Pacemakers are usually implanted when the patient’s heart rate is too slow. The system consists of a pulse generator, which houses the battery and circuitry, and leads (wires), which are introduced into the heart via the upper arm veins. These leads carry electrical impulses to the heart to cause it to beat (contract) at a rate determined by the pacemaker. Sometimes, pacemakers are implanted for patients with severe heart failure (see “Cardiac Resynchronization Therapy”) to improve their function.
What should you expect?
Done under sedation and local anaesthetic, a small incision is made in the skin under the collarbone (usually on the left) to house the pacemaker. Wires (leads) are introduced into the heart through the upper arm veins, using a needle to enter into the veins. Following positioning of the leads and electrical testing, the leads are connected to the pacemaker and the incision is closed. At the end of the procedure, all that is visible is the closed incision line.
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After the Implantation
Following the procedure, assessment of remaining battery life and adjustment of the pacemaker are done wirelessly through a special programmer and patients are required to return for regular follow-up. When the pacemaker battery is depleted in a few years’ time, the pacemaker will need to be replaced.
What are the potential risks or complications?
The risk associated with the procedure is very low, and includes bleeding (from insertion of leads into the veins), temporary injury to the lung (pneumothorax) from the needle used to insert the leads, and infection of the pacemaker and lead systems. Antibiotics are routinely given to reduce the risk of infection.
Related: Heart Failure - Other Treatments
Additional Information
Implantable Cardiac Defibrillators are used when patients are deemed to be at very high risk of sudden cardiac death from lethal heart rhythm disorders (arrhythmias). These sophisticated devices monitor the heart rhythm continuously and attempt to terminate these life-threatening rhythm disorders if they occur. This can be through rapid pacing or delivery of an electrical shock to “reset” the heart to normal rhythm. They are implanted the same way as pacemakers.
Implantable loop recorders are small devices inserted under the skin on the chest wall to monitor a patient’s heart rhythm for prolonged periods of time (up to about 3 years). They do not have any wires and may be used in certain situations such as recurrent fainting spells where a heart rhythm disorder is suspected as the cause but not documented previously.
Related: Heart Arrhythmias
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Contributed By
- National University Heart Centre, Singapore