Cardiac pacemaker

What is the heart and how does it work?

The heart is a muscle inside your chest, which pumps blood around your body to your vital organs. It’s a very special muscle that has its own electric current. This electric current moves through your heart and causes it to pump properly. It tells your heart to beat at a slower speed when you’re resting, and more quickly when you’re moving around or exercising. This is where your heartbeat comes from.

What is a pacemaker?

A pacemaker is a small device that sends electrical impulses to make your heart beat regularly. It is inserted into your chest and sits just under your collarbone, either on the left or right side of your chest. It has two parts – a small, chunky generator you can feel under your skin, and leads. The generator has a battery inside, and generates the electrical messages for your heart. The leads connect the generator to your heart and send the electrical impulses.

Why do I need a pacemaker?

A healthy, normal heart sets its own rhythm and beats anywhere between 60 and 100 times per minute. It increases in rate with exertion or stress, and slows with relaxation and sleep. There are specific regions within the heart that generate this electrical rhythm, and paths that travel like highways through the heart to conduct the electrical impulse.

Sometimes, the heart’s rhythm becomes irregular. This can be due to ageing, heart attacks, certain medications and certain genes. Symptoms of an irregular heartbeat include palpitations, fatigue, breathlessness, fainting and feeling giddy or lightheaded. If your heart beats too slowly, too quickly or too irregularly it may need to be told to beat by an external source, like a pacemaker.

A pacemaker is constantly monitoring your heart’s rhythm, and will only send impulses to your heart if it is beating too slowly or too quickly. Newer pacemakers can sense if you are exercising and increase your heart beat as required.

How is it inserted?

You will most likely have the pacemaker inserted as an operation in hospital. Your doctor will discuss whether you should not take certain medications before your operation.

You will most likely be awake for this procedure. A cannula (needle and tube) will be inserted into your hand or arm to give you some fluids. Through this drip, you’ll also be given some medication to sedate you during the procedure.

After cleaning and numbing the area, a surgeon will make a small cut under your collarbone and insert a thin tube (catheter) through a blood vessel that will lead to your heart. The doctor will check the placement of this tube using X-ray images. Using this tube, one or more wires will be connected to your heart. The other ends of these wires are connected to the pacemaker generator, which will send electrical signals to regulate your heart’s rhythm. Once the wires are placed, the surgeon will insert the pacemaker generator (the bulky part which can be felt under the skin). It will sit just under your collarbone on your non-dominant side. The cut in your skin will be stitched shut and covered with a clean dressing.

What are the risks of a pacemaker insertion?

– Bruising, swelling and pain at the insertion site
– Movement or incorrect placement of the pacemaker leads or generator
– Bleeding or blood clotting
– Infection
– Damage to the heart from the pacemaker leads
– Lung collapse
– Heart attack
– Stroke
– Death, although this is very rare

What happens after the procedure?

You may stay overnight in hospital or be discharged on the same day. You should have someone available to pick you up and take you home as you won’t be able to drive. Don’t swim or have a bath for six weeks.

Avoid lifting more than 5kg on the same side of your pacemaker for at least two weeks after the operation. Avoid activities that require pushing and pulling (like hanging laundry, mowing the lawn, sweeping etc.) for at least a month after the pacemaker insertion. Try to avoid sports with large arm movements or swinging movements, like swimming or tennis, for two months.

You should carry an ID card with you that has the details of your pacemaker on it. Each new health professional you meet should know that you have a pacemaker, especially if you will be having a scan (such as an MRI or CT). Going through security scanners at airports should not affect the function of your pacemaker, but you may set off the alarm!