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Pacemakers: Saving Your Heart One Beat At a Time

An image of a health professional holding a pacemaker illustrates the vital role pacemakers play in regulating and saving the heartbeat.
December 17, 2023
by Dr. Karthigesan

Your heart relies on an electrical impulse to produce each beat. What happens when your heart is incapable of generating the electrical impulse? That’s when you will need a pacemaker- a small, matchbox-sized wonder machine to help your heart work and prevent life-threatening cardiac disruptions.

What’s a Pacemaker & How Does it Work?

Millions of people worldwide live with pacemakers. It is a small battery-operated device that performs several tasks. It:

  • Stabilizes low or abnormal heartbeats and regulates them
  • Saves your heart and brain from any further damage
  • Helps you to take essential medications without worrying about the slow heartbeat.
  • Assist patients with chronic heart failure by improving pumping efficiency.

Temporary pacemakers are attached to your clothes, and permanent ones are implanted under the skin near your Collarbone.

How does the pacemaker work in your heart?

The need for a pacemaker arises when your heart’s electrical system malfunctions. This means your heartbeats are either too slow to pump sufficient blood or fail to do so correctly- a critical electrical malfunction that impacts the blood flow to the vital body parts. A pacemaker either supports or replaces the natural electrical system function and regulates the heartbeat according to the need.

The device weighs no more than 50 grams. It comes with one or several wires, known as pacing leads, which run towards the heart. They also have special sensors to detect body movements and your breathing rate. This feature allows the device to adjust the heart rate based on the person's activity level, called rate responsiveness.

The pacemaker is also programmed to work in response to your cardiac requirements. For instance, the pacemaker can sense if your heart has skipped a beat and also understands the pace of your heartbeats. If the beats are too slow, it generates an electrical signal to steady the pace.

The pacemaker can do all this despite its small size. What really matters are the parts inside the pacemaker and their role in making the device what it is.

3 Critical Components of the Pacemaker & Their Functions

1. Pulse generator

The pulse generator is the matchbox-like component comprising a battery and other electrical parts. All pacemakers are powered by batteries that typically last 10 years. However, newer pacemaker batteries have a longer lifespan because they consume less energy.

2. Wires or leads

One to three flexible, insulated wires extending from the device are placed inside the heart chambers. These wires or electrodes sense the rate of your heartbeat and transmit the necessary electrical signals to regulate it.

3. Electrodes

Electrodes in the pacemaker monitor your heart rate. They send electrical impulses to regulate the rhythm when the pace is slower than normal. The frequency at which the impulses are sent is called the Discharge Rate.

Pacemakers & Its Types

There are different types of pacemakers, and their usage depends on the cardiac issues they are designed to address. Currently, there are four types of pacemakers used to address cardiac issues:

1. Single chamber pacemaker

Predominantly used to rectify bradycardia (slow heart rate), this pacemaker has a single lead connected to one heart chamber.

2. Dual chamber pacemaker

As the name denotes, this pacemaker is designed to stimulate the upper and lower chambers of the heart.

3. Leadless pacemaker

This pacemaker is implanted into the heart's inner wall using a catheter from the groin. Leadless pacemakers generate signals to maintain the heartbeat. Unlike traditional devices, they do not need wires or a separate battery.

4. Biventricular pacemaker

This pacemaker has three thin wires or leads. Two leads connect with the ventricles(right & left), and a third connects to the right upper chamber or right atrium. The treatment using this device is called Cardiac Resynchronization Therapy or CRT.

Who Is An Ideal Candidate For Pacemakers?

Doctors do not suggest pacemakers unless you experience any of the following cardiac conditions:

  • Slow heartbeat with Loss of consciousness or Near Syncope
  • Very fast and very slow heartbeat(Extreme variation) with Dizziness or Loss of consciousness
  • Heartbeat that pauses suddenly and repeatedly
  • Some types of heart failures with Electrical abnormality

Most often, these above-mentioned heart issues are due to:

  • Congenital cardiac electrical issues
  • Age-related issues{degenerative}
  • Heart damage due to heart attack or infection
  • Intake of heart rate-lowering medication
  • Congenital heart defects
  • Heart transplants

So, what happens if, unfortunately, you require a pacemaker? How do you prepare for a pacemaker implantation? Generally, these procedures are pre-planned unless it is an emergency. Your doctor will recommend several diagnostic tests to determine cardiac health before scheduling an implant.

You may require:

  • Electrocardiogram
  • Echocardiogram
  • Holter monitor test or External Loop Recorder
  • Treadmill Test
  • Coronary angiogram

It is also essential to discuss the following details with your doctor:

  • Your date of arrival at the hospital
  • Continuation of medication intake (if you are on regular medicines)
  • When to refrain from eating and drinking before the implantation
  • Medication required after the procedure
  • Recovery duration and what to expect
  • Duration of your hospital stay

It is also advisable to arrange for a relative or friend to take you home after the procedure.

What to Expect During a Pacemaker Implantation?

Getting a pacemaker implanted is a common, minimally invasive procedure usually performed under local anaesthesia. Your doctor places the pulse generator under the skin near the collarbone. The generator's wire is steered into the heart via a blood vessel using X-rays as a guide. The procedure lasts almost an hour, and you may be discharged the next day, depending on your health condition.

4 Things to Avoid Doing After Pacemaker Implantation

  • Do not hold your mobile phone too close to your body or keep it in a shirt pocket. Keep it at least six inches or 15 centimetres away from the device.
  • Avoid playing rough sports like football and other activities like weightlifting for a few months after implant.
  • Refrain from being near strong magnetic fields. Strong magnets can interfere with pacemakers, causing them to malfunction.
  • Always inform your doctors before undergoing MRI scans, radiation therapy, electrocauterisation, and sound wave therapy for gallstones or renal stones.

Improving Your Quality of Life With a Pacemaker

Modern pacemakers are designed to monitor and record your heartbeat. Through remote monitoring, your doctor or cardiologist can observe how your pacemaker is functioning in real-time while you perform your daily activities.
You must also consult your doctor once or twice a year to ensure your pacemaker works correctly. During this time, your pacemaker’s battery and function will be evaluated. Your doctor will inform you when your battery needs to be replaced. This typically involves a simple procedure under local anaesthesia to replace the pulse generator.
Prioritize your heart health. Book an appointment with Dr. Karthigesan, the renowned Pacemaker Specialist in Chennai, to ensure exceptional medical care for your heart.

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