What is a pacemaker?
A pacemaker is a tiny device (not more than the size of a small matchbox), placed in the chest or abdomen, that sends small electrical impulses to the heart muscles for maintaining a suitable heart rate. It may also be used to treat heart failure, fainting spells (syncope), and certain diseases of the heart muscles (hypertrophic cardiomyopathy).
The commonest use of pacemakers, however, is the treatment of abnormal heart rhythms (arrhythmias). The heart has its internal electrical system to control the rate and rhythm of the heartbeat. During a heartbeat, the different parts of the heart receive electrical impulses from the heart’s natural pacemaker (the sinoatrial or SA node) that causes phasic contraction and relaxation of different parts of the heart. The normal heartbeat allows the heart to pump blood regularly and adequately to meet the body’s requirement.
Pacemakers can be classified as:
- Temporary pacemakers: These are used to treat short-term heart problems, such as a slow heartbeat caused by a medicine overdose, heart attack, or heart surgery.
- Permanent pacemakers: These are used to regulate long-term (chronic) heart rhythm problems.
Faulty electrical signals in the heart lead to arrhythmias. This may cause the heart to beat too fast (tachycardia), too slow (bradycardia), or with an irregular rhythm. An arrhythmia may hamper the ability of the heart to pump blood effectively leading to the following symptoms:
A permanent pacemaker may relieve the symptoms by sending low energy electrical pulses to overcome the faulty electrical signals in an arrhythmia. This regularizes the heartbeat and enables the heart to pump blood effectively to the body.
What happens during a permanent pacemaker placement?
- A permanent pacemaker implantation procedure is a minor surgery that can be done in a hospital or a special heart treatment lab.
- The surgery site is cleaned with antiseptics.
- The anesthesiologist gives intravenous antibiotics to prevent infections and sedation to keep you calm during the surgery.
- Local anesthesia is administered to numb the area where the doctor will put the pacemaker so that you do not feel any pain.
- The doctor inserts a needle into a large vein near the neck or shoulder of your non-dominant hand.
- The doctor then uses the needle to thread the pacemaker wires into the vein and correctly place it in your heart. To ensure proper placement, the procedure is done under X-ray image guidance.
- The doctor will make a small cut into the skin of your chest or abdomen to create a small pocket under your skin where they place the pacemaker's small metal box containing the pacemaker’s battery and generator.
- They will then connect the metal box to the wires that lead to your heart.
- The doctor then tests for the proper functioning of the pacemaker.
- Once the pacemaker functioning is ensured, the doctor will apply sutures to close the cut.
- A sterile dressing is applied.
- An arm restraint or immobilizer is applied to the arm on the side of the surgery for 12-24 hours to limit movement.
- Pain levels are typically low after the procedure. You may be given pain medication to manage any pain associated with the incision site.
IMAGESBrowse through our medical image collection to see illustrations of human anatomy and physiology See Images
What is the most common complication after permanent pacemaker placement?
The common complications after a permanent pacemaker surgery include:
- Early complications
- Phlebitis/thrombophlebitis (inflammation of the veins)
- Lead dislodgement or displacement
- Local infection
- Blood vessel injury
- Pneumothorax (presence of air in the space between the lungs and the chest wall)
- Hemothorax (presence of blood in the space between the lungs and the chest wall)
- Myocardial (heart muscle) perforation
- Anaphylaxis (severe and potentially fatal allergies)
- Air embolism (entry of air bubbles in the blood vessels)
- Pacemaker infection
- Pacemaker malfunction
- Dysrhythmia (abnormal heart rhythm)
- Chylothorax (lymph fluid leaks in the space between the lungs and the chest wall)
- Pacemaker syndrome (a phenomenon in which a patient feels symptomatically worse after pacemaker placement and presents with progressively worsening symptoms of congestive heart failure)
- Late complications
- Pocket erosion (damage to the skin pocket that contains pacemaker’s metal box)
- Lead dislodgement
- Hematoma (a localized collection of blood)
- Phlebitis/deep vein thrombosis (inflammation/clotting inside a vein)
- Hemothorax (collection of blood in the space between the lungs and the chest wall)
- Atrioventricular fistula (abnormal communication between an atrium and a ventricle)
- Infection of pacer lead/generator
- Myocardial perforation
- Pacer malfunction
- Pacemaker syndrome
- Allergy or sensitivity to the device
- Lead fracture
Latest Heart News
Daily Health News
Health Solutions From Our Sponsors
Top What Is a Permanent Pacemaker? Related Articles
Heart Healthy Diet: 25 Foods You Should EatWhat foods are heart healthy? Learn what foods help protect your cardiovascular system from heart attack, coronary heart disease, stroke, and cardiovascular disease. Plus, find easy meal recipes and menu ideas for more everyday heart benefit.
Ablation Therapy for ArrhythmiasThis procedure is used to treat abnormal heart rhythms. Depending on the type of arrhythmia and the presence of other heart disease, a nonsurgical ablation or a surgical ablation, may be performed. During a catheter ablation, catheters are advanced to the heart via blood vessels in the groin, neck, and arm. The conduction system of the heart is mapped and any areas responsible for the arrhythmia are destroyed.
ArrhythmiaAn arrhythmia is an abnormal heart rhythm. With an arrhythmia, the heartbeats may be irregular or too slow (bradycardia), to rapid (tachycardia), or too early. When a single heartbeat occurs earlier than normal, it is called a premature contraction.
A-Fib SlideshowAFib symptoms like heart racing, fluttering, and irregular heart beat may be caused by heart disease, obesity, alcohol use, thyroid disease, and other conditions. AFib medications may include blood thinners, drugs to control heart rate or convert the heart to a normal rhythm. AFib surgery is also a treatment possibility.
Congenital Heart DefectsCongenital heart defects are heart problems that are present at birth. Genetics may play a role in some heart defects. Symptoms can range from nonexistent to severe and life-threatening. Fatigue, rapid breathing, and decreased blood circulation are a few possible symptoms of congenital heart defects. Many cases do not require any treatment. Procedures using catheters and surgery may be used to repair severe heart defects.
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include:
- High blood pressure
- High cholesterol
- Family history
Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
Heart Disease in WomenHeart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women and health professionals are not aware of the risk factors for heart disease in women and may delay diagnosis and treatment. Lifestyle factors such as diet, exercise, tobacco use, overweight/obesity, stress, alcohol consumption, and depression influence heart disease risk in women. High blood pressure, high cholesterol, and diabetes also increase women's risk of heart disease. Electrocardiogram (EKG or ECG), stress-ECG, endothelial testing, ankle-brachial index (ABI), echocardiogram, nuclear imaging, electron beam CT, and lab tests to assess blood lipids and biomarkers of inflammation are used to diagnose heart disease. Early diagnosis and treatment of heart disease in women saves lives. Heart disease can be prevented and reversed with lifestyle changes.
CAD SlideshowWhat is heart disease (coronary artery disease)? Learn about the causes of heart disease. Symptoms of heart disease include chest pain and shortness of breath. Explore heart disease diagnosis, treatment, and prevention.
Heart Disease SlideshowHeart disease prevention includes controlling risk factors like diet, exercise, and stress. Heart disease symptoms in women may differ from men. Use a heart disease risk calculator to determine your heart attack risk.
Heart Disease QuizTake our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes, symptoms, treatments, testing, and procedures for medically broken hearts.
Heart Disease Treatment in Women
Heart disease treatment in women should take into account female-specific guidelines that were developed by the American Heart Association. Risk factors and symptoms of heart disease in women differ from those in men. Treatment may include lifestyle modification (diet, exercise, weight management, smoking cessation, stress reduction), medications, percutaneous intervention procedure (PCI), and coronary artery bypass grafting (CABG). Heart disease is reversible with treatment.
Heart Failure QuizWhat is heart failure? Learn about this dangerous condition, as well as who is at risk, and what to do about it.
Illustrations of the HeartThe muscle that pumps blood received from veins into arteries throughout the body. See a picture of the Heart and learn more about the health topic.
Smoking and Heart DiseaseSmoking increases the risk of heart disease in women and men. Nicotine in cigarettes decrease oxygen to the heart, increases blood pressure, blood clots, and damages coronary arteries. Learn how to quit smoking today, to prolong your life.
Stress and Heart DiseaseThe connection between stress and heart disease is not clear. Stress itself may be a risk factor, or high levels of stress may make risk factors for heart disease worse. The warning signs of stress can be physical, mental, emotional, or behavioral. Reducing stressors in an individuals life not only can lead to a more productive life, but may also decrease the risk for heart disease and causes of heart disease.
Cardiac Arrest QuizTake the Sudden Cardiac Arrest Quiz. Learning about this potentially deadly condition may save a life.