A pacemaker is a small device implanted under the skin that controls abnormal heart rhythms. It’s commonly used in people with heart conditions where the heart beats too slowly or irregularly.

In this article, we explore:

What a pacemaker is
How a pacemaker works
What conditions may require one
What to expect before, during and after pacemaker surgery

What is a pacemaker?

A pacemaker is a small, battery-powered device implanted in your chest to help regulate your heart rate. It consists of two main parts—a pulse generator and leads.

Pulse generator: This contains the battery and electrical circuitry that generates electrical impulses.
Leads (wires): These wires connect the pacemaker to your heart, sending electrical signals to regulate your heartbeat. They are implanted inside your heart.

How does a pacemaker work?

A pacemaker senses your heart's own electrical activity using the electrodes implanted in the heart. If it detects an abnormal heartbeat—most often too slow—it sends tiny electrical impulses to stimulate the heart to beat at a normal rate. These impulses help the heart maintain a steady rhythm, ensuring it pumps enough blood to the body.

What does a pacemaker do?

The primary job of a pacemaker is to maintain a regular heart rate, helping prevent symptoms such as fatigue, dizziness or fainting caused by slow or irregular heart rhythms. It ensures your heart works efficiently to supply your body with the oxygen and nutrients it needs.

What heart conditions may require a pacemaker?

Pacemakers are typically recommended for patients with certain heart conditions, including:

Bradycardia: Abnormally slow heart rate.
Heart block: Delayed or interrupted electrical signals between the chambers of the heart.
Sick sinus syndrome: The body’s own electrical system is unable to initiate heart beats, causing slow heart rate.
Atrial fibrillation (A-Fib): Irregular and rapid heart rate that can cause poor blood flow, often accompanied by heart block.
Heart failure: When the heart can't pump blood as well as it should.
Ventricular arrhythmias: Rapid heart rate from the bottom half of the heart that doesn’t allow the heart to pump out enough blood.

Types of pacemakers

Pacemakers come in different types depending on the patient's specific needs.

Single-chamber pacemaker: Has one lead connected to the right ventricle to control heart rate.
Dual-chamber pacemaker: Has two leads connected to both the right atrium and right ventricle, helping to coordinate the timing between the top and bottom chambers.
Implantable cardioverter-defibrillator (ICD): A type of pacemaker that can deliver shocks if the heart rhythm becomes dangerously fast.
Cardiac resynchronization therapy with defibrillator (CRT-D): Used in selected patients with heart failure to help both sides of the heart pump in sync, and it can also act as a defibrillator.

What to expect during pacemaker surgery

Pacemaker surgery is typically a minimally invasive procedure performed under local anesthesia and mild sedation. Here's a brief overview of the steps involved.

Preparation: You will be given local anesthesia to numb the area where the pacemaker will be placed. A sedative may also be given to help you relax.

Insertion: A small incision is made near the collarbone. The pacemaker's leads are threaded through a vein to the heart, and the device is placed under the skin.

Testing: The pacemaker is tested to ensure it works properly and the electrical signals are effectively regulating the heartbeat.

Closure: The incision is closed with stitches, and a dressing is applied.

The procedure typically takes about 1-2 hours. Most patients can go home the same day or after a short hospital stay.

Recovery after pacemaker surgery

Recovery from pacemaker surgery is usually quick. Here’s what to expect.

Hospital discharge: Patients are often discharged the same day or within 24 hours.
Chest X-ray (PA lateral): After the procedure, a chest X-ray may be taken to ensure the leads are properly positioned and to check for any complications, like a collapsed lung.
Activity restrictions: For about 4-6 weeks, you’ll be advised to avoid heavy lifting or strenuous activities to allow the incision to heal.
Testing threshold: In follow-up appointments, your doctor will check the pacemaker’s settings and adjust the electrical signals if needed.

How long does a pacemaker last?

The battery life of a pacemaker typically ranges from 5 to 15 years, depending on how often it’s used to regulate your heart. Regular check-ups will ensure the device continues to work properly, and your doctor will let you know when it’s time to replace the battery.

Living with a pacemaker

Life with a pacemaker requires some adjustments, but most people can return to their normal activities, including exercise.

As a cardiology fellow at Montefiore Medical Center, here are some tips for living with a pacemaker.

Avoid strong electromagnetic fields: Some electronic devices, like certain security systems or large power generators, can interfere with your pacemaker. Always inform your doctor if you work near such equipment.
Caution for magnetic resonance imaging (MRI): If you need a MRI scan in the hospital, always mention you have a pacemaker because not all pacemakers are MRI-compatible, and compatible ones need to be programmed to MRI mode prior to imaging.
Regular check-ups: Your doctor will schedule routine visits to monitor your pacemaker and ensure it is functioning correctly.
Maintain a healthy lifestyle: Regular exercise, a heart-healthy diet and managing stress are important for keeping your heart in good condition and helping your pacemaker work effectively.

Pacemaker surgery is a common and appropriate treatment for people with certain heart conditions. The procedure is straightforward, recovery is quick and most patients experience significant improvements in their quality of life. With proper care and regular monitoring, living with a pacemaker can help ensure your heart stays in rhythm for years to come.

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