Heart Rate Problems: Should I Get a Pacemaker?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Heart Rate Problems: Should I Get a Pacemaker?
Get the facts
Your options
- Get a pacemaker.
- Don't get a pacemaker.
This decision aid is NOT for people with heart failure. The decision for heart failure patients may involve a special type of pacemaker (cardiac resynchronization therapy) and may raise other issues to think about.
Key points to remember
- A pacemaker can help you feel better so you can return to your daily activities.
- A pacemaker sends electrical pulses to your heart to help it work better. You can't feel the pulses.
- If you get a pacemaker, you may still need to take medicines. You'll also need to follow a healthy lifestyle to help your heart. Eat heart-healthy foods, and don't smoke.
- Heart experts have guidelines about who might need a pacemaker. Talk to your doctor about the reasons that you might need one. For example, a pacemaker may be a good choice if your heart rate is very slow and you have symptoms like dizziness or fainting.
- There can be problems from having a pacemaker placed in your chest. The wires (called leads) that connect the pacemaker to your heart can move from the spot where they were placed. You could get an infection where the pacemaker was placed. Or the pacemaker or leads might not work.
What is a pacemaker?
Pacemakers are small electrical devices that help control the timing of your heartbeat.
A pacemaker is implanted under the skin of your chest wall. The pacemaker's wires pass through a vein into the chambers of your heart. The pacemaker sends out mild electrical pulses that keep your heart beating normally.
There are different types of pacemakers, so your doctor will work with you to decide what kind will be best for you.
What heart rate problems can a pacemaker help?
A pacemaker can help restore a normal heart rate when certain problems have damaged the heart's electrical system, which normally keeps your heart beating steadily. These problems include:
- Getting older. Aging sometimes affects the heart so that it can't keep up a normal heart rate.
- Coronary artery disease.
- Heart attack.
- Heart surgery.
- Heart block (such as an AV block), which is an abnormality in the way electricity passes through the heart's normal electrical pathways.
- Atrial fibrillation.
If your risk for getting a very slow heartbeat is high, a pacemaker can help prevent that from happening.
Pacemakers allow people to return to normal, active lives. Most people have very few limitations, if any.
How is a pacemaker placed?
Your doctor will put the pacemaker in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.
Your doctor makes a small cut (incision) in your upper chest. In some cases, the pacemaker can be placed lower in the chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered. The doctor puts the leads in a vein and threads them to the heart. Then your doctor connects the leads to the pacemaker. Your doctor programs the pacemaker and then puts it in your chest and closes the incision.
It can take about 2 to 3 hours to place the pacemaker.
Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery. But sometimes the procedure is done as an outpatient procedure, which means you don't need to stay overnight in the hospital.
You may be able to see a little bump under the skin where the pacemaker is placed.
What are the risks and side effects?
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 likely can 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 100.1
- Serious problems during the procedure are very rare. These problems include heart attack, stroke, or the need for an emergency surgery. These problems might happen 1 time out of 1000.2
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 long-term 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.3
- Device problems that need another procedure to fix them. This might happen if a pacemaker lead breaks or a lead moves out of place. A lead might move out of place about 1 time out of 100.4
Daily precautions. 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.
Why might your doctor recommend a pacemaker for a heart rate problem?
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.
Compare your options
Compare
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What is usually involved? |
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What are the benefits? |
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What are the risks and side effects? |
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- You will have minor surgery to have the pacemaker put in. The doctor will numb the area so you won't feel pain.
- It can take up to 2 to 3 hours to place the pacemaker.
- You may spend the night in the hospital to make sure that the device is working and that there are no problems.
- You will need regular checkups to make sure that the pacemaker is working and to adjust the pacing, if needed.
- You may still need to take medicines for your heart rate problem.
- You still have to eat healthy foods and to exercise as your doctor advises.
- A pacemaker can help you feel better so you can be more active.
- If your risk for getting a heartbeat problem is high, a pacemaker can help prevent that from happening.
- If your heart rate problems are due to heart block, a pacemaker may help you live longer.
- Problems can happen during the procedure to place the pacemaker or soon after the procedure. One example is a lung collapsing.
- There might be problems with the pacemaker. Examples include the leads breaking or an infection.
- Some devices with strong magnetic or electrical fields could stop the pacemaker from working. You need to avoid MRI machines, battery-powered cordless power tools, and CB or ham radios. But most everyday appliances and electronic devices are safe.
- You will need surgery to replace the battery, which lasts 8 to 10 years.
- You take medicines for whatever disease is causing your heart rate problem.
- You eat healthy foods, and you exercise as your doctor advises.
- You see your doctor regularly to check your symptoms and how your medicine is working.
- You won't have the risk of infection or other problems from the surgery.
- You won't have to think about safety around devices that could stop your pacemaker from working.
- Your symptoms could get worse. This would limit your ability to do your daily activities.
- You might be at risk for fainting or falling, which could be dangerous.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about considering a pacemaker
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have a hard time getting my chores done around the house or going grocery shopping. I get really short of breath after walking for a few minutes. My doctor says a pacemaker could help me feel better.
Jack, age 66
My doctor says my heart rate is slow. But I can still work and take my daily walks with no problem. I'm not ready to get a pacemaker. I'll keep taking my medicine and following my diet.
Serena, age 55
I get dizzy sometimes, and my doctor says I have a slow heart rate that could lead to serious problems. She says a pacemaker can help keep that from happening. It's minor surgery, so I'm choosing the pacemaker.
Shaun, age 75
I'm not very active, and I'm really afraid of surgery and of having something mechanical in my body. I don't want to get a pacemaker.
James, age 83
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to get a pacemaker
Reasons not to get a pacemaker
I want to feel better so that I can do my daily activities.
I'm not having too much trouble doing my daily activities.
I don't mind having a device in my chest.
I don't like the idea of having a device in my chest.
My medicines aren't controlling my symptoms anymore.
My symptoms aren't getting worse.
I'm not worried about risks from surgery, because they're small.
I don't want to take a chance that something could go wrong during surgery.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Getting a pacemaker
NOT getting a pacemaker
What else do you need to make your decision?
Check the facts
If I get a pacemaker, I still need to follow a healthy lifestyle.
- True You're right. You still need to follow a healthy lifestyle. Eat heart-healthy foods, and don't smoke.
- False Sorry, that's not right. You still need to follow a healthy lifestyle. Eat heart-healthy foods, and don't smoke.
- I'm not sure It may help to go back and read "Get the Facts." You still need to follow a healthy lifestyle.
I don't need a pacemaker if I don't have any symptoms.
- True Sorry, that's not right. Some people with no symptoms are still at risk of getting a dangerously slow heart rate in the future. A pacemaker may be used to help prevent that.
- False You're right. Some people with no symptoms are still at risk of getting a dangerously slow heart rate in the future. A pacemaker may be used to help prevent that.
- I'm not sure It may help to go back and read "Get the Facts." Some people with no symptoms are still at risk of getting a dangerously slow heart rate in the future. A pacemaker may be used to help prevent that.
A pacemaker may help symptoms caused by my heart rate problem.
- True That's right. Pacemakers allow people to return to normal, active lives.
- False Sorry, that's not right. Pacemakers allow people to return to normal, active lives.
- I'm not sure It may help to go back and read "Get the Facts." Pacemakers allow people to return to normal, active lives.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Credits | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
- Res JCJ, et al. (2004). Pneumothorax resulting from subclavian puncture: a complication of permanent pacemaker lead implantation. Netherlands Heart Journal, 12(3): 101–105.
- Akoum NW, et al. (2008). Pacemaker therapy. In EG Nabel, ed., ACP Medicine, section 1, chap. 7. Hamilton, ON: BC Decker.
- 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.
- Swerdlow CD, et al. (2012). Pacemakers and implantable cardioverter-defibrillators. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 745–770. Philadelphia: Saunders.
Heart Rate Problems: Should I Get a Pacemaker?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Your options
- Get a pacemaker.
- Don't get a pacemaker.
This decision aid is NOT for people with heart failure. The decision for heart failure patients may involve a special type of pacemaker (cardiac resynchronization therapy) and may raise other issues to think about.
Key points to remember
- A pacemaker can help you feel better so you can return to your daily activities.
- A pacemaker sends electrical pulses to your heart to help it work better. You can't feel the pulses.
- If you get a pacemaker, you may still need to take medicines. You'll also need to follow a healthy lifestyle to help your heart. Eat heart-healthy foods, and don't smoke.
- Heart experts have guidelines about who might need a pacemaker. Talk to your doctor about the reasons that you might need one. For example, a pacemaker may be a good choice if your heart rate is very slow and you have symptoms like dizziness or fainting.
- There can be problems from having a pacemaker placed in your chest. The wires (called leads) that connect the pacemaker to your heart can move from the spot where they were placed. You could get an infection where the pacemaker was placed. Or the pacemaker or leads might not work.
What is a pacemaker?
Pacemakers are small electrical devices that help control the timing of your heartbeat.
A pacemaker is implanted under the skin of your chest wall. The pacemaker's wires pass through a vein into the chambers of your heart. The pacemaker sends out mild electrical pulses that keep your heart beating normally.
There are different types of pacemakers, so your doctor will work with you to decide what kind will be best for you.
What heart rate problems can a pacemaker help?
A pacemaker can help restore a normal heart rate when certain problems have damaged the heart's electrical system , which normally keeps your heart beating steadily. These problems include:
- Getting older. Aging sometimes affects the heart so that it can't keep up a normal heart rate.
- Coronary artery disease.
- Heart attack.
- Heart surgery.
- Heart block (such as an AV block), which is an abnormality in the way electricity passes through the heart's normal electrical pathways.
- Atrial fibrillation.
If your risk for getting a very slow heartbeat is high, a pacemaker can help prevent that from happening.
Pacemakers allow people to return to normal, active lives. Most people have very few limitations, if any.
How is a pacemaker placed?
Your doctor will put the pacemaker in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.
Your doctor makes a small cut (incision) in your upper chest. In some cases, the pacemaker can be placed lower in the chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered. The doctor puts the leads in a vein and threads them to the heart. Then your doctor connects the leads to the pacemaker. Your doctor programs the pacemaker and then puts it in your chest and closes the incision.
It can take about 2 to 3 hours to place the pacemaker.
Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery. But sometimes the procedure is done as an outpatient procedure, which means you don't need to stay overnight in the hospital.
You may be able to see a little bump under the skin where the pacemaker is placed.
What are the risks and side effects?
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 likely can 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 100.1
- Serious problems during the procedure are very rare. These problems include heart attack, stroke, or the need for an emergency surgery. These problems might happen 1 time out of 1000.2
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 long-term 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.3
- Device problems that need another procedure to fix them. This might happen if a pacemaker lead breaks or a lead moves out of place. A lead might move out of place about 1 time out of 100.4
Daily precautions. 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.
Why might your doctor recommend a pacemaker for a heart rate problem?
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.
2. Compare your options
| Get a pacemaker | Don't get a pacemaker | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about considering a pacemaker
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I have a hard time getting my chores done around the house or going grocery shopping. I get really short of breath after walking for a few minutes. My doctor says a pacemaker could help me feel better."
— Jack, age 66
"My doctor says my heart rate is slow. But I can still work and take my daily walks with no problem. I'm not ready to get a pacemaker. I'll keep taking my medicine and following my diet."
— Serena, age 55
"I get dizzy sometimes, and my doctor says I have a slow heart rate that could lead to serious problems. She says a pacemaker can help keep that from happening. It's minor surgery, so I'm choosing the pacemaker."
— Shaun, age 75
"I'm not very active, and I'm really afraid of surgery and of having something mechanical in my body. I don't want to get a pacemaker."
— James, age 83
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to get a pacemaker
Reasons not to get a pacemaker
I want to feel better so that I can do my daily activities.
I'm not having too much trouble doing my daily activities.
I don't mind having a device in my chest.
I don't like the idea of having a device in my chest.
My medicines aren't controlling my symptoms anymore.
My symptoms aren't getting worse.
I'm not worried about risks from surgery, because they're small.
I don't want to take a chance that something could go wrong during surgery.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Getting a pacemaker
NOT getting a pacemaker
5. What else do you need to make your decision?
Check the facts
1. If I get a pacemaker, I still need to follow a healthy lifestyle.
- True
- False
- I'm not sure
2. I don't need a pacemaker if I don't have any symptoms.
- True
- False
- I'm not sure
3. A pacemaker may help symptoms caused by my heart rate problem.
- True
- False
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
3. Use the following space to list questions, concerns, and next steps.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
- Res JCJ, et al. (2004). Pneumothorax resulting from subclavian puncture: a complication of permanent pacemaker lead implantation. Netherlands Heart Journal, 12(3): 101–105.
- Akoum NW, et al. (2008). Pacemaker therapy. In EG Nabel, ed., ACP Medicine, section 1, chap. 7. Hamilton, ON: BC Decker.
- 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.
- Swerdlow CD, et al. (2012). Pacemakers and implantable cardioverter-defibrillators. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 745–770. Philadelphia: Saunders.
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Last Revised: June 2, 2011
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