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Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Treatments - Pacemaker

The first pacemakers were developed more than 60 years ago; then they were bulky, crude and very limited in function. Since that time there have been truly remarkable innovations in pacemaker technology such that they have been miniaturised, are highly sophisticated in function and easy to implant. Initially permanent pacemakers were implanted to prevent excessive slowing of the heart beat which might otherwise cause dizzy spells and blackouts. Over the years their application has broadened greatly; they play a highly important role combined with an implantable cardioverter-defibrillator (ICD) in patients at risk of dangerous heart rhythms and sudden death; complex software enables the pacemaker to mimic a normal heart beat and alter the heart rate according to the body’s needs, speeding up the heart with activity and slowing at times of rest. A particular type of pacemaker, a biventricular pacemaker, with two leads rather than one pacing the main heart chambers, can “resynchronise” the pumping action of the heart and improve the function of the heart in selected patients with heart failure.

A pacemaker, which consists of a generator and one or more pacing leads to the heart, is implanted using local anaesthetic and sedation, taking anything from 40 minutes to 2 hours, depending on the complexity of the system and the anatomy of the patient. The generator is about the size of a small match box and is typically placed via a small incision under the skin just below the outer aspect of the collar bone (right or left) on the front of the chest; it contains the battery to power the device and the software necessary to provide an appropriate heart rate, which will vary from patient to patient. From this, one, two or three leads are passed through the veins to the heart, transmitting impulses to make the heart beat as necessary. The risk of complication is generally small but includes infection, bleeding, puncture of the lung and displacement of a pacing lead. The procedure may be performed as a day case; otherwise the patient should expect to stay overnight.

The pacemaker is checked at regular intervals after implantation using a device called a programmer, which looks a little like a laptop computer; this allows interrogation of pacemaker function and the patient’s own heart beat, and assesses the electrical characteristics of the pacing lead(s); the battery life can also be calculated to determine when it should be replaced, typically around every 7 years, depending on frequency of usage. 

A patient should be able to lead a fairly normal life with a pacemaker, although contact sports which might damage the generator and strong magnetic fields should be avoided; patients are also advised not to keep a mobile phone in a jacket pocket lying directly over the generator. Patients should not drive during the first week following pacemaker implantation; more detailed information in this regard is available on the DVLA website. Patients will be given a card describing the type of pacemaker they have and other details; when travelling this should be shown at airport security to avoid going through the security gate. Some surgical procedures involve diathermy, which can interfere with pacemaker function, but this can be prevented by reprogramming the pacemaker before and after the procedure. Certain types of medical scans, and in particular MRI, should not be undertaken in patients with a pacemaker, since the magnetic fields can adversely affect pacemaker function, although some of the latest pacemakers are MRI-compatible.

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Treatments - PacemakerTreatments - Pacemaker