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A pacemaker is a battery-powered device
about the size of a pocket watch that sends weak electrical impulses to "set a
pace" so that the heart is able to maintain a regular heartbeat. Some people who have atrial fibrillation need a pacemaker.
There are two
basic types of pacemakers.
All new pacemakers are rate-response, or physiologic,
pacemakers. They can sense when your activity increases and respond by
increasing your heart rate.
Rate-responsive pacemakers are
often the ideal choice for active people. These pacemakers closely reproduce
natural heart rhythms and are able to raise heart rate in response to physical
activity. Your doctor can decide how fast the pacemaker should respond and how
quickly your heart rate should return to a resting rate.
pacemakers are surgically implanted into the chest. The procedure to implant a
pacemaker is considered minor surgery. It can usually be done using
local anesthesia. The procedure takes about an hour.
Permanent pacemakers are powered by batteries. The batteries usually last 5 to
15 years before they need to be replaced.
Temporary pacemakers are
attached to the heart by a wire threaded through a neck vein, a leg vein, or
through the chest wall. Temporary pacemakers are most commonly used for a short
time following heart surgery or when waiting for a permanent pacemaker to be
Most people stay overnight in the
hospital after they have a pacemaker implanted. And they typically go home the next day.
But sometimes the surgery is done as an
outpatient procedure, which means you do not need to
stay overnight in the hospital.
Most people return to normal
activities after a few weeks. For several weeks after
having a pacemaker implanted, avoid driving or doing
vigorous physical activity that involves the upper body.
activities and situations can interrupt the signals sent by the pacemaker to
the heart. You may need to adapt some of your activities. Follow your doctor's
specific instructions about care and precautions.
Once or twice a year your doctor will
check your pacemaker and adjust it, if needed.1 In between checkups at your doctor's office, you will probably send information from your cardiac device to your doctor. You will do this by using a telephone or the Internet.
atrial fibrillation may need a pacemaker for a
variety of reasons. These reasons include:
Pacemakers stimulate the heart to
speed up when it beats too slowly or reset the rate when the heart beats too
fast. They can also substitute for the natural pacemaker of the heart (AV or SA node).
There are several risks to getting a pacemaker. But risks
vary for each person. The chance of most problems is low.
The procedure to implant a pacemaker is safe, and most people do well afterward. You will see your doctor regularly to check your pacemaker and make sure you don't have any problems.
During the procedure. If problems happen during the procedure, doctors can likely fix them right away.
After the procedure. Problems after the procedure can be minor, like mild pain, or serious, like an infection. But your doctor can solve most of these problems. And most people do not have long-term issues with their pacemakers.
In rare cases, people feel
throbbing in the neck, chest fullness, or lightheadedness when the pacemaker
sends out impulses. Talk to your doctor about what types of side effects you
may expect from your pacemaker.
In rare cases, pacemakers are recalled by the maker of the pacemaker. A recall means that the pacemaker has a problem that needs to be watched closely or fixed. For more information on what happens if a device is recalled, see:
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Wilkoff BL, et al. (2008). HRS/EHRA expert consensus
on the monitoring of cardiovascular implantable electronic devices (CIEDS):
Description of techniques, indications, personnel, frequency, and ethical
considerations. Heart Rhythm, 5(6): 907–925. Available
Res JCJ, et al. (2004). Pneumothorax resulting from subclavian puncture: a complication of permanent pacemaker lead implantation. Netherlands Heart Journal, 12(3): 101–105.
Akoum NW, et al. (2008). Pacemaker therapy. In EG Nabel, ed., ACP Medicine, section 1, chap. 7. Hamilton, ON: BC Decker.
Baddour LM, et al. (2010). Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association. Circulation, 121(3): 458–477.
Swerdlow CD, et al. (2012). Pacemakers and implantable cardioverter-defibrillators. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 745–770. Philadelphia: Saunders.
December 14, 2012
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & John M. Miller, MD, FACC - Cardiology, Electrophysiology
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