If you’re experiencing a disorder that affects the rhythm of your heart, you may be prescribed a pacemaker. A pacemaker is a small, battery-powered medical device that monitors the heart’s electrical activity and provides electrical impulses to regulate the heart rate and rhythm when needed.
When the pacemaker detects that the heart rate is too slow or irregular, it sends electrical signals through the leads to stimulate the heart to beat at a more normal rate and pattern. This helps to ensure that the heart pumps blood effectively throughout the body, delivering oxygen and nutrients to vital organs and tissues.
In this article, we’ll examine the specific heart conditions that require a pacemaker.
Heart conditions that require a pacemaker
The following conditions require pacemakers because they involve irregularities in the heart’s electrical system or rhythm:
Bradycardia
Bradycardia is a condition where the heart beats abnormally slowly, typically much less than 60 beats per minute (and usually less than 40 beats per minutes). This slow rhythm can prevent the body from receiving enough oxygenated blood, leading to symptoms such as fatigue, dizziness, shortness of breath, and in severe cases, fainting.
Heart block
Heart block occurs when the electrical signals that control heart rhythm are partially or completely blocked between the upper (atrial) and lower (ventricle) chambers of the heart. This disruption can cause the heart to beat too slowly or irregularly.
There are different degrees of heart block, ranging from first-degree (mild) to third-degree (complete). In severe cases, a pacemaker is crucial as it bypasses the blocked pathway, ensuring that electrical signals reach the ventricles properly.
Sick sinus syndrome
Sick sinus syndrome, also known as sinus node dysfunction, is a group of heart rhythm problems caused by a malfunctioning sinoatrial (SA) node, the heart’s natural pacemaker. This condition can result in alternating episodes of bradycardia and tachycardia (fast heart rate), as well as pauses in the heart’s rhythm.
Symptoms may include fatigue, dizziness, fainting, and shortness of breath. A pacemaker is often the primary treatment for sick sinus syndrome, as it takes over the role of the dysfunctional SA node.
Atrial fibrillation
Atrial fibrillation (AFib) is a common heart rhythm disorder characterised by rapid, irregular beating of the atria. While pacemakers are not typically the first-line treatment for AFib, they may be necessary in certain situations.
For instance, after catheter ablation procedures to treat AFib, some patients may develop a slow heart rate, requiring a pacemaker to maintain proper rhythm. Additionally, in cases where medications to control AFib also slow the heart rate excessively, a pacemaker can be used to prevent severe bradycardia.
Heart failure
In certain cases of heart failure, particularly when the heart’s chambers are not contracting in a coordinated manner, a specialised type of pacemaker known as a cardiac resynchronisation therapy (CRT) device may be recommended.
Heart failure occurs when the heart cannot pump blood efficiently to meet the body’s needs. CRT devices use multiple leads to stimulate both ventricles simultaneously, improving the heart’s pumping efficiency.
Syncope
Syncope, or fainting, can sometimes be caused by a heart rhythm problem, particularly when it occurs repeatedly. In cases where syncope is due to a slow heart rate or long pauses between heartbeats, a pacemaker may be an effective treatment.
By maintaining a consistent, appropriate heart rate, pacemakers can significantly reduce or eliminate syncopal episodes, improving the patient’s safety and quality of life. This is especially important in older adults, where syncope can lead to falls and serious injuries.
What causes arrhythmias?
There are several potential causes of arrhythmias. In many cases, these causes work in tandem for an arrhythmia to develop. They include:
- Coronary artery disease: Blocked arteries that reduce blood flow and oxygen supply to the heart muscle can disrupt the heart’s electrical activity and cause arrhythmias.
- Heart attack: Damage to the heart muscle from a heart attack can lead to arrhythmias by affecting the electrical conduction pathways.
- Electrolyte imbalances: Imbalances in electrolytes like potassium, sodium, and calcium can interfere with the heart’s electrical signals and trigger arrhythmias.
- Congenital heart defects: Some people are born with abnormalities in the heart’s structure or electrical system, which can predispose them to arrhythmias.
- Cardiomyopathy: Diseases that weaken or stiffen the heart muscle, such as dilated or hypertrophic cardiomyopathy, can cause arrhythmias.
- Thyroid disorders: Both hyperthyroidism and hypothyroidism can affect the heart’s electrical activity and lead to arrhythmias.
- Medications: Certain medications, including some antiarrhythmic drugs, can paradoxically cause arrhythmias as a side effect.
- Excessive alcohol or caffeine: Excessive consumption of alcohol or caffeine can trigger arrhythmias in some individuals.
- Stress or anxiety: Intense emotional stress or anxiety can sometimes precipitate arrhythmias.
- Smoking: The chemicals in tobacco can damage the heart and increase the risk of arrhythmias.
What is the procedure for implanting a pacemaker?
If you have been prescribed with a pacemaker, it will be implanted per the following 1-2 hour procedure:
- You will be given local anaesthesia to numb the area where the pacemaker will be implanted, the left upper chest. If necessary, light sedation may also be used.
- The surgeon will make a small incision just below the collarbone, followed by another small incision made in a vein, usually the subclavian vein.
- Using X-ray guidance, the surgeon threads one to three flexible, insulated wires (leads) through the vein into the appropriate chambers of the heart.
- Once the leads are in place, they are tested to ensure they can pace the heart effectively and sense the heart’s own electrical activity.
- A small pocket is created under the skin to hold the pacemaker generator (the part containing the battery and circuitry).
- The leads are connected to the generator, which is then inserted into the pocket.
- The incision is closed with sutures and dressed.
- The pacemaker is programmed to the patient’s specific needs, which typically include:
- Setting the lower heart rate limit to prevent bradycardia
- Adjusting the upper rate limit to manage exercise tolerance
- Configuring sensing thresholds to detect the heart’s intrinsic electrical activity accurately.
What is the aftercare for a pacemaker insertion?
Pacemaker insertion comes with an aftercare regimen designed to help ensure proper healing, optimal pacemaker function, and your overall well-being. Once your pacemaker is inserted:
- You will be instructed on how to keep the incision site clean and dry to prevent infection. This means you may need to avoid showering for a few days and should watch for signs of infection like redness, swelling, or discharge.
- For the first few weeks, you will be advised to limit arm movement on the side of the pacemaker to allow the leads to settle into place. Avoid heavy lifting and strenuous activities.
- You may experience mild pain at the incision site. This is common and can usually be managed with over-the-counter pain medications as prescribed by the doctor.
- You will have a follow-up visit within a week to check the incision and ensure the pacemaker is functioning properly. Regular check-ups are then scheduled, often every 3-6 months.
- There is a possibility you may need to start, stop, or adjust medications after pacemaker insertion.
- You receive a card that identifies you as having a pacemaker, which should be carried at all times.
- You are educated about potential sources of electromagnetic interference and how to avoid them.
- You can return to their normal routines within a few weeks, under their doctor’s guidance.
- You contact your healthcare provider if you experience any unusual symptoms or concerns related to your pacemaker.
