Permanent Pacemakers Correct Heart Rhythm

By Malcolm Brand, MD

Our hearts come with a natural pacemaker that regulates the rhythm of our heartbeat, slowing down when we’re at rest and appropriately speeding up when we’re active. Some people, however, develop faulty conduction systems in their hearts that prevent the rhythmic electrical impulses from traveling through the heart muscle. The result is often a heartbeat that is too slow. This condition, called bradycardia, is very effectively treated with the implantation of a permanent pacemaker.

What are the symptoms of bradycardia?

The most common symptoms of bradycardia are episodes of feeling light-headed or dizzy. People with slow heartbeats can also have problems tolerating vigorous exercise. If conduction worsens and the heart stops for brief periods of time, you can lose consciousness. This can be very dangerous if you are behind the wheel of a car or engaged in other activities that would put you or others at risk should you pass out. When people drive off the road and have no memory of why, it can be due to heart rhythm problems.

How does a permanent pacemaker work?

A pacemaker ensures that your heart will not beat too slowly. The pacemaker is set at a certain limit: if your heart beats faster, the pacemaker monitors that; if your heartbeat becomes too slow, the pacemaker makes it beat faster. A pacemaker does not keep your heart rate the same; it just keeps it above a set rate. There are athletes with pacemakers who engage in strenuous activity and their heartbeats become very rapid as their bodies demand it; their pacemakers simply keep their heart rates from dropping too low.

How is a permanent pacemaker implanted?

In Tompkins County, permanent pacemakers are implanted in the Cardiac Catheterization Lab at Cayuga Medical Center. This is an invasive procedure but it is not open-heart surgery. Patients receive a sedative and local anesthesia, which allow them to be mildly conscious during the procedure. The cardiologist begins by making a small incision in the shoulder. Wires from the pacemaker are inserted into the vein in the shoulder. Using guided imagery (a form of x-ray), the wires travel down the vein and are attached to the inside of the heart muscle. The pacemaker, which contains a battery and computer chip, is then attached to the wires and tucked beneath the skin on the shoulder. The patient stays overnight in the hospital and goes home the next day. Activity is somewhat restricted for four weeks, at which point it is safe to resume life as usual.

What are the risks of this procedure?

Like any procedure, there are risks involved. These include bleeding, inducing abnormal heart rhythm, and damage to the heart muscle while placing the wires. The risk of complication is about one in 1,000.

How is a permanent pacemaker maintained?

The pacemaker’s function and battery are checked two to three times a year in your cardiologist’s office by lightly running a computer wand over the skin on the shoulder. Pacemakers typically last eight to ten years on average, though some last much longer.

Do people with pacemakers have to worry about being around electronic devices?

Today’s pacemakers are much more advanced than previous versions. They are better insulated from external electrical interference, so people with pacemakers can safely use cell phones, microwaves, and automatic doors.

What happens if I need an emergency pacemaker?

In an emergency situation, a temporary pacemaker can be placed by any cardiologist on staff at Cayuga Medical Center. This will stabilize the heart rhythm until a permanent pacemaker can be inserted by one of the two local cardiologists certified to implant permanent pacemakers (myself and my colleague, Dr. Lynn Swisher).

Dr. Brand is board certified in cardiovascular disease, nuclear cardiology, and internal medicine. He is a Fellow of the American College of Cardiology and a Diplomate of the Certification Board of Nuclear Cardiology. He is on the medical staff of Cayuga Medical Center and in practice with Ithaca Cardiology Associates, where he can be reached in Ithaca at (607) 272-0460. Dr. Brand completed his fellowship training, residency, and internship at the University of Massachusetts Medical School.

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