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In this Article

• Pacemaker overview
• What is a pacemaker?
• Understanding the heart's electrical system
• Who needs a pacemaker?
• Diagnostic tests
• How does a pacemaker work?
• What should I expect during pacemaker surgery?
• What should I expect after pacemaker surgery?
• What are the risks of pacemaker surgery?
• How will a pacemaker affect my lifestyle?
• Physical activity
• Ongoing care
• Battery replacement
• Pacemaker At A Glance
• Find a local Cardiologist in your town
• Pacemaker Index

Understanding the Heart's Electrical System

Your heart has its own internal electrical system that controls the rate and rhythm of your heartbeat. With each heartbeat, an electrical signal spreads from the top of your heart to the bottom. As the signal travels, it causes the heart to contract and pump blood.

Each electrical signal normally begins in a group of cells called the sinus node or sinoatrial (SA) node. As the signal spreads from the top of the heart to the bottom, it coordinates the timing of heart cell activity.

First, the heart's two upper chambers, the atria (AY-tree-uh), contract. This contraction pumps blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls). The ventricles then contract and pump blood to the rest of the body. The combined contraction of the atria and ventricles is a heartbeat.

Who Needs a Pacemaker?

Doctors recommend pacemakers for a number of reasons. The most common reasons are bradycardia and heart block.

Bradycardia is a slower than normal heartbeat. Heart block is a problem with the heart's electrical system. The disorder occurs when an electrical signal is slowed or disrupted as it moves through the heart.

Heart block can happen as a result of aging, damage to the heart from a heart attack, or other conditions that interfere with the heart's electrical activity. Certain nerve and muscle disorders also can cause heart block, including muscular dystrophy.

Your doctor also may recommend a pacemaker if:

• Aging or heart disease damages your sinus node's ability to set the correct pace for your heartbeat. Such damage can cause slower than normal heartbeats or long pauses between heartbeats (as discussed above). The damage also can cause your heart to alternate between slow and fast rhythms. This condition is called sick sinus syndrome.
  
  
• You've had a medical procedure to treat an arrhythmia called atrial fibrillation. A pacemaker can help regulate your heartbeat after the procedure.
  
  
• You need to take certain heart medicines, such as beta blockers. These medicines may slow your heartbeat too much.
  
  
• You faint or have other symptoms of a slow heartbeat. For example, this may happen if the main artery in your neck that supplies your brain with blood is sensitive to pressure. Just quickly turning your neck can cause your heart to beat slower than normal. If that happens, not enough blood may flow to your brain, causing you to feel faint or collapse.
  
  
• You have heart muscle problems that cause electrical signals to travel too slowly through your heart muscle. (Your pacemaker may provide cardiac resynchronization therapy for this problem.)
  
  
• You have long QT syndrome, which puts you at risk for dangerous arrhythmias.

Children, adolescents, and people who have certain types of congenital heart disease may get pacemakers. Pacemakers also are sometimes implanted after heart transplants.

Before recommending a pacemaker, your doctor will consider any arrhythmia symptoms you have, such as dizziness, unexplained fainting, or shortness of breath. He or she also will consider whether you have a history of heart disease, what medicines you're currently taking, and the results of heart tests.