What is a pacemaker?
A pacemaker is a small electronic device that helps regulate slow electrical problems in the heart. The pacemaker is usually implanted in the chest, just below the collarbone. Your doctor may recommend this device to keep your heartbeat from slowing down to a dangerously low rate.
The heart is a pump made up of muscle tissue that is stimulated by electrical currents, which normally follow a specific circuit within the heart. These natural electrical impulses coordinate contractions of the different parts of the heart to keep blood flowing the way it should. A pacemaker may be needed when there are problems with the natural electrical conduction system of the heart.
A pacemaker is made of 3 parts: a pulse generator, 1 or more leads, and an electrode on each lead. A pacemaker signals the heart to beat when the natural heartbeat is too slow or irregular.
Why might I need a pacemaker?
Your doctor may recommend a pacemaker to stimulate a faster heart rate when your heart beats too slow and the problem can't be fixed with other treatments.
Problems with the heart rhythm may mean your heart is not pumping enough blood to the body. If your heart rate is too slow, the blood is pumped too slowly. If the heart rate is too fast or too irregular, the heart chambers are unable to fill up with enough blood to pump out with each beat. When the body does not get enough blood, symptoms such as tiredness, dizziness, fainting, or chest pain may occur.
Some examples of heart rate and rhythm problems for which a pacemaker might be inserted include:
- Bradycardia. This is when the heart beats too slowly.
- Tachy-brady syndrome. This is characterized by alternating fast and slow heartbeats.
- Heart block. This occurs when the electrical signal is delayed or blocked as it travels through the heart muscle. There are several types of heart blocks.
There may be other reasons for your healthcare provider to recommend pacemaker insertion.
What happens after pacemaker insertion?
In the hospital
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. A nurse will monitor your vital signs.
Let your nurse know right away if you feel any chest pain or tightness, or any other pain at the insertion site.
After the period of bed rest has been completed, you may get out of bed with help. The nurse will be with you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. Move slowly when getting up from the bed to avoid any dizziness.
You will be able to eat or drink once you are completely awake.
The insertion site may be sore or painful. Pain medicine may be taken if needed.
Your arm may be placed in a sling overnight. Your provider will give you specific instructions on any activity restrictions and about immobilizing your arm after the procedure.
You will have a chest X-ray to make sure the lung was not injured during the procedure, and to check the device position.
You may be prescribed antibiotics to protect you from an infection around your pacemaker or at the incision site.
Your healthcare provider will see you in your room while you are recovering. The healthcare provider will give you specific instructions and answer any questions you may have.
Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or allowed to go home. It’s common to spend at least one night in the hospital after pacemaker implantation.
Arrange to have someone drive you home from the hospital following your procedure.
You should be able to return to your normal daily routine within a few days. Your healthcare provider will tell you if you will need to wait before returning to your normal activities. Do not do any lifting or pulling for a few weeks. You may need to limit movement of the arm on the side that the pacemaker was placed.
You will most likely be able to go back to your usual diet, unless your healthcare provider tells you differently.
It will be important to keep the insertion site clean and dry. You will be given instructions about bathing and showering.
Your healthcare provider will give you specific instructions about driving.
Ask your healthcare provider when you will be able to return to work. The nature of your work, your overall health, and your progress after surgery will determine how soon you may go back to work.
Call 911 if you have severe, unrelenting chest pain or trouble breathing.
Contact your healthcare provider right away if you have any of the following:
- Fever of 100.4°F (38°C) or higher
- Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
- Chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, lightheadedness, fainting, or lack of energy
- Palpitations, rapid or pounding heartbeat
- Swelling in the arms or hands on the side of the incision
- You have hiccups that will not stop
- You have muscle twitching in your abdomen
- Shortness of breath
After a pacemaker insertion, regularly scheduled appointments will be made to ensure the pacemaker is working the way it should. The healthcare provider uses a special computer, called a programmer, to review the pacemaker's activity and adjust the settings when needed.
Your healthcare provider may give you other instructions after the procedure, depending on your particular situation.
Things to keep in mind
Always consider the following precautions. Discuss these in detail with your healthcare provider, or call the company that made your device:
- Always carry an ID card that states you have a pacemaker. In addition, you may want to wear a medical ID bracelet or necklace indicating that you have a pacemaker.
- Let security screeners know you have a pacemaker before going through security detectors at the airport or court house. In general airport detectors are safe for pacemakers, but the small amount of metal in the pacemaker and leads may set off the alarm. If you are selected for additional screening by hand-held detector devices, politely remind the screeners that the detector wand should not be held over your pacemaker for longer than a few seconds, as these devices contain magnets that may affect the function or programming of your pacemaker.
- You should not have a magnetic resonance imaging (MRI) imaging test (unless you have a specially designed pacemaker).
- You should avoid large magnetic fields such as power generation sites and industrial sites such as automobile junkyards that use large magnets.
- Do not use short-wave or microwave diathermy that uses high-frequency, high-intensity signals (this may be used in physical therapy to treat muscles). The signals can interfere with or damage your pacemaker.
- Turn off large motors, such as cars or boats, when working close to them, they may create a magnetic field.
- Avoid high-voltage or radar machinery, such as radio or television transmitters, electric arc welders, high-tension wires, radar installations, or smelting furnaces.
- If you need a surgical procedure in the future, be sure to let the surgeon know that you have a pacemaker well before the operation. Also ask your cardiologist's advice on whether anything special should be done before and during the surgery, the electrocautery device that controls bleeding may interfere with the pacemaker. Sometimes the pacemaker's programming will be temporarily changed (using a magnet) during the surgery to minimize the possibility of interference from the electrocautery.
- When involved in a physical, recreational, or sporting activity, protect yourself from trauma to the pacemaker. A blow to the chest near the pacemaker can affect its functioning. If you are hit in that area, you may want to see your healthcare provider to make sure your pacemaker is working the way it should be.
- Cell phones in the U.S. with less than 3 watts of output do not seem to affect pacemakers or the pulse generator, but as a precaution, keep cell phones at least 6 inches away from your pacemaker. Do not carry a cell phone in your breast pocket over your pacemaker.
- Always consult your healthcare provider when you feel ill after an activity, or when you have questions about beginning a new activity.
- Always contact your healthcare provider if you have any questions about using certain equipment near your pacemaker.