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Heart Pacemaker - Types, Functions, Placement, and Risks

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A heart pacemaker is a small device implanted under the skin, usually near the collarbone, to help regulate the heart's rhythm. Read more in the article.

Medically reviewed by

Dr. Yash Kathuria

Published At February 24, 2023
Reviewed AtFebruary 24, 2023

What Is a Heart Pacemaker?

A heart pacemaker is a medical device that helps regulate the heartbeat in individuals with heart rhythm disorders. It is a small, battery-operated device implanted under the skin, usually in the chest, and connected to the heart with one or more wires (also called leads). The pacemaker's role is to direct electrical impulses to the heart to maintain a normal heart rate and rhythm.

What Are the Types of Heart Pacemakers?

There are three main types of heart pacemakers:

  1. Single-chamber pacemakers.

  2. Dual-chamber pacemakers.

  3. Biventricular pacemakers.

Single-Chamber Pacemakers: It is the most basic type to treat slow heart rhythms (bradycardia). An electrode is placed in the heart's right ventricle, sending electrical impulses to pace the heart. This type of pacemaker is suitable for patients with normal heart function.

Dual-Chamber Pacemakers: These are more advanced than single-chamber pacemakers and have two electrodes, one in the right atrium and one in the right ventricle. This type of pacemaker is designed to mimic the natural electrical signals of the heart, allowing for more coordinated and efficient heartbeats. It is commonly used to treat patients with atrioventricular block, where the electrical signals between the atria and ventricles are disrupted.

Biventricular Pacemakers: It is, also referred to as cardiac resynchronization therapy (CRT) devices that treat heart failure by coordinating the contractions of the right and left ventricles. They have three electrodes, one in the right ventricle, one in the right atrium, and one in the left ventricle. By synchronizing the contractions of the ventricles, biventricular pacemakers can improve the efficiency of the heart's pumping and relieve heart failure symptoms.

How Does a Heart Pacemaker Work?

  • It sends electrical impulses to the heart to regulate its rhythm and ensure it beats normally. This device is usually implanted just under the skin near the collarbone and connected to the heart by one or more wires, known as leads.

  • The pacemaker continuously monitors the heart's rhythm. If it detects a problem, such as a slow or irregular heartbeat, it sends electrical impulses to the heart to resume its regular rhythm. It can also be programmed to provide extra stimulation in response to physical activity or temporarily increase the heart rate.

  • Pacemakers are typically recommended for individuals with heart conditions such as bradycardia, a slow heartbeat, or heart block when the disruption of electrical signals between the heart's upper and lower chambers. They can also treat fainting or dizziness due to slow heartbeats.

  • In most cases, a pacemaker is a safe and effective treatment option. The implantation does involve risks and side effects, including but not limited to infection, bleeding, or injury at the implant site and lead malfunction. Patients with pacemakers typically need to limit their exposure to strong electromagnetic fields, such as those produced by airport security scanners.

  • Overall, a heart pacemaker can greatly improve the quality of life for individuals with heart rhythm disorders and help prevent serious health problems associated with these conditions.

What Are the Tests Performed Before a Heart Pacemaker's Placement?

Before a pacemaker implantation procedure, a patient undergoes several diagnostic tests to determine the need for the pacemaker and to prepare for the procedure. These tests include:

  • Electrocardiogram (ECG): An ECG records the heart's electrical activity and helps diagnose heart rhythm problems.

  • Echocardiogram: This test uses ultrasound to produce images of the heart and helps determine the heart's structure and function.

  • Chest X-ray: This test provides an image of the heart and chest to help determine the location and size of the heart and to identify any other medical conditions that could affect the pacemaker implantation procedure.

  • Blood Tests: Blood tests help to determine if there is an underlying medical condition that could affect the procedure, such as anemia, or if there is any risk of infection.

  • Cardiac Catheterization: This test involves inserting a small tube into a blood vessel in the arm or leg and threading it to the heart to record the blood pressure and oxygen levels in different heart parts.

  • Holter Monitor: This portable device records the heart's rhythm over 24 hours.

What Is the Procedure for the Placement of Heart Pacemakers?

Implanting a pacemaker typically involves the following steps:

  • Preparation: Before the procedure, a local anesthetic is administered to the patient, and a pacemaker is implanted. The patient may also be given a mild sedative to help relax.

  • Small incision: This is performed in the chest, usually below the collarbone. The incision is, at most, two inches long.

  • Placement of the Pacemaker: A pocket is created under the skin to hold the pacemaker inserted into the pocket.

  • Lead Placement: The lead(s), or thin wire(s), are guided through a vein and positioned in the heart. The lead(s) is(are) then attached to the pacemaker.

  • Closing the Incision: The incision is closed with dissolvable sutures or surgical tape, and a sterile dressing is placed over the incision.

  • Testing: Once the pacemaker is in place, it is tested to ensure it functions properly and communicates with the heart.

  • The procedure typically takes one to two hours and is done on an outpatient basis, allowing the patient to return home the same day. After the procedure, the patient may experience discomfort or soreness in the area where the pacemaker was implanted, but this usually improves within a few days.

  • It is essential to follow the physician's instructions and attend follow-up appointments to ensure the pacemaker works properly and make any necessary adjustments.

What Are the Risks of the Placement of Heart Pacemakers?

Heart pacemakers are generally considered safe and effective medical devices, but like all medical procedures, there are risks associated with their use. Some potential risks of a heart pacemaker include the following:

  • Infection: The chance of infection at the pacemaker insertion site can be serious if not treated promptly.

  • Lead Malfunction: The leads that connect the pacemaker to the heart can malfunction, causing them to break or move out of place, which can require additional procedures to correct.

  • Battery Failure: The pacemaker battery can fail, requiring the replacement of the entire device.

  • Electromagnetic Interference: Exposure to certain sources of electromagnetic interference, such as metal detectors or MRI machines, can cause the pacemaker to malfunction.

  • Overstimulation: The pacemaker can overstimulate the heart, leading to discomfort or a rapid heartbeat.

  • Skin Irritation: In some cases, the skin around the pacemaker can get irritated or develop a response due to an allergy to the device's materials.

  • Blood Clots: Blood clots can form around the pacemaker, increasing the risk of stroke or other serious complications.

Conclusion:

Heart pacemakers are important medical devices that help regulate heartbeats and improve heart function. The type of pacemaker used depends on the specific needs of the patient and the underlying heart condition. Therefore, it is essential to follow the physician's instructions and attend regularly scheduled follow-up appointments to ensure that the pacemaker is functioning properly and to assess if any adjustments or modifications are necessary.

Dr. Yash Kathuria
Dr. Yash Kathuria

Family Physician

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