Treatment Overview
A pacemaker is a battery-powered device
about the size of a pocket watch that sends weak electrical impulses to "set a
pace" so that the heart is able to maintain a regular heartbeat. Some people who have atrial fibrillation need a pacemaker.
There are two
basic types of pacemakers.
- Single-chamber pacemakers stimulate one chamber of the heart, either an atrium or more
often a 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 atria and
ventricles in a pattern that closely resembles the natural heartbeat.
All new pacemakers are rate-response, or physiologic,
pacemakers. They can sense when your activity increases and respond by
increasing your heart rate.
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. The procedure takes about an hour.
Permanent pacemakers are powered by batteries. The batteries usually last 5 to
15 years before they need to be replaced.
Temporary pacemakers are
attached to the heart by a wire threaded through a neck vein, a leg vein, or
through the chest wall. Temporary pacemakers are most commonly used for a short
time following heart surgery or when waiting for a permanent pacemaker to be
implanted.
What To Expect After Treatment
Most people stay overnight in the
hospital after they have a pacemaker implanted. And they 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, avoid driving or doing
vigorous physical activity that involves the upper body.
About twice a year your doctor will
check your pacemaker and adjust it, if needed. In
between checkups, you may be asked to send information from your pacemaker to
your doctor or clinic over the telephone (telephone monitoring).
Why It Is Done
People with
atrial fibrillation may need a pacemaker for a
variety of reasons. These reasons include:
- You have atrial fibrillation that comes and goes. And you have a fast heart rate when you are in atrial
fibrillation and a slow heart rate when you are not in atrial fibrillation. This is called tachy-brady syndrome.
- You had a catheter ablation procedure that destroyed the AV node in your heart. This AV node helps control your heart rate. A pacemaker is placed to control the heart rate.
- You have a problem with the natural pacemaker of the
heart (AV or SA node).
- You take a medicine for atrial fibrillation that slows your heart rate too much.
How Well It Works
Pacemakers stimulate the heart to
speed up when it beats too slowly or reset the rate when the heart beats too
fast. They can also substitute for the natural pacemaker of the heart (AV or SA node).
Risks
Few activities interrupt the signals sent by
the pacemaker to the heart. Follow your doctor's specific instructions about
care and precautions if you have a pacemaker.
Risks during the
procedure to implant a pacemaker include:
- Puncture of the
heart.
- Bleeding.
- Difficulty
breathing.
- Irregular heart
rhythms.
- Infection.
- Blood clot.
- Pacemaker
malfunction (wire breaks or device has sensing problems).
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.
Rate-responsive pacemakers are
often the ideal choice for active people. These pacemakers closely reproduce
natural heart rhythms and are able to raise heart rate in response to physical
activity. Your doctor can decide how fast the pacemaker should respond and how
quickly your heart rate should return to a resting rate.
Strong
electric or magnetic fields can interfere with your pacemaker. You can safely
use most household and office equipment. And you can usually avoid electrical
interference from magnetic or electrical sources by keeping certain things a
few inches away from your pacemaker. You should completely avoid things like
heavy electrical or industrial equipment.
You may walk through
metal detectors (in airports or other security checkpoints) at a normal speed. But avoid standing near or leaning on these systems. Your pacemaker may set off
a metal detector, but the security archways will not damage the device. Your
doctor will give you a pacemaker identification card to carry at all times.
Before you pass through a metal detector, tell the security guards that you
have a pacemaker, and show them your device identification card.
If you have a pacemaker, you will not be able to have an MRI (magnetic
resonance imaging) test. Before you have any tests or surgery, tell all of the
health professionals involved in your care that you have a pacemaker. You may
choose to wear a medical alert bracelet that says you have a pacemaker. Experts
are trying to make pacemakers that can work safely during an MRI test.
Heart Problems: Living With a Pacemaker or ICD
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer |
John M. Miller, MD, FACC - Cardiology, Electrophysiology |
| Last Revised |
November 2, 2010 |
