Pacemaker for Bradycardia

Introduction

Bradycardia is a condition where the heart beats too slowly, usually fewer than 60 beats per minute. While in some individuals (such as athletes) a slow heart rate may be normal, in others, it can cause serious symptoms like dizziness, fatigue, fainting (syncope), or even heart failure.

A pacemaker is a small device implanted in the chest to regulate the heartbeat. It sends electrical impulses to stimulate the heart when it beats too slowly.

Causes of Bradycardia

Bradycardia can have several causes, including: - Age-related degeneration of the heart’s electrical system (the most common cause in older adults) - Heart diseases like coronary artery disease or heart attack affecting the electrical pathways - Congenital heart conditions (present from birth) - Side effects of medications, such as beta-blockers or calcium channel blockers - Hypothyroidism (underactive thyroid) - Electrolyte imbalances, such as potassium or calcium disorders

If bradycardia is causing serious symptoms, a pacemaker may be recommended.

How Does a Pacemaker Work?

A pacemaker consists of: - A pulse generator (a small metal box) that contains the battery and electronic circuits - Leads (electrodes) that are placed in the heart and deliver electrical impulses

It continuously monitors the heart rhythm. If the heart rate drops too low, the pacemaker delivers a mild electrical impulse to restore a normal heartbeat.

Indications for a Pacemaker

A pacemaker is recommended in cases such as: - Symptomatic bradycardia, causing dizziness, fatigue, or fainting - Sick sinus syndrome (malfunction of the heart’s natural pacemaker) - Heart block (a delay or complete block in electrical signal transmission) - Post-heart attack complications leading to slow heart rates

Not everyone with a slow heart rate needs a pacemaker. The decision is based on symptoms, the severity of conduction disturbances, and overall heart function.

Procedure and Recovery

• The pacemaker is implanted under local anesthesia with mild sedation.
• It is typically placed under the skin near the collarbone.
• The procedure takes about 1-2 hours.
• Recovery is quick, with most patients resuming normal activities within a few days, but avoiding strenuous physical exertion for a few weeks.
• Routine check-ups are required to monitor pacemaker function.

Complications and Risks

Though rare, complications may include: - Infection at the implantation site - Bleeding or swelling - Movement of the pacemaker leads - Malfunction of the device requiring adjustment or replacement

Modern pacemakers are highly advanced, with long-lasting batteries (lasting 5-15 years) and features that adapt to the individual’s heart rate needs.

Conclusion

A pacemaker is a highly effective treatment for managing bradycardia and preventing serious complications like fainting or heart failure. If you experience symptoms of bradycardia, consult your doctor for an evaluation to determine if a pacemaker is right for you.

Source recommendations

1. 2023 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

1. https://www.heartrhythmjournal.com/article/S1547-5271(23)02026-X/fulltext
2. https://academic.oup.com/eurheartj/article/42/35/3427/6358547
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiac-Pacing-and-Cardiac-Resynchronization-Therapy
4. https://pubmed.ncbi.nlm.nih.gov/34455430/
5. https://www.hrsonline.org/guidance/clinical-resources/2023-hrsaphrslahrs-guideline-cardiac-physiologic-pacing-avoidance-and-mitigation-heart-failure

2. ACC/AHA/HRS 2018 Guidelines on the Evaluation and Management of Bradycardia and Cardiac Conduction Delay

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000628
2. https://pubmed.ncbi.nlm.nih.gov/30412710/
3. https://www.hrsonline.org/guidance/clinical-resources/2018-accahahrs-guideline-evaluation-and-management-patients-bradycardia-and-cardiac-conduction
4. https://pubmed.ncbi.nlm.nih.gov/30586772/
5. https://www.jacc.org/guidelines/bradycardia