Pacemaker – Treatment to Regulate Heart Rhythms

A pacemaker is a compact medical device implanted under the skin, usually in the chest, near the collarbone, to help manage irregular heartbeats, such as bradycardia (slow heartbeat) or arrhythmias (irregular heartbeat).  

The pacemaker consists of a battery, a pulse generator, and wires (called leads) that connect the device to the heart. The leads monitor the electrical activity of the heart and when an abnormal rhythm is detected they send electrical signals to the heart to prompt it to beat correctly.  

Types of Pacemakers 

There are different types of pacemakers designed to address specific heart conditions: 

• Single-Chamber Pacemaker: Connects to either the right atrium or right ventricle. 
• Dual-Chamber Pacemaker: Connects to both the right atrium and right ventricle, helping to coordinate the timing of these chambers. 
• Biventricular Pacemaker (CRT): Used for cardiac resynchronization therapy, it connects to both ventricles and sometimes the right atrium, helping to improve the heart’s pumping efficiency in patients with heart failure. 

Conditions Managed with Pacemaker 

A pacemaker is used to manage several heart conditions that affect the heart’s rhythm and rate including: 

• Bradycardia: This is a condition in which the heart beats at a slow rate.
• Heart Block: This condition occurs when the electrical signals that control the heart’s beats are partially or completely blocked slowing down the heart rate or causing irregular beats. 
• Heart Failure: For this condition, a pacemaker can help the heart’s chambers beat in a more coordinated way, improving the heart’s efficiency and relieving symptoms. 
• Atrial Fibrillation: This condition is the result of the heart beating irregularly and often rapidly. A pacemaker can help manage the rate. It is often used in combination with other treatments to stabilize the heart’s rhythm. 

Symptoms Indicating the Need for a Pacemaker 

A pacemaker may be needed if you experience symptoms related to an irregular or slow heartbeat.  Heartbeats are too slow or too irregular, affect blood flow and overall health. Common symptoms that may indicate the need for a pacemaker include: 

• Persistent fatigue and weakness 
• Dizziness or lightheadedness 
• Shortness of breath 
• Fainting or near-fainting spells 
• Chest pain 
• Fainting or Near-Fainting Spells 
• Palpitations 

Pacemaker Implantation Procedure 

Pacemaker implantation is a minimally invasive procedure performed under local anesthesia.  

Preparation: Initially, patients undergo a thorough evaluation that will include: 

• Detailed medical history review. 
• Physical examination. 
• Electrocardiogram (ECG or EKG). 
• Echocardiogram. 
• Holter Monitor. 
• Stress Test. 
• Blood Tests. 
• Chest X-ray. 

Procedure: A small incision is made near the collarbone to thread the thin wires (leads) guiding them through a vein to the heart.  They are then positioned in the appropriate heart chambers. These leads are then connected to the pacemaker device, which is placed in a small pocket under the skin and muscle. The device is tested to ensure it functions correctly, and the incision is closed with stitches or surgical glue.  

Living with a Pacemaker 

Life with a pacemaker involves some adjustments, but most people return to their normal activities shortly after the procedure.