Pacemakers

Medically Reviewed by Jabeen Begum, MD on September 23, 2024
Written by Kathryn Whitbourne
12 min read

A pacemaker is a small device that sends electrical impulses to the heart muscle to keep a suitable heart rate and rhythm. Your heartbeat can become too slow or too fast due to a variety of health problems. The device is implanted just under the skin of the chest during minor surgery. 

A pacemaker is about 2 x 1.5 inches in size and weighs about an ounce. You might be able to see it under your skin, though some of the newer ones are too small to be seen.

The heart has its own pacemaker that regulates the rate at which it beats. But some hearts don't beat regularly, a problem called arrhythmia. Often, a pacemaker can correct it.

The pacemaker has two main parts: the pulse generator and the leads. 

  • The pulse generator houses the battery and a tiny computer, and it resides just under the skin of the chest. 
  • The leads are wires threaded through the veins into the heart and implanted into the heart muscle. They send impulses from the pulse generator to the heart muscle, as well as sense the heart's electrical activity.

Each impulse causes the heart to contract. The pacemaker may have one to three leads, depending on the type of pacemaker needed to treat your heart problem.

Wireless pacemakers

These newer pacemakers have no leads. Instead the pulse generator and electrodes are in one small device about the size of a large pill capsule. Your doctor puts this inside a chamber in your heart via a small tube placed in one of your veins. No surgery is needed.

 

If you need a pacemaker, your doctor will decide on the type based on your heart condition. There are three main types of pacemakers:

Single-chamber pacemaker

This uses one lead to connect your pulse generator to usually your right ventricle. A connection to the right atrium instead is possible depending on your symptoms. Your heart has four chambers: a left and right atrium (upper chambers) and a left and right ventricle (lower chambers). 

Dual-chamber pacemaker

This uses two leads: one to connect to your right atrium and the other to your right ventricle. The pacemaker will allow the blood to flow freely from the right atrium into the right ventricle.

Biventricular pacemaker

This uses three leads: one placed in the right atrium, one placed in the right ventricle, and one placed near the left ventricle. You might get this type if you have arrhythmia caused by advanced heart failure. A biventricular pacemaker is also known as a cardiac resynchronization therapy (CRT) device. It makes sure the two ventricles pump at the same time.

With all types of pacemakers, your doctor will program your minimum heart rate. When your heart rate drops below that set rate, your pacemaker generates (fires) an electrical impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heartbeat.

Temporary pacemakers

Temporary pacemakers are used when the arrhythmia is expected to be short-term (such as during a hospitalization) or as a bridge to putting in a permanent pacemaker. The pulse generator is taped to the skin or attached to your hospital bed. You have to be continuously monitored with a temporary pacemaker, so that means a hospital stay. 

Pacemakers are usually used to treat the following conditions:

Bradyarrhythmia

This means that your heart beats too slow. It's the most common reason for getting a pacemaker. You might get bradyarrhythmia from a problem with your heart's electrical conduction system or from taking beta-blockers to lower blood pressure.

Tachyarrhythmia

This means your heart beats too fast. The pacemaker can regulate your heartbeat.

Heart failure

This happens when your heart isn't pumping enough blood to your body. It might be due to a heart attack, an enlarged heart muscle, or some other kind of heart defect.

Tachy-brady syndrome

Also known as tachycardia-bradycardia syndrome, with this condition your heart alternates between beating too quickly and too slowly. You may get it if you have sick sinus syndrome, a problem in the part of the heart that regulates the speed of heartbeats. Having atrial fibrillation (AFib), a type of irregular heartbeat, may also put you at risk for tachy-brady syndrome. (Note: Tachycardia and bradycardia have similar meanings to tachyarrhythmia and bradyarrhythmia. The difference is that the latter terms specify that the unusually slow or fast heartbeats are caused by arrhythmia or an irregular heartbeat as opposed to something else).

Syncope due to arrhythmia

"Syncope" is another word for fainting or passing out. You can faint for many reasons, but when it's due to arrhythmia, that means your heart isn't working properly and not enough oxygen is going to the brain. Bradyarrhythmias and tachyarrhythmias are two types of arrhythmias that can cause syncope.

Congenital heart disease

"Congenital" means that you were born with the heart disease. There many types of congenital heart disease such pulmonary atresia or atrial septal defect. You may not have any symptoms until later in life, and when you do, they could include things like arrhythmias, shortness of breath, and swelling due to fluid collecting in your body (edema). 

Pacemaker after surgery

You're more likely to get a pacemaker after heart surgery if you already had issues with your heart's electrical system or you're having surgery to replace an aortic valve.

Your doctor might run some tests before deciding whether to implant a pacemaker. These could include:

Electrocardiogram (ECG or EKG). This checks how your heart is beating by recording its electrical signals.

Holter monitor. You wear this portable device for a day or so to record your heart's rhythm during daily activities. Your doctor might order this if they need more details than they got with the EKG.

Echocardiogram. This uses sound waves to make images of your beating heart. It can show how blood moves through your heart.

Stress test. This shows how your body responds to exercise. You'll walk a treadmill or ride a stationary bike while your heart rate and rhythm are recorded.

Once your doctor has decided to give you a pacemaker, ask them what medications you're allowed to take before getting it implanted. Your doctor may ask you to stop taking certain drugs 1 to 5 days before the procedure. If you have diabetes, ask your doctor how to adjust your diabetes medications.

  • Don't eat or drink anything after midnight the evening before the procedure. If you must take medicines, take them only with a small sip of water.
  • When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.

Pacemakers are implanted two ways:

Endocardial approach

This is the more common technique. The procedure is done in a pacemaker or electrophysiology lab.

  • Your doctor gives you a local anesthetic to numb the area, but you're still awake. They make an incision (cut) in the chest.
  • They insert the lead(s) through the incision and into a vein, then guide it to the heart with the aid of a fluoroscopy machine that can make real-time moving images of your body parts.
  • Your doctor attaches the lead tip to the heart muscle and places the other end of the lead (attached to the pulse generator) in a pocket created under the skin in your upper chest.
  • You usually go home the next day. 

Epicardial approach

This is used mostly in children. This procedure is done by a surgeon in a surgical suite. 

  • General anesthesia is given to put you or your child to sleep.
  • Your surgeon attaches the lead tip to the heart muscle, while placing the other end of the lead (attached to the pulse generator) in a pocket created under the skin in the abdomen.
  • You may need to stay in hospital for as long as 5 days.

Your doctor will determine which pacemaker implant method is best for you.

Pacemaker placement

Generators are usually placed on the left side of your chest, under skin near your collarbone. One end is connected to your heart while the other end is connected to your pulse generator. 

The endocardial pacemaker takes about 1-2 hours to implant.

What happens during pacemaker implantation?

  • You lie on a bed and the nurse will start an intravenous line (IV) into your arm or hand. This is so you may receive medications and fluids during the procedure. You'll be given medicine through your IV to relax you and make you drowsy, but not to put you to sleep.
  • The nurse connects you to several monitors. The monitors allow the doctor and nurse to check your heart rhythm, blood pressure, and other measurements during the pacemaker implant.
  • Hospital staff shave the left or right side of your chest and cleanse it with a special soap. They'll use sterile drapes to cover you from your neck to your feet. A strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

How are pacemakers implanted?

  • Your doctor numbs your skin by injecting a local numbing medication. You'll feel a pinching or burning feeling at first. Then, it will become numb. 
  • Your doctor makes a cut to insert the pacemaker and leads. You may feel a pulling as they make a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse.
  • After your doctor makes a pocket, they insert the leads into a vein and guide them into position using a fluoroscopy machine.
  • After the leads are in place, their function is tested to make sure they can increase your heart rate. This is called "pacing" and involves delivering small amounts of energy through the leads into the heart muscle. This causes the heart to contract. When your heart rate increases, you may feel your heart is racing or beating faster. It is very important to tell your doctor or nurse any symptoms you feel. You should report any pain right away.
  • After the leads are tested, your doctor connects them to your pacemaker. The doctor determines the rate of your pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a programmer.
  • Then your doctor sews you up.

 

You'll be admitted to the hospital overnight for the pacemaker implantation. Nurses will monitor your heart rate and rhythm. The morning after your implant, you'll have a chest X-ray to ensure the leads and pacemaker are in the proper position.

You will be shown how to care for your wound. Keep your wound clean and dry. After 5 days, you can take a shower. Look at your wound every day to make sure it is healing. Your pacemaker settings will be checked before you leave the hospital.

You'll get a temporary ID card that states:

  • The type of pacemaker and leads you have
  • The date of the pacemaker implant
  • The name of the doctor who implanted the pacemaker

Within 3 months, you'll receive a permanent card from the pacemaker company. Carry this card with you at all times in case you need medical attention at another hospital or to show airport security before going through a metal detector. 

Restrictions after pacemaker surgery

  • Don't lift objects that weigh more than 10 pounds.
  • Don't hold your arms above shoulder level for 3 weeks.
  • Avoid activities that require pushing or pulling heavy objects, such as shoveling the snow or mowing the lawn.
  • Stop any activity before you become overtired.
  • For 6 weeks after the procedure, avoid golfing, tennis, and swimming.
  • Try to walk as much as possible for exercise.
  • Ask your doctor when you can resume more strenuous activities.
  • Your doctor will tell you when you can go back to work, usually within a week after you go home. If you can, ease back to your regular work schedule.

How often will I need to see my doctor for my pacemaker?

A complete pacemaker check should be done 6 weeks after your pacemaker is implanted. Your doctor will make adjustments to prolong the life of your pacemaker. Modern pacemakers can transmit data to your doctor's office and be checked remotely every 3 months. Some types transmit data via a small monitoring device usually plugged in by your bedside table. Others transmit data automatically via an app, requiring that you keep your phone or tablet near you for about 3 hours a day. Either way, you'll still need to make an office visit once a year for a more complete exam.

If you have a biventricular pacemaker, you may need to visit the doctor's office or hospital every 6 months to make sure your device is working properly and the settings don't need to be adjusted.

Talk with your doctor about the benefits and risks of pacemaker surgery.

Pacemaker surgery is generally safe, but problems do happen. Call your doctor if you notice:

  • Increased swelling, bleeding, bruising, or infection near the site
  • Blood vessel or nerve damage
  • A collapsed lung
  • Reaction to any medicine used during the surgery
  • Air leak if a lung is accidentally punctured during surgery (pneumothorax)

What can interfere with a pacemaker?

Anything with a strong electromagnetic field can interfere with a pacemaker's function. Here are some dos and don'ts to minimize pacemaker problems. 

  • Don't store your cellphone in your shirt pocket or near your chest. Keep it at least 6 inches from your pacemaker.
  • If you're making a call, place your cellphone on the side opposite of where the pacemaker was implanted. If you have the pacemaker on the left side of your chest, for example, put the cellphone to your right ear. Or use the speaker setting.
  • Avoid strong electric or magnetic fields from some industrial equipment, ham radios, high intensity radio waves (found near large electrical generators, power plants, or radio frequency transmission towers), and arc resistance welders.
  • Keep headphones away from your chest. Most headphones have a magnet in them. Try to wear them away from your pacemaker.
  • When going through airport security, show your pacemaker card so you can avoid going through the screening machine. Even though the risk of harm to your heart is low, the pacemaker will set off the security alarms.
  • Don't have any tests that require magnetic resonance imaging (MRI) unless you've been told that you have an MRI-compatible pacemaker.
  • Your pacemaker might be affected by other medical tests or procedures including radiation therapy for cancer; transcutaneous electrical nerve stimulation (TENS) to treat pain; and electrocautery, used during surgery to stop bleeding. It depends on the type of pacemaker you have.  
  • If a device causes your pacemaker to malfunction, step away from it so your pacemaker can reset.
  • Electric blankets, heating pads, computers, radios, and microwave ovens should not affect by your pacemaker.

Your doctor or nurse can provide more information about what types of equipment may interfere with your pacemaker. If you have concerns about your job or activities, ask your doctor. 

How long does a pacemaker last?

A pacemaker battery usually lasts 5 to 7 years, depending on how often it's used. Some can last as long as 15 years. When the battery becomes low, your pulse generator will need to be replaced via surgery. Feeling dizzy or faint can be signs that your pacemaker is no longer working and you need to talk to your doctor.

A pacemaker is a small device implanted in your heart to keep your heartbeat regular. You're most likely to get this if your heartbeat is too slow. Getting one implanted is usually a simple procedure involving an overnight hospital stay. Once you have a pacemaker, be careful to not carry a cellphone in a shirt pocket or go through a metal detector. But you should be able to go on with your daily activities. A pacemaker battery can last anywhere from 5 to 15 years.

Can you live 20 years with a pacemaker?

Yes. One 2004 study showed about 22% of patients were alive 20 years after having a pacemaker implanted. Some patients have had pacemakers for even longer than that. Pacemakers don't shorten your life expectancy, and most people who get them are over 65.

What is the cost of a pacemaker?

The cost can range from $20,000 to $100,000, according to one source. A lot depends on whether you have insurance and how much the insurance company will cover. Medicare Part A caps your copayment at under $2,000 for having a pacemaker implanted. Part B can help to cover costs for doctor's visits to monitor your pacemaker. You usually pay a coinsurance of 20% along with your premium. 

Can a pacemaker cause pre-excitation?

Pre-excitation is a heart condition where parts of the ventricles activate too early. It's caused by a problem with the electrical connections in your heart. A biventricular pacemaker can cause pre-excitation, which is detected by a EKG pattern.

 

 

Print
View privacy policy, copyright and trust info
View privacy policy, copyright and trust info