Pacemaker Procedures
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Cardiac Event Recorder
This is a battery-powered portable, wearable, user-activated electrocardiogram. It is typically used when a doctor suspects an abnormal heart rhythm that occurs at unpredictable intervals. It can also be used to see how you respond to medicines. The monitor is worn for two to four weeks, 24 hours a day, while you perform normal activities. By activating the monitor when you sense a change in your heartbeat, you can record your heart’s electrical activity. This produces a graph that will help your doctor determine the cause of these changes.
There are two types of event recorders: a loop memory monitor and a symptom event monitor.
By turning on the event recorder, when you have fast or slow heartbeats or feel dizzy or faint, you create an electrocardiogram (EKG). Some cardiac event recorders store your EKG data; it can be transmitted to a receiving center or your doctor.
There are no risks when using a cardiac event recorder.
Why do people need to use a cardiac event recorder?
Tests such as EKGs let your doctor look at your heart’s activity at rest and at one point in time. But abnormal heart rhythms and cardiac symptoms may come and go. An event monitor can record your heart rate and rhythm during a symptom (or “event”). It works only when you turn it on. Your doctor may recommend an event monitor when symptoms are infrequent—less than daily.
What does the monitor tell my doctor?
- If your medicines are working.
- If a pacemaker or an implantable cardioverter defibrillator (ICD) is working properly.
- Why you have symptoms such as chest pain, dizziness, faintness or the feeling that your heart is racing or skipping a beat.
- If your heart is getting enough oxygen to meet its needs.
Pacemaker Insertion
A pacemaker is a small, battery-powered computer that is implanted in the chest to help control abnormal heart rhythms. Since the first pacemaker was implanted in 1958, millions of people have benefitted from pacemaker therapy.
A pacemaker has two parts: a generator and thin wires, called “leads.” Both are implanted at the same time. The generator sends electrical pulses through the leads to restore and maintain your heartbeat at a normal rate. These pulses timed to flow at regular intervals just as impulses from your heart’s natural pacemaker would.
Why do I need a pacemaker?
Your heart has an electrical system that controls the rate and rhythm of your heartbeat. In a normal heartbeat, the heart’s two upper chambers, the atria, contract first. This pumps blood into the heart’s two lower chambers, the ventricles. The ventricles then contract and pump blood to the rest of the body. The combined contraction of the atria and ventricles is a heartbeat.
A variety of conditions can block or disrupt the heart’s electrical signals. The result can be arrhythmia—problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heartbeat can be too fast, too slow, or irregular. A heartbeat that’s too fast (over 100 beats per minute) is called tachycardia. A heartbeat that’s too slow (under 60 beats per minute) is called bradycardia. An irregular heartbeat is called dysrhythmia.
For the heart to work correctly, the chambers must beat in a coordinated pattern at a resting heart rate between 60 and 100 beats per minute. The pacemaker uses small electrical pulses to maintain your heartbeat at a normal rate.
Understanding the heart’s electrical system
With each heartbeat, an electrical signal begins in a group of cells called the sinus (or sinoatrial) node. As the signal starts at the top of the heart, it coordinates the timing of each beat.
First, the heart’s two upper chambers, the atria, contract. The electrical signal then moves through the heart to the atrioventricular (AV) node, another cluster of specialized cells in the center of the heart between the atria and ventricles (the heart’s lower chambers). From the AV node, the electrical current travels along special fibers to the ventricles, which contract and pump blood to the body. The combined contraction of the atria and ventricles is a heartbeat.
During an arrhythmia, the heart may not be able to pump enough blood to the body. This can cause symptoms such as fatigue, shortness of breath, or fainting. Severe arrhythmias can damage the body’s vital organs and may even cause loss of consciousness or death.
A pacemaker can relieve arrhythmia symptoms such as fatigue and fainting, helping you resume a more active lifestyle. More severe arrhythmias may require a pacemaker that includes an implantable cardiac defibrillator .
How does a pacemaker work?
Pacemakers are implanted just under the skin, usually in the chest area, to support the heart’s electrical system. The device has very thin wires, called leads, that are threaded through a blood vessel into the heart. The pacemaker sends electrical pulses through the leads to maintain a normal heartbeat. These impulses are very tiny, and most people do not feel them at all. While the device helps your heart maintain its rhythm, it also stores a lot of information about your heart that can be retrieved by your doctor. This helps him program your device so that it provides the best therapy for your condition.
Most pacemakers have a sensing mode that prevents the pacemaker from sending impulses when the heartbeat is above a certain level. It allows the pacemaker to fire when the heartbeat is too slow. These are called demand pacemakers.
How big is the pacemaker?
It’s about the size of two stacked half-dollars. Smaller units are currently in clinical trials.
How much will it protrude?
It depends on the person and on the type of implant. If you’re thin, it generally will protrude more. If you have a little more bulk it will be less obvious. The device can be implanted under the breast muscle, which would prevent it from being seen. Ask your doctor about options for your implant location.
Will a pacemaker change my quality of life?
No. Your life will only change if you allow it to. The pacemaker won’t hinder you or your activities. Your doctor will discuss any restrictions with you.
Are there any risks?
Serious risks are very rare (1%), but they include stroke, heart attack, and possible damage to the heart or lungs. At least some of this risk depends on the patient’s overall condition.
Other risks are infection at the implant site, allergic reactions, and swelling, bruising, or bleeding at the implant site, especially for patients who take blood thinners.
What kinds of devices will affect my pacemaker?
Electromagnetic frequencies can interfere with the pacemaker’s ability to sense an abnormal rhythm. Generally, you just need to maintain a certain distance to avoid interaction.
These devices are safe to use:
- Computers
- DVR players
- Garage door openers
- Microwave ovens
- Small electrical tools
Use caution around these devices:
- Airport security scanners: When traveling in an airport, tell security you have a pacemaker and request a manual search.
- Anti-theft security systems: These are unlikely to create any interference as you walk through them, but you should be aware of their locations.
- Cell phones, Bluetooth headphones, and MP3 players (iPods): Keep these at least 6 inches away from your pacemaker. Hold the phone on the ear opposite your pacemaker.
- Medical devices and procedures: Tell your dentist and other health care providers that you have a pacemaker before they perform any tests or procedures. Normal teeth cleanings are safe and require no special instructions.
Avoid these devices:
- Electrical transformers
- Large generators
- Large machinery