What Is a Pacemaker?
When there’s a problem with your heart’s electrical system, a pacemaker can help. A pacemaker is a small, lightweight electronic device that’s placed inside your body. The pacemaker keeps track of your heartbeat and, when necessary, generates electrical signals similar to the heart’s natural signals. These signals keep your heart beating at the right pace.

Why You Need a Pacemaker
Your doctor may have told you that you need a pacemaker. To understand why, you need to know that your heart has an electrical system that helps it beat at a regular speed or pace. Problems with this electrical system can make your heart’s pace slow or uneven, possibly leaving you feeling run-down or even faint. A pacemaker is a small electronic device that helps your electrical system keep your heart beating at the right pace.

A Pacemaker Can Help
Having a pacemaker implanted is a fairly simple surgical procedure, but it does require a lifelong commitment. Your doctor can answer your questions and offer you reassurance. Keep in mind that pacemakers have been around for more than 30 years. With proper care, a pacemaker can help keep you feeling good for many years to come.

Your Heart’s Electrical System
Your heart’s job is to keep blood moving through your body. To do this, your heart beats many times each minute. Signals from your heart’s electrical system tell it when to beat. If there’s a problem with these signals, your heart may not beat when it should. This doesn’t always mean you’ve had a heart attack or have a problem with your blood vessels — it simply means your heart’s not beating often enough.

Signals Tell Your Heart to Beat
Your heart is divided into four chambers that hold blood as it moves through the heart. The two upper chambers are the atria and the two lower chambers are the ventricles. When the heart beats, the atria contract (squeeze) to move blood to the ventricles and the ventricles contact to move blood out to the rest of the body. Certain areas of the heart’s electrical system, known as nodes, send the signals that tell the chambers when to contract. When you’re active, these signals speed up to move your blood faster. When you’re resting, the signals return to a slower pace.

Problems with Your Signals
Sometimes your heart’s signals don’t work properly. The signals from the SA node (sinus node) may be too slow (sinus bradycardia), may alternate between being too fast and too slow (sick sinus syndrome), or may occasionally stop (sinus pause). Or, signals may not be able to leave the AV node or move along the pathways to the ventricles (heart block). These problems mean that the atria, the ventricles, or both contract at too slow a pace — fewer times each minute than they should.

What a Pacemaker Does
A pacemaker helps keep your heart from beating too slowly, but it doesn’t stop your heart from beating on its own. The pacemaker “listens” to your heart. When the heart’s own electrical system sends a signal and the heart beats, the pacemaker waits and does nothing. When the heart’s system misses a signal, the pacemaker sends a signal to replace it.

The Parts of the Pacemaker
The generator makes the electrical signals when they’re needed. It’s a smooth, lightweight case containing a tiny computer and a battery. You won’t feel the electricity coming out of the generator.

The connector is the part of the generator where the lead or leads are attached.

Leads are wires covered by soft, flexible plastic. They help the generator listen to the heart and carry the generator’s signals to the heart. A pacemaker may have one or two leads. The leads won’t cut or poke you, and they won’t stop the blood from flowing through your vein.

Types of Pacemakers
Your doctor will choose the type of pacemaker that’s best for you. A pacemaker with one lead is called a single-chamber pacemaker. Depending on where the signal problem is in your heart, the lead will end in either your right atrium or your right ventricle.

A pacemaker with two leads is called a dual-chamber pacemaker. A dual-chamber pacemaker has one lead that ends in your right atrium and one that ends in your right ventricle. Two leads may help some hearts beat more efficiently by coordinating the signals between the chambers.

Rate-adaptive Pacemakers
When you’re active, your heart beats at a faster pace or rate. Electrical system problems can sometimes keep your heart’s rate from speeding up when you’re active. Because of this, some single-chamber and dual-chamber pacemakers are also rate-adaptive. This means they can help change the rate of your heartbeat depending upon your activity level. So when you’re dancing or doing a similar activity, a rate-adaptive pacemaker helps your heart beat faster. And when you sit down to rest, the pacemaker lets your heart return to a slower rate.

Implanting Your Pacemaker
Inserting the pacemaker into your body is called implantation. Pacemaker implantation is not open heart surgery. Rather, it’s a minor procedure that’s done in a operating room or cardiac catheterization lab. You’ll be given instructions on how to prepare for the procedure. Pacemakers can be inserted near the right or left shoulder. If you prefer to have it implanted on a particular side, discuss your preference with your doctor.

Preparing for Implantation
Ask your doctor whether you should stop taking aspirin or other medications before your procedure. Unless instructed otherwise, don’t eat or drink anything for six hours before the procedure. You’ll probably be admitted to the hospital on the day of the procedure. Before the procedure begins, you may be given some medication to help you relax. The skin where the pacemaker is implanted may be washed and shaved.

Understanding Potential Risks and Complications
Implanting a pacemaker is a simple procedure involving little risk. But, as with any other surgical procedure, there can be complications. You may be asked to sign a consent form stating that you understand the risks of implantation and give your permission to perform the procedure. The possible risks of implanting a pacemaker include the following:

• Bleeding or bruising
• Tearing of the vein or artery wall
• Clotting or air bubbles in the vein
• Puncture of the lung or heart muscle
• Infection or nerve damage at the incision site

During the Procedure
The most common method used to insert a pacemaker is called endocardial (”inside the heart”) implantation. In many cases, this procedure takes one to two hours. You may stay awake during the procedure. If so, you’ll probably hear the surgical team talking. You may be asked some questions or be asked to take some deep breaths.

Implanting the Pacemaker
This is how endocardial implantation is commonly done:

A local anesthetic is given by injection to numb the area where the pacemaker will be inserted. This keeps you from feeling pain during the procedure.

An incision is made in your skin below your collarbone to create a small “pocket.”

The lead is threaded through the incision into a vein in your upper chest. The lead is then guided into your heart’s chambers using x-ray monitors. Electrical measurements are taken to determine a good position for the lead in the heart. If there is a second lead, this process is repeated.

The pacemaker generator is attached to the lead or leads. Then, the generator is placed in its pocket under your skin.

The pacemaker’s settings are programmed to help your heart beat at a rate that’s right for you. The incision is then closed and covered with a sterile dressing.

An Alternative Method
Your doctor may use another method, called epicardial (”outside the heart”) implantation. Epicardial implantation takes longer than endocardial implantation and requires more recovery time. An opening is made in the lower chest, and the lead is threaded up to the outside of the heart. The generator is attached to the leads and placed underneath the skin of the abdomen.

Living Your Life
A pacemaker may give your heart the extra help it needs to relieve your symptoms and help you feel better. Far from restricting your activities, your pacemaker frees you to enjoy your life. This means that you can be active and do the things you love.