Download Print This Information

Pacemaker for Bradycardia
Table of Contents
•
•
•
•
•
•
•
•
Treatment Overview
What To Expect After Treatment
Why It Is Done
How Well It Works
Risks
What To Think About
References
Credits
Treatment Overview
A pacemaker is a small battery-powered device that sends weak electrical impulses to
"set a pace" so that the heart is able to keep a regular heartbeat.
There are different types of pacemakers, so your doctor will work with you to decide what
kind will be best for you.
• Single-chamber pacemakers stimulate one chamber of the heart, either an upper
chamber (atrium) or, more commonly, a lower one (ventricle).
• Dual-chamber pacemakers send electrical impulses to both the atrium and the
ventricle and pace both chambers. A dual-chamber pacemaker synchronizes the
rhythm of the atrium and ventricles in a pattern that closely resembles the natural
heartbeat. Dual-chamber pacemakers are often used to treat a slow heart rate.
Heart Problems: Should I Get a Pacemaker?
Most new pacemakers are rate-responsive, or physiologic, pacemakers. This type of
pacemaker varies its rate to cause the heart to beat faster when you are exercising to
meet your body's increased needs or slower when you are at rest. Another type, the
fixed-rate pacemaker, sends electrical impulses at a set rate that does not vary either
faster or slower. Both types of pacemakers send electrical impulses when the heart rate
drops to a predetermined "slow" level.
How pacemakers are placed
Permanent pacemakers are surgically implanted into the chest.
The procedure to implant a pacemaker is considered minor surgery. It can usually be
done using local anesthesia. Your doctor will make a small incision in your chest wall just
below your collarbone. He or she then usually threads the pacemaker wires (leads)
through the incision into a large blood vessel in the upper chest and into the heart. Your
doctor uses X-rays to place the leads in the heart. Using the same incision, your doctor
creates a small pocket under the skin to hold the pacemaker. He or she then attaches the
leads to the pacemaker. The procedure takes about an hour.
Temporary pacemakers
Temporary pacemakers are located outside the body and attached to the heart by a wire
threaded through a neck vein or leg vein or through the chest wall. Temporary
pacemakers are most commonly used for a short time following heart surgery or in
emergency situations.
What To Expect After Treatment
Most people stay overnight in the hospital after having a pacemaker implanted and
typically go home the next day. But sometimes, the surgery is done as an outpatient
procedure, which means you do not need to stay overnight in the hospital.
Most people return to normal activities after a few weeks. For several weeks after having
a pacemaker implanted, you should avoid vigorous physical activity that involves the
upper body.
Some activities and situations can interrupt the signals sent by the pacemaker to the
heart. You may need to adapt some of your activities. Follow your doctor's specific
instructions about care and precautions if you have a pacemaker.
Once or twice a year your doctor will check your pacemaker and adjust it, if needed.1 In
between checkups at your doctor's office, you will probably send information from your
pacemaker to your doctor. You will do this by using a telephone or the Internet.
Permanent pacemakers are powered by batteries. The batteries usually last 5 to 15
years before they need to be replaced.
Why It Is Done
Your doctor might recommend that you get a pacemaker if:
• You have a problem with your heart rhythm that could be helped by a pacemaker.
• You have trouble doing everyday activities, or you can't do them at all.
• You have health problems that increase your chances of having heartbeat
problems.
How Well It Works
Pacemakers stimulate the heart to speed up when it beats too slowly. They can also
substitute for the natural pacemaker of the heart (SA node) or the heart tissue that
regulates the beating of the ventricles (AV node).
Pacemakers allow people to return to normal, active lives. Most people have very few
limitations, if any.
Risks
There are several risks to getting a pacemaker. But risks vary for each person. The
chance of most problems is low.
The procedure to implant a pacemaker is safe and most people do well afterward.
Afterward, you will see your doctor regularly to check your pacemaker and make sure
you don't have any problems.
During the procedure
If problems happen during the procedure, doctors can likely fix them right away.
• A lung could collapse (pneumothorax). This happens if air builds up in the space
between the lung and the chest wall. But a pneumothorax can be treated and
people recover well. This problem may happen about 1 to 5 times out of a 100.2
• A tear in the heart could happen. Or a person might need emergency medicine or
surgery. Based on rates of complications from patients, these problems happen
about 1 time out of 100. So about 99 times out of 100, these problems do not
happen.3
After the procedure
Problems after the procedure can be minor, like mild pain, or serious, like an infection.
But your doctor can solve most of these problems. And most people do not have longterm issues with their pacemakers.
Problems include:
• Pain, bleeding, or bruising soon after the procedure.
• Blood clots in your arms, which cause a lot of swelling.
• Infection in your chest near the pacemaker. An infection might happen about 1 time
out of 100. This means that about 99 times out of 100 there is no infection. 4
• Device problems that need another procedure to fix them. This might happen if a
pacemaker lead breaks or a lead moves out of place.
What To Think About
In rare cases, people feel throbbing in the neck, chest fullness, or lightheadedness when
the pacemaker sends out impulses. Talk to your doctor about what types of side effects
you may expect from your pacemaker.
In rare cases, pacemakers are recalled by the maker of the pacemaker. A recall means
that the pacemaker has a problem that needs to be watched closely or fixed.
What to Do if Your Cardiac Device Is Recalled
Complete the special treatment information form (PDF) to help you understand this
treatment.
References
Citations
1. Epstein AE, et al. (2013). 2012 ACCF/AHA/HRS focused update
incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based
therapy of cardiac rhythm abnormalities. Circulation, 127(3): e283–e352.
2. Res JCJ, et al. (2004). Pneumothorax resulting from subclavian puncture:
a complication of permanent pacemaker lead implantation. Netherlands
Heart Journal, 12(3): 101–105.
3. Poole JE, et al. (2010). Complication rates associated with pacemaker or
implantable cardioverter-defibrillator generator replacements and upgrade
procedures. Circulation, 122(16): 1553–1561. DOI: 10.1161/
CIRCULATIONAHA.110.976076. Accessed December 15, 2016.
4. Baddour LM, et al. (2010). Update on cardiovascular implantable
electronic device infections and their management. A scientific statement
from the American Heart Association. Circulation, 121(3): 458–477.
Other Works Consulted
• Grossman SA (2015). Pacemaker therapy. In EG Nabel et al., eds.,
Scientific American Medicine, chap. 38. Hamilton, ON: BC Decker.
https://www.deckerip.com/decker/scientific-american-medicine/chapter/38/
pdf. Accessed November 9, 2016.
• Swerdlow CD, et al. (2015) Pacemakers and implantable cardioverterdefibrillators. In DL Mann et al., eds., Braunwald's Heart Disease: A
Textbook of Cardiovascular Medicine, 10th ed., vol. 1, pp. 721–742.
Philadelphia: Saunders.
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Martin J. Gabica, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer John M. Miller, MD, FACC - Cardiology, Electrophysiology
Current as of December 29, 2016
Note: The "printer friendly" document will not contain all the information available in the online document.
Some information (e.g. cross-references to other topics, definitions or medical illustrations) is only available
in the online version.
This information does not replace the advice of a doctor. Healthwise,
Incorporated, disclaims any warranty or liability for your use of this information.
© 1995-2017 Healthwise, Incorporated. Healthwise, Healthwise for every health
decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.