The heart is a hollow, muscular organ with four chambers.
- The top two chambers are called the left and right atrium. The right atrium receives blood from the body. The left atrium receives blood from the lungs.
- The bottom two chambers are called ventricles. The right ventricle receives blood from the right atrium and pumps it out to the lungs. The left ventricle receives blood from the left atrium and pumps it out to the rest of the body.
- The heart's normal pacemaker initiates contractions of its four chambers in a regular, coordinated rhythm. A normal resting heart rate for is sixty to one hundred beats per minute. The beats happen at regular intervals.
- An arrhythmia can cause the heart to beat irregularly (i.e., at varying intervals from beat to beat) and at abnormally fast or slow rates.
If the heart's electrical system is not working properly, an artificial pacemaker may be needed.
- Pacemakers may also be used to treat other conditions (atrial fibrillation, heart failure).
- Sometimes a pacemaker is needed if you must take medication that causes a slow heartbeat.
Pacemakers are typically inserted just below the collarbone, in the soft tissue outside the ribs. It is made up of leads and a generator.
- The leads conduct electrical impulses from the generator to the heart muscle.
- The generator is a small device that is inserted under the skin. It is powered by a lithium battery, which usually lasts from five to ten years.
- A pacemaker can be programmed to stimulate the heart to beat at a steady rate or at a rate needed to support physical activity.
- The generator can be analyzed and programmed electronically, even after insertion.
The type of pacemaker your healthcare provider recommends will depend on your:
- General health
- Medical history
- Current diagnosis
- Provider preference
Pacemakers are most often used when the heart rhythm is too slow. In some cases it may be used to interrupt a fast heart rhythm.
- When the heart rate is less than 60 beats per minute it is called bradycardia.
- When a heart rate is more than 100 beats per minute it is called tachycardia.
Symptoms that occur when your heart beats to slow include:
- Exercise intolerance
- Symptoms of heart failure (such as shortness of breath)
- Feelings of fatigue and/or weakness
Contact your healthcare provider if you have symptoms of a low heart rate. He or she will do a physical exam, review your medications, and possible order some tests.
- A medication review will focus on medications that might be causing a problem with your hearts rhythm.
- An electrocardiogram (EKG) will show problems with your heart rate or rhythm. It will only show the problems if they are happening at the time of the recording.
- Holter monitoring can provide a continuous recording of your heart's electrical activity for twenty-four to seventy-two hours. It will show problems that happen at any time during the recording.
- An electrophysiology study (EP study or cardiac mapping) may be done to detect arrhythmias and problems with your heart's electrical system.
A pacemaker is typically inserted by a cardiologist in a cardiac catheterization laboratory or electrophysiology laboratory (EP Lab).
- You may be given some medicine to relax. However, you will be awake for the procedure.
- You may feel some discomfort where the pacemaker is inserted.
- Your cardiologist will create a "pocket" by numbing the area and making a small incision in the skin under your right or left collarbone. (Tell your doctor if you have a preference for which side you would like the generator placed.)
- The generator will be put in the pocket and the lead wires will be threaded to your heart.
Many people who receive pacemakers go home the same day or the next morning.
- After the procedure, a chest x-ray will be done to confirm proper positioning of the leads. It will also check for any possible problems.
- Additional electrocardiograms will likely be done before you are discharged.
- You may need pain medication and help at home while you recover.
Do not forget to ask your cardiologist for any specific instructions to follow after surgery. This can include not driving or lifting your arm above your shoulder for a week. Although you may be able to resume most normal activities right away, you should avoid strenuous activities for at least two weeks.
- You may learn how to transmit data from the pacemaker to your cardiologist through your home phone. This helps ensure your pacemaker is working properly.
- Before medical or dental procedures, let the provider know you have a pacemaker.
- If you are a smoker, you should quit smoking, as it can interfere with your recovery.
Contact your healthcare provider if:
- Your original symptoms return
- Your pulse becomes abnormal
- You develop prolonged hiccups
- Your arm or chest muscles are twitching
This care path includes the costs of a pacemaker inserted as an inpatient requiring an overnight stay in the hospital.
If your healthcare provider recommends a pacemaker, ask him or her the following questions
- Do I need any special tests? What are the benefits and risks of having the tests?
- Will the tests change your treatment recommendations? If not, is there a need for them?
- Why do I need a pacemaker? What are my treatment options and what is the best treatment for me? What are the risks of each one?
- What are the different brands and types of pacemakers? Which one do you prefer, and why? How does one compare to another?
- After the pacemaker is inserted, what symptoms should I be concerned about? What precautions do I need to take?
- Can my symptoms be controlled with medications? If so, are their Tier 1 or Tier 2 medications on my Prescription Drug List that I should take? How long will I need to take these medications?
- How often do I need to follow up with you? How often do I have to have the pacemaker checked? How do I know if it is working correctly?
Prior to discharge, you should understand all home care instructions. This includes symptoms to report before your next appointment, medications and their side effects and follow-up plans.