A pacemaker works by supporting the heart's natural rhythm and restores regular electrical impulses to your heart when required. The pacemaker has two basic parts:
A pulse generator contains the battery and circuitry, functioning like a mini computer by controlling the timing of electrical impulses sent to the heart.
Pacing leads are insulated wires through which the electrical impulses travel. These leads are connected to the pulse generator and are extremely flexible and able to withstand twisting and bending caused by normal body movement and heartbeats.
At the tip of the lead is a metal electrode. It is through this electrode that the pacemaker monitors (or senses) the heart's electrical activity and is able to send out electrical impulses when the heart needs them.
Pacemakers have a special sensor that detects changes in your exercise state. The pacemakers' circuitry interprets these changes and increases or decreases the pacing rate to meet your body's demands. It will increase with physical activity (i.e. walking, gardening, exercising) and will slow down accordingly with rest or sleep.
In many heart rhythm disturbances, your heart may beat normally part of the time and therefore your pacemaker will only work when required.
Your pacemaker stores information about your heart's rhythm and is completely programmable. If your pacing requirements change, this is easily attended to in your cardiologist's rooms without the need for further hospitalisation.
Most devices now have the ability to remotely transmit information directly to your cardiologist through our Remote Monitoring Service. For more information, see Remote Monitor Service under Post-operative Care below.
Who needs a pacemaker?
The most common condition requiring a pacemaker is bradycardia; a heart rate that is too slow for the body's demands. Symptoms of bradycardia may include dizziness, extreme fatigue, shortness of breath or fainting spells.
Bradycardia is most commonly caused by one or both or the following:
- Sick Sinus Syndrome: When the sinus node sends our electrical impulses too slowly or irregularly.
- Heart Block: When the electrical impulse is slowed, becomes irregular or is stopped.
Types of Pacemakers
The type of pacemaker you require will depend upon your medical condition. You may require a single chamber, a dual chamber or bi-ventricular chamber pacemaker:
- Single chamber pacemaker: Uses one lead, placed in the right ventricle to sense and pace that chamber.
- Dual chamber pacemaker: Uses two leads, one placed in the right atrium and the other in the right ventricle.
- Bi-Ventricular pacemaker: Has three leads, one in the right atrium, one in the right ventricle and one is placed within a vein that lies on the outside surface of the left ventricle.
- Prior to the procedure, you will have the opportunity to ask questions if you have any uncertainties.
- You will be required to fast for 6 to 8 hours prior to your procedure.
- You will be admitted to hospital the day prior to or on the day of your procedure.
- You may be required to have a blood test and a 12 lead Electrocardiograph (ECG).
- You will have your right groin shaved and you will be required to have an antiseptic shower.
- You will have an IV drip inserted into your arm vein.
The procedure is performed under a local anaesthetic. This will make the site numb during the procedure, but it is normal to still feel some pushing and pulling. You may also be given a sedative to help you relax.
The procedure should take approximately 60 to 90 minutes.
The pulse generator, which is about the size and weight of three 50 cent coins, is generally implanted under the skin just below the collarbone on either the right or left side. The leads will be introduced transvenously (through a vein) in the left upper chest region. The lead is then threaded through the vein to the appropriate chamber in the heart.The leads are tested before the pulse generator is attached and the incision is closed.
On return to the ward you will be monitored overnight. You will remain resting in bed until the next morning.
Your PPM will be checked the following morning by your doctor or pacemaker technician. The monitoring leads will be removed once your device has been checked. It is normal to still experience some pain at the insertion site. This should be eased by taking paracetamol.
You will have a waterproof dressing placed over your wound site and will be advised on how to care for this by the nursing staff. The dressing will be removed 3 days after you are discharged. The site will then be left uncovered. You do not need to have any stitches removed as they are dissolvable.
The day after your procedure, your doctor will review you on the ward. The monitoring leads will be removed once your pacemaker has been checked and a nurse will remove your dressing prior to discharge.
It is normal to experience some pain at the insertion site, which should be eased by taking Panadol as directed.
You will receive a pacemaker identification card along with an information booklet produced by the manufacturer of the pacemaker.
Returning to Daily Life
Usual activities such as working, driving a car and light exercise can resume upon the advice of your doctor, usually after one to two weeks recovery. You can safely use common household appliances, including televisions, computers, microwave ovens, gardening machinery etc.
Avoid the following probable sources of electrical interference
- Mobile phones and handheld devices (iPad etc.)
- Studies have indicated that there may be some potential interaction between mobile phones, handheld devices and pacemakers. The effect is temporary and may include preventing pacing when the phone is within close proximity (15cms). You can use your mobile phone and device safely by doing the following:
- Maintain a minimum distance of 15cms between your pacemaker and mobile phone/device.
- Hold the phone / device to the ear opposite your pacemaker.
- Don't carry your phone in your breast pocket.
- MRI Scanners.
- TENS machines used by physiotherapists.
- Electrical arc welding equipment.
- Dielectric heaters – used in industry to bend plastic.
- Electric steel furnaces.
Airport screening devices may detect the pacemaker's metal case. It will be necessary to present your pacemaker identification card to obtain clearance.
Always tell any health professional that you have a pacemaker and show your ID card. Most medical procedures are unlikely to interfere with your pacemaker, except MRI scanners.
Follow Up Appointments
An important feature of your pacemaker is the ability for your doctor to program it to suit your individual needs. This takes place at regular routine check-ups either in the QCG's rooms or via our Remote Home Monitoring service (see below) that your doctor will schedule; the first after 3 months, and at least every 12 months thereafter. At these appointments, your doctor will also ensure that your pacemaker is functioning correctly. A typical follow up appointment in the rooms will last about 20 minutes, during which time your doctor will assess how your device has performed since your last visit and remaining battery life (which will be replaced well before the battery is flat).
Remote Monitoring Service
QCG offers a remote monitoring service that enables 'virtual check-ups' for your implanted device. This allows you to directly and securely transmit data from your device to your cardiologist from the comfort of your own home. This enables us to detect significant events such as an abnormal heart rhythm, monitor the performance of your device such as battery life, and optimise your care through device programming or medication change.
Your participation in remote monitoring allows us to follow your device function between visits, and in some situations, it may replace office visits. This means less time spent at the doctor’s office for regular checks, faster time to treatment if your cardiologist detects a medical problem and faster troubleshooting if a problem is detected with your device. Research evidence has shown that early detection of issues through remote monitoring leads to improved health outcomes and a reduced risk of hospital admission. It also allows you to monitor your own heart rhythm and quickly detect any irregularities or arrhythmias.
For more information go to Remote Monitoring Service.