarmed; this is very
normal. During the operation, they may call out
numbers or other information to each other. They
may also occasionally talk to you to check that
you are comfortable.
33
How do they actually perform the implant
surgery?
The heart doctor will make an incision in your
upper chest to create a pocket where the pulse
generator is placed.
Pocket
Also called pacemaker pocket. A small area
that the physician forms in the upper chest
that is just big enough to hold the implanted
pacemaker.
This pocket is typically formed above the muscle,
and it is only large enough to contain the
pacemaker. Once the pocket is formed, the clinical
team will drench it in antibiotics to prevent
infection. Meanwhile, the doctor will make a small
incision in a nearby vein. Through this tiny cut, he
or she will insert the pacemaker lead. The lead is
temporarily stiffened for this procedure by the
34
insertion of a very thin wire called a stylet. Using a
fluoroscope, or video X-ray machine, the physician
will gently advance the lead with stylet through the
vein and into the heart.
Fluoroscope
A device that allows for real-time X-rays to
be taken, creating a sort of X-ray movie. A
fluoro-scope is used during pacemaker
implantation so the physician can observe
the lead advancing through the vein and
into the heart.
When the lead is in the proper place, seen on the
fluoroscope, the doctor will then attach it to the
inside of the heart. The lead may attach using
small protrusions called tines or may attach with
a corkscrew-type mechanism. Once the lead is
attached in the heart, the other end is plugged
into a special device used for testing. The
35
physician will test the lead to make sure that it
paces and senses properly. It is sometimes
necessary for the clinical team to detach the lead
and reposition it to get it to work better. This is
not unusual. Once the clinical team has the lead
in the best possible position, the lead is
unplugged from the test device, plugged into the
pacemaker, and tested again. After making sure
it is working properly, the pacemaker is placed
into the pocket and the pocket is sewn closed.
How long is the recovery time after
pacemaker surgery?
The recovery time depends on your overall health,
your condition, the type of procedure you had and
your age. While some pacemakers are implanted
on an outpatient basis, many people stay overnight
in the hospital. When you are discharged from the
hospital, you will be given specific instructions
about how to care for yourself.
36
What should I do right after surgery?
In the first days after your pacemaker surgery,
you may find the implant site to be tender and
slightly swollen. The clinical team will advise you
how to keep the implant site clean and dry. If you
notice any redness or extreme soreness at the
implant site, contact your doctor immediately or
go to the emergency room, as these are possible
37
signs of infection. You may soon feel some of
your arrhythmia symptoms are lessened or gone.
In the first few days after surgery, avoid all
strenuous activity and exercise, and do not lift
your arms over your head. Moving your arms can
place a strain on the implanted lead. In a few
weeks, the leads will be firmly attached inside
the heart, but in the first weeks after surgery,
strenuous activity may move the leads out of
their proper place.
What should I do in the recovery period?
You will likely need a few weeks, possibly even up
to six weeks, to fully recover from pacemaker
surgery. During this time, there are a few
recommendations to speed your healing:
Do not wear clothing that binds or is tight over
the implant site.
38
Avoid touching the pacemaker site as much as
possible.
Do not lift or carry heavy objects, and do not
carry anything heavy on your shoulder (such as
a heavy bag, purse or backpack).
Avoid strenuous exercise and “big” or twisting
motions. This would include swinging a golf
club or baseball bat, picking up a child,
gardening, and so on.
Do not raise your arms up over your head for
the first few weeks after surgery.
Your doctor will tell you when you can resume
your normal activities and what activities you
might have to modify or give up.
What activities might I need to give up
now that I have a pacemaker?
Your doctor will give you specific advice about
what you can and cannot do as a pacemaker
39
patient. In general, people who have a
pacemaker can do most of what they used to
do – and may even find that they have more
energy and feel better so that they can resume
doing things that they had previously given up.
That being said, if you have a pacemaker, you
should avoid participating in sports that might
cause you to suffer a blow to chest, such as
football or boxing. Do not fire a rifle with the gun
butt directly over the pacemaker site. You will
likely be able to resume most regular activities
such as:
Returning to work
Driving a car
Traveling
Playing sports (with the exception of contact
sports where the pacemaker site could be hit)
Bathing, swimming, showering
40
Normal sexual activity
Moderate exercise, as your overall health
permits
If you find that any particular activity makes you
feel worse, tell your doctor at once.
How long does this battery-operated
device last?
The pacemaker runs on a special battery. How
long the battery lasts depends in part on how
often your pacemaker has to pace and how much
electricity it uses for each pacing pulse (these
will vary depending on how the device is
programmed to meet your needs). Even if your
pacemaker paces 100 % of the time with a high
output setting, your pulse generator will last for
several years. When you go for your checkup,
your heart doctor can estimate how much longer
your pulse generator will last.
41
Is there any warning before the battery
runs out?
Yes. Pacemaker batteries are different from car
batteries or other batteries that deplete
suddenly. A pacemaker battery signals when it is
nearing depletion, but still runs for many months
at full capacity. Your heart doctor will alert you
when the battery is nearing depletion, but you
will still likely have weeks or even months to
schedule a replacement.
What is a replacement?
When the pacemaker battery wears out, the
entire device is removed and a new pacemaker is
inserted in place of the old one. This involves a
new surgical procedure, but it is usually faster
and easier than the original procedure. In most
cases, the lead(s) stays in place. The lead(s) is
just unplugged from the old pacemaker and then
plugged into the new pacemaker.
42
Why can’t they just replace the battery?
Your pacemaker is hermetically sealed to
prevent fluids in your body from entering the
device and interfering with the circuits. There is
no way to open it up and remove the battery. For
that reason, the entire pacemaker is removed
and replaced.
Is it safe to be around a microwave oven?
Yes. Normal household appliances in good
working condition will not interfere with your
pacemaker.
Can I still use a computer?
Yes. A computer or tablet computer will not
interfere with your pacemaker.
What about cell phones?
In general, most cell phones in good working
condition are safe around pacemakers. It is
recommended that you do not place the phone
43
over the implanted pacemaker (even if the phone
is turned off) and that you hold the phone on the
side of the body opposite your pacemaker.
Can I go through airport security or other
checkpoints?
There are so many different types of security
systems in use today that it is difficult to make
any general recommendation. Instead, we
recommend that you present your pacemaker ID
card to the security personnel, request a patdown, and follow their instructions. Whether or
not you can go through security machinery, you
should have no problem traveling. Airport and
other personnel are trained to assist people with
pacemakers so that they can safely clear security
checkpoints.
44
Why do I need to keep seeing my doctor
after the pacemaker is implanted and
seems to be working fine?
Follow-up visits are very important to you now
that you have a pacemaker. During these
checkups, your heart doctor will make sure your
pacemaker is functioning properly, confirm that
the lead system is operating correctly and check
the device’s battery. The doctor may also decide
to make adjustments to how your pacemaker is
programmed so that it works even better.
45
What should I tell my doctor during my
routine checkup?
Report to your doctor any unusual symptoms
such as redness at the implant site, difficulty
breathing, swelling of your legs or hands, chest
pain, dizziness, lightheadedness, shortness of
breath, fainting spells, persistent hiccups or
abnormal heart rates (such as a very slow or fast
or abnormal pulse). Also tell your doctor about
any changes in your health, new medications you
are taking, and medications you have
discontinued.
What should I tell my family about my
pacemaker?
Chances are that unless you tell someone you
have a pacemaker, they will never know. Most
people with pacemakers live normal, active lives.
While your medical privacy is important, you
should consider that in the event of an
46
emergency, those around you should be able to
inform the medical team that you have a
pacemaker. For that reason, we recommend that
you share this information with your family and
those close to you.
47
BIOTRONIK Home
Monitoring®
BIOTRONIK Home Monitoring® is an
important feature of some BIOTRONIK
pacemakers. Ask your doctor if you have it
and, if so, which features apply to you.
You may have a special type of pacemaker with a
separate transmitter device. Together, your
pacemaker and the transmitter can share
information with your doctor about your heart and
your pacemaker and how they are working
together. In simple terms, the pacemaker
communicates automatically to the transmitter
and the transmitter then sends information to a
secure computer server that your doctor can
access. This happens without any special action on
your part. In fact, you will not even be aware that it
is going on.
48
Please note the transmitter is NOT an emergency
system. It is for monitoring only.
BIOTRONIK Home Monitoring® has changed
pacemaker therapy. With Home Monitoring®,
your pacemaker can report directly to the doctor
about any unusual heart rhythms you have
49
experienced or if the device battery is low or a
lead is not functioning properly. In such cases,
the pacemaker can detect and identify a problem
before you even know it is there. But most of the
time, BIOTRONIK Home Monitoring® just
confirms to your doctor’s office that everything is
working fine.
BIOTRONIK Home Monitoring® system provides
you with an automatic connection to your heart
doctor, even as you go about your ordinary daily
activities. Your heart doctor will help explain how
to take advantage of the Home Monitoring
system.
50
Resources
You may want to learn more about your pacemaker
or want to meet other people who have pacemakers to share experiences. There are a number
of resources that may be helpful to you.
Websites
Please note that websites change frequently, and
the ways to access patient information may
change with time. Visit the sites and seek the
sections designated for patients. Except for the
BIOTRONIK site, BIOTRONIK is not responsible
for the content of these sites, but has examined
them at the time of printing and found them to
be of potential interest to you.
BIOTRONIK
BIOTRONIK maintains an extensive website
with high quality information for patients
about pacing in general and its products.
51
Visit [www.biotronik.com] and click on the tab
marked “Patients.” You will find information about
the heart, heart disease and cardiac pacing.
HRSOnline
The Heart Rhythm Society is a large nonprofit
organization for clinicians who specialize in
pacing. Visit them online at HRSonline.org.
Locate the tab marked “Patient Resources.”
There is information about the heart, electrical
heart problems and pacing.
FDA
The U.S. Food and Drug Administration (FDA) has
an extensive website that contains a significant
amount of consumer information. FDA
information is more likely to be topical and based
on new research, new products or potential
product problems. Visit them at FDA.gov and
then select “Medical Devices.” Look for
resources for consumers. If there is ever a safety
52
issue related to pacemakers, it will likely appear
on this site.
Pacemaker Club
The Pacemaker Club is an organization run by
individuals who have pacemakers. It operates as
a message board where people with pacemakers
can share experiences, ask questions, and find
support and encouragement. It is important to
know that the Pacemaker Club is not run by
53
medical experts or monitored by physicians. This
site should not be taken as a source for medical
or health information, but it is a great way to
connect informally with other people who have
pacemakers. Visit them at pacemakerclub.com.
You must to register to participate, but
registration is free.
Support groups
Some hospitals hold regular support group
meetings for people with pacemakers or other
cardiac rhythm management devices, such as
implantable defibrillators. Ask your heart doctor if
there are any such meetings in your community,
or contact local hospitals. These groups bring
together patients and their loved ones to share
experiences and encourage and support one
another, and they may periodically offer
educational sessions or host guest speakers.
54
Important information
Contraindications
In the United States, the law requires this manual
to describe the contraindications for the device.
Contraindication
A condition or situation for which it may not
be appropriate for you to have this device.
This pacemaker may be contraindicated in
certain people. Your physician has evaluated
these contraindications for you. If you have
questions about whether or not a pacemaker is
appropriate for you, please talk to your physician.
This pacemaker is contraindicated:
If your anatomy does not allow it to
be properly placed.
If you have a tricuspid mechanical heart valve.
If you have other implanted medical devices
that are not compatible with this pacemaker.
55
Special types of wire also called leads, are used
with your pacemaker that may be contraindicated
if you cannot tolerate a small dose of steroid
medication. In such cases you still may be able to
have a pacemaker, but it must use a different
type of lead.
Risks, warnings and precautions
As with any medical device, there are certain
risks and safety concerns associated with having
a pacemaker.
Adverse events
Sometimes called “side effects,” these are
negative occurrences and/or symptoms that
may be associated with the pacemaker.
Risks
The following lists some rare but possible
adverse events associated with a pacemaker.
56
These adverse events may be unpleasant,
uncomfortable or painful. Some of these risks
may require you to undergo surgery again to
replace, remedy, or remove the pacemaker
system. Your physician can explain these risks to
you in more detail and may be able to take steps
to minimize these risks. If you experience any of
these adverse events or other unusual problems
that may or may not be related to the pacemaker,
please tell your physician immediately.
Bleeding around the heart
Damage to the heart
Collection of air or gas in the chest cavity, also
known as “pneumothoax”
Pacemaker moving from its original location
and / or protruding through the skin
Infection
57
Problems with the pacing wire or lead,
including dislodgment of the pacing wire
or lead
Blood clots
Blocked blood vessels
Rejection of the pacemaker by the body
Muscle or nerve stimulation that may
cause hiccups
Fluid accumulation around the pacemaker
Scar tissue around the pacemaker
Faster heart rates
Vein closure
Some of these conditions may occur without
your being aware of them. For that reason, you
should see your pacemaker doctor for all
regular checkups.
58
Warnings
Warnings advise you about certain situations that
can put you at serious risk and may damage your
health. There are some important warnings for
people with pacemakers.
59
Strong magnetic fields can interfere with your
pacemaker. These include industrial magnets,
heavy industrial equipment and certain
amusement park rides. If you are around a
strong magnetic field, you may develop
symptoms such as lightheadedness, dizziness
or a feeling of being unwell. If this occurs or if
you have no symptoms but know that you are
near a strong magnet, move away from the
magnetic field as soon as you can.
Magnetic resonance imaging (MRI) can
interfere with the pacemaker, damage the
pacemaker and / or wire(s) and may harm you.
If an MRI is ever recommended, tell the clinical
team that you have a pacemaker. Always carry
your pacemaker ID card with you in case you
cannot speak for yourself.
60
This warning does not apply to BIOTRONIK
ProMRI® systems.
Some devices may be approved as safe for
certain kinds of MRI procedures. If yours is one
of these, your patient ID card from BIOTRONIK
will have a MR symbol on it.
Magnetic resonance imaging or MRI
A procedure to painlessly take a picture of soft
tissue of the body using magnetic waves.
61
Precautions
Precautions are words of advice told to you to
protect you from minor injury and to keep your
pacemaker in good working condition.
Cell phones
You may use a cell phone with a pacemaker
provided you take some simple precautions.
Keep the phone at least 6 inches (15 cm) away
from the pacemaker at all times, even when
the phone is turned off.
Hold the phone to the ear opposite the
pacemaker. For example, if your pacemaker is
implanted on your left side, hold your cell
phone to your right ear.
Do not put the phone over the pacemaker or
carry it in a breast pocket so it is over the
pacemaker, even if the phone is turned off.
62
Electromagnetic interference
People with pacemakers should try to avoid
electromagnetic disturbance which may cause
electromagnetic interference (EMI).
Electromagnetic interference (EMI)
Electronic disturbances are invisible signals,
sometimes called “static” or “noise” that can
interfere with certain medical devices, including
pacemakers. Power tools, heavy machinery,
63
theft detection systems and security systems
may all produce electromagnetic emissions,
which can create electromagnetic disturbances.
These disturbances may result in
Electromagnetic interference (EMI).
Your pacemaker was designed with special
filters to keep out and reduce unwanted
electromagnetic disturbance which may cause
EMI. However, there are many types of devices
and sources of electromagnetic disturbance in
the world today, so complete protection from
EMI is not possible. If your pacemaker senses
EMI, it may “think” that these signals are
coming from your heart and cause your
pacemaker to respond inappropriately. Though
electromagnetic disturbance may interfere with
the pacemaker, it does not damage it
permanently. If your pacemaker is sensing EMI,
64
you may have symptoms such as feeling
lightheaded, dizzy or unwell.
If this occurs or if you know you are near an
electromagnetic disturbance that may cause
EMI – even if you do not have symptoms – move
out of the area. This should allow the pacemaker
to go back to its normal operation.
Most household appliances (including microwave
ovens) are safe to operate near pacemakers.
Appliances in good working order will not
interfere with your pacemaker. Electrical tools,
power tools or other electrical devices may
interfere with your pacemaker if they are not
properly shielded or not in good repair. If these
affect your pacemaker, turn them off or move
away from them.
Many stores use theft detection systems, and
sometimes this equipment can affect your
65
pacemaker. If you know you are passing through a
theft detection system, simply walk through it at a
normal pace. This should not interfere with your
device. Some stores conceal these theft detection
systems, which may be located anywhere within the
store. If you are in a store and notice symptoms
(dizziness, lightheaded-ness, feeling unwell), move
out of the area and see if you feel better. It may be
necessary for you to leave the store.
Some equipment is known to produce
electromagnetic disturbance that could cause EMI
and should be avoided or used with caution.
This includes:
Electric welding equipment
Electric melting furnaces
Radio and TV transmitters, including
commercial stations
66
Radar transmitters
Power plants
High-voltage lines
Walkie-talkies and other two-way communication
systems, including
emergency vehicle two-way radios
Microwave transmitters, TV satellite dishes
Paging transmitters
Satellite towers
Electrical starting systems of gasoline
engines, if not properly shielded
Electrical tools, power tools
Electrical appliances not in good
working condition
Some amusement park rides, such as
bumper cars
67
Other healthcare providers
Always tell other healthcare professionals that you
have a pacemaker (this includes, but is not limited
to, doctors, dentists, X-ray technicians, nurses, and
emergency room staff). Carry your pacemaker ID
card with you at all times. Some people who have a
pacemaker wear a special medical alert bracelet,
and while this is not required, it may communicate
this information for you if you ever need emergency
medical care and cannot speak for yourself.
If you ever need surgery, make sure the clinical team
knows about your pacemaker. High doses of
68
radiation or X-rays can damage the pacemaker, so
everyone caring for you must know about your
pacemaker. If you need surgery, your heart doctor may
be consulted to take the necessary steps with your
pacemaker to protect you and the device. This usually
involves turning the pacemaker off for the duration of
the procedure. After the operation, the pacemaker will
be turned back on. This step is completely painless
and usually takes only a few minutes.
Once you have a pacemaker, there are certain
procedures and operations that may possibly harm
you or the pacemaker. Tell the clinical team that you
have a pacemaker, and they can help to evaluate the
risks and benefits and discuss them with you. There
may be protective steps to help make the procedure
safe for you and / or protect the pacemaker from
possible damage. If you undergo any type of
procedure, your doctor should test the pacemaker
before and after the procedure to make sure it is
69
working properly. Some procedures can damage
the pacemaker. This damage may not be detected
right after the procedure, but it could cause a
malfunction or device failure in the future.
The following are some procedures that should be
avoided if you have a pacemaker. In some cases, it
may be possible for you to undergo the procedure
with special steps taken. If you might need to
undergo any of these procedures, discuss the
possible risks and your safety with your physician.
Diathermy
Diathermy
Heat produced by electricity and used on
tissue in the body, usually as a form of
physical or occupational therapy and in
surgical procedures.
70
Diathermy may cause heating of the pacemaker,
wire(s) or implant site. If diathermy must be
used, it should be used as distant from your
pacemaker as possible.
Transcutaneous electrical nerve
stimulation (TENS)
TENS
The use of electrical energy to stimulate
muscles. The energy is produced by a TENS
device and is carried by wires through
electrodes stuck onto the skin.
TENS devices are often used to treat pain. They
are not implanted in the body and can be easily
removed or turned off.
Magnetic resonance imaging (MRI), see
pages 60–61.
71
Electrical cautery
Electrical cautery
The use of heat from an electrical device
to seal a wound or remove tissue.
Electrical cautery is usually performed during
surgery.
External defibrillation
Defibrillation
The use of large amounts of electrical energy
to “shock” the heart out of cardiac arrest and
restore normal rate and rhythm.
External Defibrillation
is given through paddles applied to the chest
(“external” to the body).
In an emergency situation, first responders may
72
deliver external defibrillation by placing large
paddles on the chest and sending electrical
energy to change your heart rhythm from a
dangerous rhythm to a more normal one. During
external defibrillation, very large amounts of
energy will be sent through the skin to your heart.
External defibrillation can be effective in
pacemaker patients for restoring a normal heart
rhythm, but in rare cases the electrical energy
could damage the pacemaker. If you ever receive
external defibrillation, alert your heart doctor at
once so that your pacemaker can be checked.
Your pacemaker is designed to withstand external
defibrillation energy, but should still be checked
following external defibrillation.
Radiation therapy
There are different types of radiation treatments
used in medicine. An X-ray is a type of radiation
therapy, and so are devices that send
73
concentrated radiation energy to specific areas
of the body (called “radiotherapy”). It may be
possible for a person with a pacemaker to
undergo radiation therapy, but your pacing
doctor should be consulted.
Lithotripsy
Lithotripsy
A procedure in which sound waves are used
to break up kidney stones.
Lithotripsy may damage the pacemaker. If your
doctor decides you may undergo lithotripsy, the
procedure should be performed as distant from
the pacemaker as possible.
74
Cardiac ablation
Cardiac ablation
A surgical procedure in which very tiny
sections of cardiac tissue are destroyed, either
by surgically cutting them out or destroying
them with heat energy or freezing cold.
Cardiac ablation is often performed using a
catheter and a very small incision. Although it
may be considered minor surgery, it may damage
the pacemaker. Cardiac ablation using heat or
radiofrequency energy may overheat the
implanted pacemaker wire. This can damage the
wire, possibly damage the pacemaker, and could
even harm you. If cardiac ablation is necessary,
your heart doctor should be consulted to make
sure proper precautions are taken. It may be
possible to perform the ablation far from the
pacemaker wire; the pacemaker should be
turned off during the ablation.
75
Changes in your health and condition
Your health and physical condition are always
changing. Changes in your overall health and
fitness, the drugs you take and illnesses you
might have may all affect your pacemaker. For
these reasons, you should see your heart doctor
regularly and tell him or her about your current
health and all of the drugs you are
taking – including those prescribed by other
clinicians. You should also tell your heart doctor
about any over-the-counter drugs, vitamins and
supplements you are taking, since these may
also affect your heart. Some drugs can have an
effect on your heart that may change the way
your pacemaker should be programmed.
76
Glossary
Adverse events
Sometimes called “side effects,” these are
negative occurrences and/or symptoms that
may be associated with a particular form of
treatment, such as your pacemaker.
Arrhythmia
Any type of abnormal heart rhythm and / or rate.
Other terms for this are dysrhythmia and rhythm
disorder.
Atrial fibrillation
A very rapid atrial rate (300 beats per minute or
higher) that causes a loss of one-to-one
atrioventricular synchrony (1:1 AV synchrony).
The ventricles try to keep up with the atria and
end up beating too fast as well, but their rate is
erratic. Atrial fibrillation may stop and start
suddenly, or it may be longer lasting – even
permanent. Also called A-fib. Abbreviated AF.
77
Atrial flutter
A tachycardia (too-fast heart rate) that originates
in the heart’s upper chambers (atria) and causes
a rapid atrial rate. The lower chambers
(ventricles) try to keep up with the atria and also
beat too quickly, but without one-to-one
atrioventricular synchrony (1:1 AV synchrony).
This causes the heart to pump inefficiently.
Atrioventricular node
A specialized area of cardiac tissue located in
about the middle of the heart (below the upper
chambers and above the lower chambers) that is
an important stop on the electrical conduction
pathway through the heart. In the healthy heart,
the atrioventricular node slows the electrical
pulse slightly (fractions of a second) so that the
upper chambers can fully pump and relax before
the lower chambers pump. Abbreviated AV node.
78
Atrioventricular synchrony
The healthy heart rhythm in which there is one
atrial contraction or beat for every ventricular beat.
Often called one-to-one atrioventricular synchrony.
Abbreviated AV synchrony or 1:1 AV synchrony.
Brady-tachy syndrome
A rhythm disorder in which the heart alternates
beating too slowly and then too rapidly. Also
called tachy-brady syndrome.
Bradycardia
Any heart rate that is too slow to support the
person’s activity. Braydcardia is a type of
arrhythmia. Sometimes called bradyarrhythmia.
Cardiac ablation
A surgical procedure during which very tiny
sections of cardiac tissue are destroyed, either by
surgically cutting them out or destroying them
with heat energy or freezing cold.
79
Contraindication
A condition or situation in which it may not
be appropriate for you to have a particular
treatment or medical device.
Defibrillation
The use of large amounts of electrical energy
to “shock” the heart out of cardiac arrest and
restore its normal rate and rhythm.
Diathermy
Heat produced by electricity and used on tissue
in the body, typically during a surgical procedure.
Dual-chamber pacemaker
A pacemaker that paces and senses in the atrium
(via a lead in the right atrium) and paces and
senses in the ventricle (via a lead in the right
ventricle).
80
Electrical cautery
The use of heat from an electrical device to seal
a wound or remove tissue, typically during a
surgical procedure.
Electromagnetic interference
Electronic disturbances are invisible signals,
sometimes called “static” or “noise” that can
interfere with certain medical devices, including
pacemakers. Power tools, heavy machinery, theft
detection systems and security systems may all
produce electromagnetic emissions, which can
create electromagnetic disturbances. These
disturbances may result in electromagnetic
interference (abbreviated EMI).
External defibrillation
The use of large amounts of energy via paddles
applied to the chest (“external” to the body) to
“shock” the heart out of cardiac arrest and restore
its normal rate and rhythm.
81
Fluoroscope
A device that allows for real-time X-rays to be
taken, creating a sort of X-ray movie. A
fluoroscope is used during pacemaker
implantation so the physician can observe the lead
advancing through the vein and into the heart.
Heart block
Any type of too-slow heart rate that occurs
because the electrical pulses from the sinus
node (SA node) are delayed or even blocked
at the atrioventricular node (AV node).
Lithotripsy
A procedure during which sound waves are used
to break up kidney stones.
Intermittent
A medical term that describes a condition that
comes and goes. An intermittent arrhythmia is
one that occurs at times, but not continuously.
82
Lead
A thin, flexible insulated wire with one or more
electrodes at the end. One end of the lead is
plugged into the pacemaker and the other end
(with the electrode) is attached to the inside
of the heart. Electrical pulses from the pulse
generator travel via the lead into the heart to
pace; electrical energy from the heart travels
via the lead into the pulse generator to sense.
Magnetic resonance imaging
A procedure to painlessly take a picture of
soft tissue of the body using magnetic waves.
The common abbreviation is “MRI”.
One-to-one AV synchrony
The healthy heart rhythm in which there is one
atrial contraction or beat for every ventricular beat.
83
Pacing
The ability of a pacemaker system to generate
and deliver a small electrical output pulse to the
heart that causes it to beat.
Pocket
Also called pacemaker pocket. A small area that
the physician forms in the upper chest that is just
big enough to hold the implanted pacemaker.
Sensing
The ability of a pacemaker to pick up electrical
signals from within the heart and interpret them
to know how rapidly the heart is beating.
Single-chamber pacemaker
A pacemaker with one wire (or lead) attached to
the inside of the right ventricle or atrium so that
it can pace and sense in that chamber.
84
Sinoatrial node
Sometimes called the sinus node or just the sinus.
An area of highly specialized tissue on the upper
right side of the heart (the “high right atrium”). The
sinoatrial node generates electrical pulses and
drives the heart rate. In fact, the sinoatrial node is
nicknamed the “heart’s natural pacemaker.” The
common abbreviation is “SA node”.
Sinus bradycardia
Any type of too-slow heart rate that occurs
because the SA node (sinus node) does not fire
quickly enough or because it is erratic or
unreliable.
Tachycardia
Any heart rate that is too fast for the person’s
activity. Tachycardia can also be called
tachyarrhythmia.
85
Transcutaneous electrical nerve stimulation
The use of electrical energy to stimulate muscles.
The energy is produced by a small device and is
carried by wires through electrodes stuck onto
the skin. The common abbreviation is “TENS”.
86
Index
A
Ablation.................................................................75
Arrhythmia......................... 9, 10, 14, 19, 20, 21, 22,
23, 30, 38, 77, 79, 82
Atrial fibrillation..................................16, 18, 19, 77
Atrial flutter...............................................16, 17, 78
Atrial tachycardia............................................15, 16
Atrioventricular synchrony.......................77, 78, 79
Atrium.................................. 6, 27, 28, 29, 80, 84, 85
AV node............................................7, 12, 13, 78, 82
AV synchrony...................................................13, 79
B
Bath.......................................................................40
Battery.....................................25, 41, 42, 43, 45, 50
BIOTRONIK.................. 1, 2, 5, 19, 48, 51, 52, 61, 98
87
BIOTRONIK Home Monitoring.............1, 48, 49, 50
Blood clot..............................................................58
Bradycardia...............................................10, 11, 79
Brady-tachy syndrome...................................20, 79
C
Cardiac ablation..............................................75, 79
Cell phones.....................................................43, 62
Chest pain.............................................................46
Complete heart block...........................................13
Computer..................................................23, 43, 48
Conduction pathway.........................................7, 78
Contraindications.................................................55
D
Defibrillation...................................................72, 80
Diathermy..................................................70, 71, 80
88
Difficulty breathing...............................................46
Dizziness............................. 5, 13, 15, 18, 46, 60, 66
Driving...................................................................40
Dual-chamber pacemaker................28, 29, 30, 80
E
Electrical cautery............................................72, 81
Electromagnetic interference........................63, 81
EMI.......................................................63, 64, 65, 66
Exercise.....................................................38, 39, 41
External defibrillation...............................72, 73, 81
F
Fainting..............................................................5, 46
Fatigue.........................................................5, 17, 18
FDA........................................................................52
First-degree heart block......................................12
89
Fluoroscope....................................................35, 82
Follow-up..............................................................45
G
Guns.......................................................................40
H
Heart..................... 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14,
15, 16, 17, 18, 19, 20, 21, 22, 25, 26, 27, 28, 31, 35,
38, 46, 48, 52, 55, 57, 58, 64, 72, 73, 76, 78, 79, 80,
81, 82, 83, 84, 85
Heart block................................................11, 12, 82
Heart doctor... 30, 31, 34, 41, 42, 45, 50, 54, 69, 73,
75, 76
Heart medications................................................21
Heart rhythm................... 8, 9, 10, 49, 73, 77, 79, 83
Heart Rhythm Society..........................................52
Hiccups............................................................46, 58
90
Home Monitoring®, BIOTRONIK..................48, 49
HRSOnline.............................................................52
I
ID card.................................................44, 60, 61, 68
Implant surgery..............................................31, 34
Incision............................................................34, 75
Infection.....................................................34, 38, 57
L
Lead............................ 25, 27, 28, 29, 30, 31, 34, 35,
36, 38, 42, 45, 50, 56, 80, 82, 83, 84
Lightheadedness............................5, 13, 15, 46, 60
Lithotripsy.......................................................74, 82
M
Magnetic field........................................................60
Magnetic resonance imaging............60, 61, 71, 83
91
Magnets.................................................................60
Microwave oven...............................................43, 65
MRI.......................................................60, 61, 71, 83
N
Natural pacemaker..........................................6, 85
O
One-to-one (1:1) AV synchrony...................8, 9, 12,
14, 16, 18, 77, 78, 79, 83
P
Pacemaker..................... 1, 2, 3, 4, 5, 19, 20, 21, 23,
24, 25, 26, 27, 30, 31, 32, 34, 35, 36, 39, 40, 41, 42,
43, 44, 45, 46, 47, 48, 49, 50, 51, 53, 54, 55, 56, 57,
58, 59, 60, 62, 64, 65, 66, 68, 69, 70, 71, 73, 74, 75,
76, 77, 80, 82, 83, 84
Pacemaker Club.............................................53, 54
Pacemaker ID card...................................44, 60, 68
92
Pacemaker surgery.......... 23, 31, 32, 33, 36, 37, 38
Patient ID card......................................................61
Power tools.....................................................65, 67
Precautions...............................................56, 62, 75
Programmer...................................................23, 24
Pulse generator......................27, 28, 29, 34, 41, 83
R
Radiation...................................................69, 73, 74
Radio waves..........................................................24
Replacement.........................................................42
Risks..............................................21, 56, 57, 69, 70
S
SA node.....................................6, 11, 12, 13, 82, 85
Second-degree heart block.................................13
Sexual activity.......................................................41
93
Showering.............................................................40
Single-chamber pacemaker..............27, 28, 30, 84
Sinoatrial node..................................................6, 85
Sinus node...................................................6, 11, 85
Sports....................................................................40
Stroke....................................................................19
Support group.......................................................54
Symptoms........................ 10, 12, 13, 14, 18, 22, 23,
38, 46, 56, 60, 65, 66, 77
T
Tachycardia...................................14, 15, 16, 78, 85
Theft detection system...................................65, 66
Third-degree heart block...............................13, 14
Transmitter.........................................48, 49, 66, 67
94
V
Ventricle...................................... 7, 8, 15, 16, 18, 27,
28, 29, 30, 77, 78, 80, 84
Ventricular tachycardia..................................15, 20
W
Warnings.........................................................56, 59
X
X-ray...............................................35, 68, 69, 73, 82
95
Notes
96
All About Your Pacemaker
A manual for pacemaker patients
© BIOTRONIK SE & Co. KG
All rights reserved. Specifications
are subject to modification,
revision and improvement.
M4178-A 09/15
© 2015 BIOTRONIK, Inc. All rights reserved.
MN052r1 9/22/2015
BIOTRONIK, Inc.
6024 Jean Road
Lake Oswego, OR 97035, USA
Technical Services:
1-800-284-6689
Home Monitoring Help Line:
1-800-889-9066
www.biotronik.com