When it comes to having a Pacemaker implanted, not many people are aware of what the device is all about and why it’s implanted. Below are some of the most frequently asked questions regarding Pacemakers and their implant procedure:
A Pacemaker is an electrical device implanted in the chest to help maintain the heartbeat of a person with a slower than average heart rate. It’s a tiny device, weighing around 25–35 grams and operates by sending an electrical impulse to the hearts muscles, which creates an artificial heartbeat in patients suffering from a slow heart rate.
There are a few pacemaker options available that are implanted in different ways.
The first is the traditional Pacemaker, which has a lead (or leads) advanced through veins near the collarbone to the heart muscle and connected to the pacemaker battery (the pulse generator), which is placed in a pocket under the skin.
A new option, which is in many aspects safer, is the Medtronic Micra Leadless Pacemaker. This pacemaker is no bigger than a £1 coin and is inserted through a tube in the thigh, avoiding any scars to the chest area. It is secured to the heart muscle using flexible nitinol (memory metal) wires. The device has no pacing leads, having miniaturized the entire pacing system into a tiny capsule. By avoiding leads, a pocket under the skin for the battery and puncture of veins under the collar bone, it potentially offers a near-perfect solution to avoid many of the problems associated with traditional pacemakers, including infection, collapse of the lung, lead displacement and surgical scars. However, at present there is only a leadless pacing option for the right ventricle, the bottom chamber of the heart and so many patients who benefit from dual chamber systems (where both the upper and lower heart chambers are paced) still require a dual chamber pacemaker.
Other alternatives have included a leadless pacemaker called the Nanostim made by St. Jude Medical (now part of Abbott Healthcare). This is a longer device and uses a screw (or helix) at the tip to secure it to heart muscle. Other manufacturers are designing their own versions. One can also still opt for a traditional single chamber pacemaker (also known as a VVI pacemaker).
A regular/normal heart rate sits at around 60 – 100 beats per minute. Should this rate drop due to a failure of the heart’s normal electrical system, it is can sometimes be a cause for concern. After a series of tests on heart rate and heart function, your doctor will decide whether a pacemaker is suitable for your heart.
Outside of the extensive tests carried out by your doctor, there are a number of symptoms that indicate that your heart rate has fallen below the normal range. These include giddiness, black out episodes or experiencing unconsciousness. If you have any of the aforementioned symptoms, then you may want to consult your doctor as it might be necessary to implant a pacemaker.
Following the implant procedure, you may feel some pain or discomfort during the first 48 hours after having your pacemaker implanted, however you’ll be provided pain-relieving medication to ease this.
You may also notice some bruising where the pacemaker is inserted. This is normal and usually passes within a few days, however be sure to tell your doctor if your symptoms are persistent or severe for longer than 48-36 hours.
You’ll be able to feel the pacemaker right after it has been implanted, but you’ll soon get used to it. It may seem a bit heavy in your chest at first and may feel uncomfortable when you lie in certain positions where the pacemaker is being pushed upon. However, in time, most people barely notice the pacemaker is there after a few weeks
Although the procedure can be quite daunting, you should feel back to normal, or even better, very quickly. We advise you to avoid any elevating the arm above shoulder height on the side you had your operation for four to six weeks – this includes things like taking off sweaters or T-shirts, reaching up to shelves, heavy lifting or any other action that would put strain on that side of your body.
With that being said, it is important to use your arm regularly and keep it mobile throughout the day by performing gentle movements to avoid getting what is known as a frozen shoulder. A physiotherapist can inform you of which movements are suitable to prevent this from happening, but you will usually be back to normal and doing all the things you want to do at around four to five weeks.
For more information about Pacemakers please visit my Pacemakers & ICD’s page on this website. If you need to speak to a specialist about a possible Pacemaker implant, or to discuss your options in further detail then please get in touch with Dr Segal here on the website or via his dedicated Doctify page.