Pacemakers are devices work to treat arrhythmias . During this type of episode, the patient’s heart may beat differently than normal, either faster, slower, or irregularly.1Thus, the function of the pacemaker work is to send electrical impulses to the heart, guiding it as it should beat . The pacemaker can also be useful for synchronizing the beats in different areas of the organ, called chambers. This makes pumping blood more efficient.

What are the indications of the device?

Now, let’s understand what types of heart irregularities may indicate the use of a pacemaker. Check it out!

Sick sinus disease

The sinus node is an important part of the heart that regulates the rhythm of the heartbeat. When it doesn’t work properly, it can cause the heart to beat too slowly, too quickly, or irregularly.2

This can lead to symptoms such as dizziness, fainting, and weakness. Using a pacemaker helps regulate your heart rhythm and relieve these symptoms.

Carotid sinus syndrome

Carotid sinus syndrome occurs when there is an abnormal response by the body to certain stimuli in the carotid sinus (located in the neck), resulting in fainting.2

A pacemaker may be recommended to prevent these fainting spells, especially when conservative treatment (such as avoiding carotid sinus stimulation) is not effective and the fainting episodes are frequent and disabling.

Neuromodulated or vasovagal syndromes

These syndromes are common causes of fainting, especially in people without apparent heart or neurological problems. They are usually triggered by stress or certain situations.2

Pacemaker implantation may be considered in severe cases, especially if there is a cardioinhibitory response involved in the fainting.

Atrioventricular blocks

Atrioventricular blocks are disturbances in electrical conduction between the upper and lower chambers of the heart. Depending on the severity, they can cause symptoms such as dizziness and fainting.2

Implantation of a pacemaker may be recommended to regulate the heart’s electrical conduction and prevent these symptoms in advanced atrioventricular blocks.

How does a pacemaker work?

A pacemaker works by sending low-energy electrical pulses to control the rhythm and frequency of your heartbeat, as we’ve seen. They can be divided into different categories, as you’ll see below.  Let’s go!

Traditional pacemakers

Also called transvenous , traditional pacemakers have three main parts:

the pulse generator;

• the wires (also called electrodes) implanted in the veins that carry the pulses to the heart;
• the electrodes that detect the heart’s natural rhythm.

When the heart rate is slower than normal, the electrodes send electrical impulses to the heart to make it beat normally. The generator is located outside the heart, usually in the chest or abdomen, and is connected to the electrodes by wires.

Wireless pacemakers

They are smaller than traditional ones and the entire system (pulse generator and electrodes) is located inside a chamber of the heart, inserted through a small tube into a vein, eliminating the need for surgery.

They are used when there is a slow heart rate or electrical blockage between the chambers of the heart.

 types of pacemakers

There are also pacemakers in which the electrodes are placed on the surface of the heart, rather than in the center. This type of pacemaker requires surgery, just like the traditional one.

How is pacemaker surgery performed?

Surgery to place a pacemaker is generally done in two main ways: transvenous implantation and epicardial implantation.

The first is the most common method. In this method, the cardiologist makes a small incision, usually below the collarbone, and inserts the pacemaker wires into a vein . Using X-rays, the wires are guided to the correct chamber of the heart and attached to the heart tissue.

The pacemaker generator is placed under the skin of the chest. The surgery is done under local anesthesia, so the patient will be awake, but the area will be numb.

Less common, the second method is performed in specific cases, such as in children or people who need to undergo another heart surgery simultaneously.

In these cases, the wire is connected to the outer surface of the heart through an abdominal incision . The pacemaker generator is placed under the skin of the abdomen. This surgery is done under general anesthesia, so you will be asleep during the procedure.

And then?

Have you had pacemaker surgery? Now you will need to recover from the procedure. The period of hospital observation, that is, the time you spend in the hospital before being discharged, can range from a few hours to a few days .

During your observation, you may be asked to stand up and walk around the room to help with your recovery. The day after the procedure, you will likely have an x-ray to check that the pacemaker and wires are in the correct place.

Additionally, an electrocardiogram may be performed to assess your heart rhythm. The medical team will also ensure that the device is programmed correctly before you are discharged. Professionals can also set up the device to send data remotely for medical monitoring.

Finally, you will receive detailed instructions on how to care for your pacemaker while you recover at home. This may include information about medications to take, activities to avoid, and how to prevent movements that could dislodge the device’s wires.

You’ll usually be told to avoid driving, lifting, or engaging in strenuous physical activity for at least a week . Most people resume their regular daily activities within a few days after surgery.

In any case, don’t forget to ask the team any questions you may have post-operatively and before the procedure. After all, having information is the best way to a full recovery!

Are there complications associated with pacemaker placement?

Before we talk about the care that a person with a pacemaker should take, it is important to highlight the possible complications associated with this procedure.  These include:

• allergic reactions, often associated with medications used during the procedure;
• appearance of clots, which can be prevented with the use of some specific medications;
• infections;
• tiredness, difficulty breathing and a drop in blood pressure, among others.

However, the procedure is generally considered safe . ¹ Still, it’s important to talk to your doctor about any potential complications associated with your condition and what you can do to address them if they occur.

What precautions should someone with a pacemaker take?

Anyone who undergoes the pacemaker implantation procedure needs to take some daily precautions. Check out some of the main ones below!

Keep up with physical activity

The first tip is to keep your body active, since the pacemaker should not interfere with physical activities. Therefore, invest in activities that you enjoy and feel comfortable with . This can include short walks, for example.

Don’t overdo it

Regardless, respect your limits and stop before you get tired . The right amount of activity should make you feel better, not worse.  Be careful!

Baths and showers

Your bathing routine can continue as usual, okay? Your bathing routine can be resumed about 2 days after the procedure. There is no need to be afraid of getting the device wet.

Trips

Another very important aspect of our lives is leisure. So, feel free to travel as you wish. Car, train or plane journeys should not pose any danger.

Inform other healthcare professionals

Another important tip is to remember to tell people that you have a pacemaker . So make sure all your doctors, dentists, nurses, physical therapists, health technicians and other professionals are aware of this! ⁴

Return to sexual activity

The return to sexual activity may vary depending on a number of factors. Therefore, ask your cardiologist your questions directly, okay?

Security at airports, banks and public places

Another change and precaution in the life of someone with a pacemaker involves visiting certain places, such as banks or airports. When passing through metal detectors, inform security agents that you have the device, as it may be detected by the sensors.

Pacemaker: what are the main myths?

To close our chat, it’s time for you to learn about some of the main myths (and also some truths!) about pacemakers. Are you ready? Keep reading to find out more!

1. Pacemakers interfere with other electronic devices

Devices with strong magnetic fields or specific electronic devices can interfere with the pacemaker’s operation. However, most everyday electronic devices do not cause significant problems, such as cell phones and general household appliances .

Regarding cell phones, the tip is to use them on the opposite side of the pacemaker. ¹ In addition, there are some more modern pacemakers that can even be used in MRIs.

. Pacemakers need to be replaced frequently

Pacemakers generally last for many, many years, but some parts need to be replaced over time. One example of this is the battery.

The health of your device’s battery can be checked during your routine checkups, which usually take place every 6 to 12 months, depending on your health needs and medical recommendations. During these checkups, your healthcare professional will use a device to check whether or not the battery needs to be replaced.

3. Pacemakers can be accidentally turned off

Although it is uncommon, there is a small chance that a pacemaker will stop working properly. This is because we are dealing with an electronic device that is unfortunately subject to failure.

Some reasons for this event are cable displacement, battery failures, problems associated with exposure to magnetic fields, and improper programming of the device.

But how do you identify this type of problem? Some signs that indicate that your pacemaker is having problems are changes in your heartbeat, which may be slower or faster than normal, dizziness, hiccups and a feeling of fainting. In some cases, fainting may even occur.

4. Pacemakers limit physical activity

Having a pacemaker doesn’t mean you have to avoid physical activity. In fact, moderate exercise is often recommended to improve cardiovascular health . However, it’s essential to follow some guidelines to ensure that exercise is safe and beneficial .

After the pacemaker is implanted, it is advisable to start with light walks. This is an excellent way to start exercising.  Take your time. Recovery is done one day at a time!

As you feel more comfortable, gradually increase the time and then the speed of your walk. By week 4 or 6, try to walk for 15-20 minutes at a time .

If walking isn’t feasible or you want to vary your exercise types, consider the following options (with your health care provider’s approval): swimming or water aerobics . Water activities are great because they’re gentle on your joints and provide a full-body workout.

But be warned: Before starting any new exercise regimen , it’s crucial to consult your cardiologist or health care professional . He or she can provide specific guidance based on your individual condition and the type of pacemaker you have.

In any case, it is always recommended to talk to your doctor about possible treatments for your condition . He or she will be able to explain the alternatives and show you how to deal with the problem on a daily basis.

Conclusion

In summary, pacemakers are vital medical devices that play a crucial role in managing heart rhythm disorders. By delivering electrical impulses to the heart, they ensure that it beats in a coordinated and effective manner. With advancements in technology, modern pacemakers are more sophisticated, offering features such as remote monitoring and adaptive rates that respond to the patient’s physical activity. As a result, individuals with pacemakers can lead healthier, more active lives, underscoring the importance of this innovative medical solution in contemporary healthcare.

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