Pacemaker

Pacemaker

A pacemaker is a small electronic device that helps regulate your heartbeat when it becomes too slow or irregular. It works by sending electrical signals to your heart to maintain a steady rhythm.

There are several types of pacemakers, and your doctor will choose the one that best suits your condition:

  • Single chamber – sends signals to one chamber, usually the right ventricle.
  • Dual chamber – sends signals to both the right atrium and right ventricle.
  • Biventricular (CRT) – used for heart failure, sends signals to both lower chambers and the atrium to improve coordination.
  • Leadless pacemaker – A small device directly implanted in the right ventricle without any attached leads (discussed separately)

Each pacemaker (except the leadless pacemaker) includes a pulse generator (battery) under the skin and one or more leads (wires) that deliver impulses to the heart.

Once implanted, your pacemaker will be programmed to your needs. It will monitor your heart and activate only when your heart rate drops below a set level which is also programmable.

What happens after the procedure?

You will usually stay in hospital overnight for monitoring. After discharge:

  • Avoid driving for at least two weeks.
  • Limit arm movement on the side of the implant to allow healing.
  • Attend follow-up appointments to check the device and adjust settings if needed.

You will be given a pacemaker ID card and instructions for living with the device, including precautions around strong magnets and medical imaging.

Always inform healthcare providers that you have a pacemaker, especially before procedures like MRIs.

How is the procedure performed?

  • A canula or drip will be placed in your arm to deliver medications.
  • You will receive antibiotics prior to the procedure to prevent infection.
  • A sedative and local anaesthetic will be given to keep you comfortable.

Your cardiologist will make a small incision below your collarbone and guide the leads through a vein into your heart using X-ray imaging. Once the leads are in place, they are connected to the pulse generator, which is positioned under the skin.

The system is tested to ensure it is working correctly, and the incision is closed with dissolving stitches.

What are the risks?

  • Minor bleeding or bruising at the incision site.
  • Discomfort or swelling around the device.

Less common risks

  • Lead dislodgement.
  • Infection related to the device.
  • Vein damage or blockage
  • Punctured lung (pneumothorax)
  • Cardiac perforation or valve injury
  • Blood clots in the arm or lung
  • Stroke
  • Heart attack
  • Death, though this is extremely rare.
  • Pacemaker malfunction (e.g. failure to deliver or inappropriate pacing)

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