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The pacemaker procedure

When the heart's rhythm gets off-beat, a surgically implanted pacemaker may help get it back on track.

Each of us is born with a natural pacemaker in our heart called the sinoatrial or sinus node. This small group of cells produces electrical impulses that travel through each chamber of the heart, causing them to contract. These contractions together make up a heartbeat.

When a defect or disease interferes with the heart's natural pacemaker, an artificial one can help the heart beat properly again.

What's an artificial pacemaker?

A traditional pacemaker includes a battery; a pulse generator, which produces electrical charges; insulated wires called leads that connect the generator to the heart; and electrodes that sense your heartbeat.

The pacemaker sits in the chest, where it can take over the work of sending electrical impulses to the heart. Many pacemakers today respond to physical movement, body temperature and breathing rate, altering the heart rate to meet the body's changing needs.

In certain cases, a doctor may recommend a wireless pacemaker, which is smaller than the traditional kind and does not have leads. The device contains a pulse generator and electrodes. In a nonsurgical procedure, the wireless pacemaker is placed inside a chamber of the heart.

When are they needed?

You may need an artificial pacemaker if your heartbeat, because of disease or a defect, is too fast, too slow or irregular, or if your heart fails to respond to specific demands, such as not speeding up during exercise or not slowing down afterward.

An artificial pacemaker can regulate your heartbeat, allowing you to return to normal activities.

How it's done

The pacemaker procedure is done in a hospital or a special heart-treatment laboratory.

You'll be given a mild sedative and local anesthetic just before the procedure. The sedative helps you relax, and the anesthetic numbs the area that will be worked on.

To implant a traditional pacemaker, the surgeon makes a small cut just under the collarbone and guides the leads through a vein into the heart. Then he or she attaches the leads to the pulse generator and tests the pacemaker.

The surgeon places the pacemaker in a natural "pocket" just above the chest muscle and tests it once more before closing the skin with stitches.

After the procedure, you'll stay in a recovery room until the sedative has almost worn off. Your heart is monitored and your chest is x-rayed to make sure the leads are in the right place in the heart.

After the procedure

You'll probably be tender at the incision site, restricting activity that requires moving your elbow higher than your shoulder.

The American Heart Association recommends these measures for self-care:

  • Before you leave the hospital, ask your doctor about your acceptable maximum heart rate, any restrictions on your diet or physical activity, and any other precautions you should take.
  • Keep your follow-up appointments, and take medicines as your doctor prescribes.
  • Tell your healthcare providers you have a pacemaker.
  • Always carry your medical identification card.
  • Call your doctor if you have difficulty breathing, rapid weight gain, swelling in your legs and ankles, faintness or dizzy spells. Also call your doctor if your pulse rate suddenly drops below the accepted rate or increases dramatically.

Reviewed 4/26/2023

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