Pacemaker. What Is It?

A pacemaker is a small medical device implanted in the chest to help regulate the heart's rhythm. It is primarily used to treat heart conditions where the heart beats too slowly (bradycardia), too fast (tachycardia), or irregularly (arrhythmias). The device works by sending electrical impulses to the heart, ensuring it beats at a regular and appropriate rate. 

How Does a Pacemaker Work?

A pacemaker’s primary function is to keep the heart beating in sync, especially when the electrical signals that regulate heartbeats are malfunctioning. The device detects the heart's natural rhythm through electrodes and sends electrical impulses when necessary to correct an irregular heartbeat. These impulses stimulate the heart to beat at a desired rate, improving blood circulation and overall heart health.

When the heart rate is too slow (bradycardia), the pacemaker sends tiny electrical signals through the leads to prompt the heart to beat at a normal rate.

Some pacemakers are also designed to regulate fast rhythms (tachycardia) or correct irregular beats.

What Are the Types of Pacemakers?

The choice of pacemaker depends on the type of heart problem a patient has and the treatment needs.

Temporary Pacemakers

• Purpose: For short-term use in hospitalised patients when arrhythmias are expected to be temporary or as a bridge until a permanent pacemaker can be placed.
• Placement: The pulse generator is external, often taped to the skin, or secured to a belt or the patient’s bed.
• Monitoring: Hospitalised patients require continuous monitoring and regular evaluations to detect any complications.

Permanent Pacemakers

• Purpose: Implanted devices for long-term treatment of chronic or recurrent arrhythmias that are not transient.
• Indications:
• Symptomatic bradyarrhythmia (slow heart rate).
• Prevention or termination of certain types of tachyarrhythmias (fast heart rate).
• Based on specific guidelines, permanent pacing is recommended for conditions where it is beneficial or necessary.

• Implantation:

• Requires stopping specific medications (e.g., blood thinners) as advised by the doctor.
• Antibiotics are administered during the procedure to prevent infections.
• Typically performed under local anaesthesia with conscious sedation.

Pacemaker with Leads

• Pulse Generator:
• Commonly implanted under the skin below the clavicle (prepectoral region).
• Occasionally implanted in the upper abdomen.

• Lead Placement:

• Single-Chamber: One lead in the right atrium or right ventricle.
• Dual-Chamber: One lead each in the right atrium and right ventricle.
• Leads to improve cardiac synchrony:
• Cardiac Resynchronisation Therapy (CRT):
• Uses three leads: right atrium, right ventricle, and a branch of the coronary sinus for the left ventricle.
• Enhances the coordination of ventricular contractions.
• Conduction System Pacing:
• Positions the right ventricular lead to stimulate the heart’s natural conduction system, eliminating the need for a third lead.

Leadless Pacemakers

• Features:

• Implanted directly into the heart via a vein in the leg.
• No leads required, reducing complications associated with traditional leads.

• Applications:

• Usually single-chamber devices for the right ventricle.
• Newer models offer dual-chamber pacing for both the right atrium and ventricle.

Why Is a Pacemaker Important?

A pacemaker plays a crucial role in improving the quality of life for individuals with heart rhythm issues. The device ensures that the heart's electrical system functions efficiently, preventing complications such as heart failure, stroke, or sudden cardiac arrest. In many cases, pacemakers help prevent the need for more invasive procedures, offering a safer and less risky treatment option for patients.

FAQs

1. Can I feel the pacemaker working?

No, you typically will not feel the pacemaker working. However, some people might notice a slight flutter or sensation initially, which usually subsides over time.

2. How long does a pacemaker last?

Most pacemakers last between 5 to 15 years, depending on the type. Regular check-ups with a heart specialist will determine when the pacemaker’s battery needs to be replaced.

3. Are there any lifestyle changes required after getting a pacemaker?

After getting a pacemaker, patients are usually advised to avoid heavy lifting or vigorous physical activity for a few weeks. However, most people can return to normal activities after a brief recovery period.

4. Can a pacemaker be removed?

In some cases, a pacemaker may be removed if it is no longer needed or if complications arise. This is usually a rare situation, and decisions regarding removal are made on a case-by-case basis with the heart specialist.

Book an Appointment at Pantai Hospitals

A pacemaker can greatly improve your quality of life if you are dealing with heart rhythm issues. If you or a loved one are experiencing symptoms such as dizziness, fainting, fatigue, or irregular heartbeats, it is important to consult with a heart specialist promptly.

If you have concerns about your heart health or are considering a pacemaker, contact us to schedule an appointment at your nearest Pantai Hospitals. The expert cardiology team is here to provide personalised advice and guidance on pacemaker treatment. To book an appointment or schedule a consultation, please reach out to the cardiology department at your nearest Pantai Hospitals.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.