A pacemaker (pūrere whakakapa manawa) is a small device designed to help your heart beat regularly. It contains a long-lasting battery and an electronic circuit sealed in a metal case. The pacemaker sits under your skin and produces an electrical impulse, which is sent directly to the heart muscle by one or two leads. When the impulse reaches the heart muscle, it causes the heart to beat.
Your heart beats regularly at varying rates depending on your body's needs. However, if your heart beats too slowly or at an irregular rate, it may cause you to feel light-headed, breathless or even experience blackouts. These slow or irregular heartbeats are called arrythmias and can be due to:
- heart disease
- damage to the heart's electrical conducting system
- congenital heart defects.
The pacemaker may do one or more of the following:
- control the rate at which the ventricles pump
- restore "communication" between the atria and ventricles, coordinating their contractions
- increase the heart rate, when required, in response to physical activity demands.
When your heart is beating normally, the pacemaker will not be activated. It only activates when your heart rate is too slow.
The pacemaker rate can be reprogrammed to meet your needs. This is done via an external device that communicates with the pacemaker. The pacemaker can also be programmed not to activate at times when your heartbeat would normally slow down, e.g. when sleeping.
There are several types of pacemaker available, and your heart doctor (cardiologist) will discuss the different options with you to decide which is the most suitable.
Inserting a pacemaker
Pacemaker implantation procedures are normally undertaken in hospital as a day stay or overnight stay. Before the procedure you may be given a light sedative to help you relax. The doctor will begin the procedure by injecting local anaesthetic to numb the area where the pacemaker will be inserted.
The pacemaker leads are inserted into a vein below your collarbone and passed along this vein into your heart. The leads are then attached to the inside of the heart wall. The leads are tested and connected to the pacemaker. The pacemaker is then implanted under your skin, below your left or right shoulder. The procedure normally takes about one hour, although this can vary.
Your cardiologist or cardiac technologist will then check and programme your pacemaker to best suit your individual needs.
What happens afterwards?
Once your pacemaker has been checked, you will usually be sent home within 6 to 24 hours. You may experience some discomfort and bruising around your pacemaker site. Discomfort can be relieved with regular paracetamol.
Before going home, your doctor/nurse/cardiac technologist will discuss with you how to care for the pacemaker site, including keeping it dry for one week. You will also be given a pacemaker information booklet. It is important that you read this booklet and discuss any queries during the appointment.
When back home you will also be sent a pacemaker clinic appointment. Regular follow-ups will be arranged by your local pacemaker clinic to ensure the pacemaker continues to function appropriately.
How will I know if the pacemaker is not working correctly?
If the pacemaker is not working correctly, you may not feel your pacemaker when it activates. Contact your doctor or pacemaker clinic immediately if you develop:
- symptoms similar to those prior to pacemaker implantation
- hiccuping or twitching in your chest area
- a racing heart
- redness, pain, swelling and/or discharge from around the pacemaker site.
It is important if you have any concerns about your new pacemaker or wound, to contact your local pacemaker clinic immediately.
How long does the pacemaker battery last?
Most pacemaker batteries last between five and ten years, but it depends on the type of pacemaker and how often it is activated. At each pacemaker clinic appointment the battery will be checked. Replacing the battery requires a local anaesthetic and is generally a very brief procedure.
When will I be able to return to normal activities?
It takes a few weeks for the pacemaker wires to become fully secure and for the discomfort to go away. For this reason, heavy lifting and activities that require you to lift your arm above shoulder height should be avoided. In general, after four to six weeks you should be able to build up to your normal living activities, including work and travel. Your doctor will advise as to when you can start to drive again.
Electrical devices and your pacemaker
While most electrical appliances will not affect your pacemaker, the following equipment may interfere with a pacemaker's electronic system.
Devices and equipment to avoid:
- medical equipment, such as magnetic resonance imaging (MRI), lithotripsy or radiotherapy
- magnetic bracelets and mattresses or chairs
- shortwave diathermy treatment/TENS machines used by physiotherapists and during surgery
- electrocautery and ultrasonic scaling equipment used by dentists and electrolysis for hair removal
- working on car ignition systems
- electric arc welders
- close proximity to high power radar or electrical installations
- cellphones should be kept at least six inches away from the pacemaker.
In general, prior to any treatment you should advise all health professionals that you have a pacemaker fitted. You may be required to have a pacemaker check before and after some procedures or treatments.
If unsure of the effects of treatments, contact your local pacemaker clinic for advice. Your doctor will advise you about wearing a medical alert bracelet.
Information for healthcare providers
Management of atrial fibrillation in general practice Best Practice Journal, NZ, 2011