What is a pacemaker and how it works

A small device implanted under the skin, designed to mimic the heart’s natural pacemaker

When the heart natural ” battery” becomes depleted , the artificial pacemaker is implanted to take over.

A Pacemaker has two purposes

• Pacing- sending  an impulse when your own heart rhythm is too slow, ” taking over your heart” when needed

• Sensing- or ” monitoring” your heart activity; when you have a normal heart beat, will not deliver an impulse

A Normal Sinus Beat

B Longer pause, Pacemaker senses and  takes over

C  Pacemaker delivers the impulse

What I tell my patients before implant

• The Pacemaker won’t prolong your life; will make it safer – no falls, passing out

• The Pacemaker improves quality of life; more energy, better stamina

• Won’t correct Atrial Fibrillation; you will still need to take the blood thinners!

• Your lifestyle wont change after Pacemaker; will be better by increasing the level of activity.

When do you need a Pacemaker

• Slower pulse than normal (bradycardia) or pauses > 3 sec

• Fainting, Dizziness, Fatigue, Chest pain, Shortness of breath,

• Palpitations, Decreased stamina

The day before implant

My office will advice you

• Hold blood thinners: 3 days for Eliquis, Xarelto or Pradaxa; Coumadin will be held to decrease the INR to less than 1.5

• Hold metformin for 2 days. If you take insulin, hold the morning dose.

• The hospital will call you the night before regarding time of surgery

• No eating or drinking after midnight the night before surgery. Take your pills ( except blood thinners and metformin) in the morning with a few sips of water.

•  Clean your entire chest with Hibiclens Antiseptic Cleanser the evening before procedure and again the morning of procedure; Hibiclens can be found over the counter at any pharmacy

• If allergic to iodine, follow my office protocol

How do I implant the pacemaker?

• The surgery lasts about 1-2 hours

• You’ll receive a sedative but no general anesthesia; you may be awake during surgery, but will not feel any pain

• I will make a small incision under the collarbone, and I’ll pass a wire through it into your veins, guiding it to your heart. The procedure is performed under X ray guidance

• Over the guiding  wire , I will advance the pacemaker lead to your Right ventricle, attaching the tip to the heart muscle.Using a different wire , I will advance and attach the second lead to your Right atrium.

• The proximal end of the leads is attached to the Generator, ” the battery of pacemaker”, positioned  under your skin

Every invasive procedure may result in complications.

• Infections at implant site

• Allergy to the dye or anesthesia

• Bruising, Bleeding at incision, if on blood thinners

• Collapsed lung- rare

• Heart Perforation- rare

• Lead dislodgement with second procedure needed  for reinsertion