Overview

What is Pacemakers permanent ?

A pacemakers permanent is a small device that is implanted under the skin (most often in the shoulder area just under the collarbone) it ends electrical signals to start or regulate slow heartbeat. Some are permanent (internal) and some are temporary (external).They can replace a defective natural pacemaker or blocked pathway.

Pacemakers permanent can be surgically placed into the chest (a permanent pacemaker) through a small incision, or they can be worn outside the body (a temporary pacemaker) and attached to the heart through a wire that is threaded through a neck vein. Temporary pacemakers are used only while a person is in the hospital.

Electrical Impulses :

Electrical impulses from the heart muscle cause your heart to beat (contract). This electrical signal begins in the sinoatrial (SA) node, located at the top of the heart's upper-right chamber (the right atrium). The SA node is sometimes called the heart's "natural pacemaker."

When an electrical impulse is released from this natural pacemaker, it causes the upper chambers of the heart (the atria) to contract. The signal then passes through the atrioventricular (AV) node. The AV node checks the signal and sends it through the muscle fibers of the lower chambers (the ventricles), causing them to contract.

The SA node sends electrical impulses at a certain rate, but your heart rate may still change depending on physical demands, stress, or hormonal factors. Sometimes, the SA node does not work properly, causing the heart to beat too fast, too slow, or irregularly. In other cases, the heart's electrical pathways are blocked, which can also cause an irregular heart rhythm


What is an implantable pacemaker?

A pacemaker is a small device that is run by a battery. It helps the heart beat in a regular rhythm. Pacemakers can help pace the heart in cases of slow heart rate, fast and slow heart rate, or a blockage in the heart's electrical system.

A pacemaker can pace the heart's upper chambers (the atria), the lower chambers (the ventricles), or both. Pacemakers may also be used to stop the heart from triggering impulses or from sending extra impulses.

A Pacemakers is about the size of a matchbox. It is made up of two parts:

A pulse generator, which includes the battery and several electronic circuits.
Wires, called leads, which are attached to the heart wall. Depending on the type of pacemaker you need, there may be one or two leads.


Will electronic devices affect my pacemaker?

The American Heart Association (AHA) advises that if you have a pacemaker, you should be aware of your surroundings and of any devices that may interfere with it. Here is a list of devices that will not affect or damage pacemakers. Most people do not need to worry about coming into contact with these devices.

CB radios
Electric drills
Electric blankets
Electric shavers
Ham radios
Heating pads
Metal detectors
Microwave ovens
TV transmitters
TV remote controls
X-ray machines
Airport security detectors

Here is a list of devices that will affect pacemakers. Your pacemaker may not work properly if you come into contact with these devices.

Power-generating equipment
Welding equipment
Certain pieces of equipment used by dentists
Magnetic resonance imaging (MRI) machines
Radiation machines for treating cancer
Heavy equipment or motors that have powerful magnets


Can I use my cell phone if I have a pacemaker?

The types of cell phones used in the United States are less than 3 watts and do not seem to affect pacemakers. But to be safe, you should keep your cell phone at least 6 inches away from your pacemaker. When you are talking on your cell phone, hold it on the opposite side of the body from your pacemaker. Do not carry your cell phone in your breast pocket if that means that it will be within 6 inches of your pacemaker.

Newer cell phone technology means that more cell phone frequencies will need to become available. According to the AHA, some of the cell phones using these new frequencies might make pacemakers less reliable. More studies are needed before we can know how these frequencies will affect pacemakers.


Who needs a pacemaker?

Typically pacemakers are implanted in patients with a history of bradycardia, or slow heart rhythms. These can include the following conditions:

Sick sinus syndrome (sinus node arrest, tachy-brady syndrome, symptomatic sinus bradycardia)
Syncope secondary to a bradycardic rhythm
Atrial fibrillation with a slow ventricular response and bradycardia (due to medications or after AV node junction ablation)
AV block
Distal conduction system block
Heart failure in patients deemed appropriate for cardiac resynchronization therapy (CRT)


The day of the procedure :

Please arrive at the hospital "fasting" from the previous midnight
You may take your morning medications with a small sip of water
If you have been instructed to have blood drawn, please do not forget (you may be instructed to have this done several days before your procedure)
Please make sure you have consulted with your physician if you are on coumadin or insulin for diabetes. For most procedures, your coumadin will be discontinued or adjusted several days prior.


What are the risks?

In general, pacemaker insertion is a safe procedure. However, as with any surgical procedure, there is a risk of complications. The 1-2% risk of complications from permanent pacemaker implantation includes the following:

Bleeding, including a hematoma
Infection
Damage the artery or veins
Blood clot
Tearing the heart muscle
Stroke, death, or heart attack
Puncturing the lung requiring a chest tube


Possible long-term complications you need to be aware of include:

Infection
Pocket erosion
Device or lead malfunction
Lead insulation failure, or lead conductor fracture necessitating the placement of a new lead


What to expect after the procedure ?

Procedure duration is typically 1-3 hours
You will have an arm sling for 24 hours
Overnight hospital stay is generally advised
You will be instructed to perform daily dry dressing changes at home to the incision site.
You may be asked to keep the incision site dry for the following week after implantation (you may shower, but need to keep the affected site dry).
You will need to return to the clinic in 1 week after device implantation
You can return to normal activities within several days
Typically driving is discouraged for at least 1 week or longer after the device is implanted

Extreme motion with the involved arm (above the shoulder) should be avoided for 4-6 weeks after device implantation (this includes activities such as swimming and golf); this could result in lead dislodgement

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