The heart has a natural pacemaker, which fires electrical signals in a coordinated fashion across the heart and controls the contraction or beating of the heart and the heart rate. If these electrical signals do not work properly or are damaged or blocked at key points, this can lead to abnormal fast or slow heart rates.
Slow heart rate (bradycardia) is the commonest reason a pacemaker is required. However, very special devices or defibrillators may be needed for very fast heart rates especially ventricular tachycardia or fibrillation.
Who is most likely going to need a pacemaker?
Slow heart rates or heart block are more common in older age groups but can occur at any age. The main symptoms include dizziness, fainting or blackouts. Some special pacemakers are also used for some patients with heart failure to help support cardiac function. This is called cardiac resynchronisation therapy (CRT) and some of these devices can also shock the heart if there is an abnormal rhythm like ventricular fibrillation.
What are the different types of pacemakers?
Pacemakers may be required for slow heart rates or fast heart rates.
How is a pacemaker fitted?
Pacemakers are commonly implanted below the left clavicle or collarbone. It is implanted under strict sterile conditions. Antibiotics are commonly given beforehand to reduce the risk of infection. The skin is cleaned thoroughly and sterile drapes cover the body. A local anaesthetic is used and sometimes sedation. The patient is normally awake at the time. The pacemaker normally sits in a pocket made under the skin and the leads which are used to pace the heart are placed through veins into the heart. X-rays are used to position these leads. The leads are stitched in place and the pocket closed sometimes using a special glue.
Are there any side effects?
There are small risks as with any operations involving the heart. There is a small chance of damage to blood vessels, tissues and the lungs which are nearby. There is also a small risk of infection and bruising.
How often do the pacemaker batteries have to be changed?
Batteries normally last several years and can be changed if they wear out.
What is life like following a pacemaker being implanted?
Immediately after a pacemaker fitting resting the arm is advised, especially not raising the arm above shoulder height for a few weeks on the side that the pacemaker was implanted. Also, one should not do heavy lifting or drive for at least one week. In the longer term patients will need to be careful of magnetic fields and some electrical equipment. Patients have described feeling as though they have more energy, no longer need an afternoon nap and that their head is clearer.