Pacemaker Operation: A Complete Guide for Patients

Introduction

A pacemaker is a small device implanted in the chest to help control abnormal heart rhythms (arrhythmias). It works by sending electrical impulses to stimulate the heart when needed. Pacemakers are commonly used for conditions such as bradycardia (slow heart rate) or heart block.

When is a Pacemaker Needed?

A pacemaker may be recommended if you experience symptoms like: - Dizziness or fainting due to slow heart rate - Fatigue or shortness of breath - Heart block (a condition where electrical signals don’t properly pass through the heart) - Atrial fibrillation with slow ventricular response

Types of Pacemakers

• Single-chamber pacemaker: Stimulates one chamber of the heart (usually the right ventricle or right atrium).
• Dual-chamber pacemaker: Stimulates both the right atrium and right ventricle, improving coordination between them.
• Biventricular pacemaker (cardiac resynchronization therapy, CRT): Used for heart failure patients to stimulate both ventricles and improve heart efficiency.

The Surgical Procedure

1. Preparation: The procedure is usually performed under local anesthesia with sedation. You’ll need preoperative tests such as EKG, echocardiogram, and blood tests.
2. Insertion: A small incision is made in the chest, and leads (thin wires) are guided into the heart through a vein. The pacemaker is placed under the skin near the collarbone.
3. Testing and Adjustment: The device is tested to ensure proper function, and settings are adjusted for optimal heart rhythm control.
4. Recovery: Most patients go home the same day or the next day. Full recovery takes about 4-6 weeks.

Aftercare and Lifestyle Considerations

• Avoid heavy lifting and strenuous activities for a few weeks.
• Monitor for symptoms like swelling, redness, or infection at the incision site.
• Carry a pacemaker identification card in case of emergencies.
• Avoid close exposure to strong electromagnetic fields (certain MRI machines, security scans, etc.).
• Regular follow-ups with your cardiologist are essential to ensure the pacemaker functions correctly.

Risks and Complications

• Infection at the implantation site
• Lead dislodgement
• Device malfunction (rare)
• Blood clots or bruising in the area

Conclusion

Pacemakers significantly improve quality of life for people with heart rhythm disorders. Modern pacemakers last 7-15 years and can usually be replaced easily when needed. If you experience symptoms like dizziness, extreme fatigue, or irregular heartbeats, consult your doctor to determine if a pacemaker is necessary.

Source recommendations

1. American Heart Association Guidelines on Pacemaker Therapy

1. https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/pacemaker
2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000627
3. https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/devices-that-may-interfere-with-icds-and-pacemakers
4. https://www.ahajournals.org/doi/10.1161/01.cir.97.13.1325
5. https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/living-with-your-pacemaker

2. European Society of Cardiology Guidelines on Cardiac Pacing and Resynchronization Therapy

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiac-Pacing-and-Cardiac-Resynchronization-Therapy
2. https://academic.oup.com/eurheartj/article/42/35/3427/6358547
3. https://pubmed.ncbi.nlm.nih.gov/34455430/
4. https://academic.oup.com/eurheartj/article/34/29/2281/401445
5. https://pubmed.ncbi.nlm.nih.gov/23801827/