Sometimes, you might come across the term pacemaker and wonder what it is. How does it work, and where is it indicated? This article will answer some of these queries and give valuable advice about its care and safety.
A pacemaker is a small electronic medical device implanted in the chest (just under the collarbone) or abdomen to help regulate abnormal heart rhythms (arrhythmias), especially when heartbeats become very slow (bradycardia). It sends electrical impulses to stimulate the heart to beat at a normal rate and rhythm.
What is the indication of a Pacemaker?
A pacemaker is primarily required when there is a symptomatic conduction system disorder. Our heart has an electrical conduction system, which generates and propagates our heartbeats throughout our lifetimes. Sometimes, this conduction system develops electrical abnormalities, causing very slow or irregular heartbeats, leading to symptoms like fainting, dizziness, light-headedness, or even sudden cardiac death.
Common indications are:
- Symptomatic bradycardia
- Sick sinus syndrome
- Complete heart block (third-degree AV block)
- High-grade AV block
- Chronotropic incompetence (inability to increase heart rate with activity)
- Heart failure (e.g., cardiac resynchronisation therapy)
Types of Pacemaker
There are different types of pacemakers. The most common types are:
- Single-chamber Pacemaker: These pacemakers have only one lead, which stimulates either the right atrium or right ventricle.
- Dual-chamber Pacemaker: They have two leads, that stimulate both the right atrium and right ventricle.
- Bi-ventricular Pacemaker (CRT: cardiac resynchronisation therapy): Stimulates both ventricles simultaneously. Used in heart failure patients with wide QRS (e.g., LBBB) and low ejection fraction.
- ICD (implantable cardioverter defibrillator): It monitors for life-threatening irregular heartbeats (arrhythmias) and can deliver electrical shocks to prevent sudden cardiac death.
Some pacemakers are MRI compatible, and some are not. It means an MRI-compatible device is designed and tested to be safe for use in the magnetic field of an MRI scanner under specific conditions. In contrast, older or non-MRI-compatible pacemakers can be affected or damaged by MRI scans
The pacemaker’s battery life is definite. It usually lasts 7-10 years, after which it should be replaced.
Benefits of a Pacemaker
- Prevention of sudden cardiac death in high-grade AV blocks
- Relief from symptoms like fatigue, dizziness, syncope (fainting), or palpitations. Improved quality of life and exercise tolerance.
- In some heart failure patients, improved cardiac output and reduced hospitalisation (via biventricular pacing or CRT)
Precautions After Pacemaker Implantation
Immediate Post-op:
- Avoid heavy lifting and overhead arm movements on the implant side for 4–6 weeks
- Keep the incision clean and dry
- Monitor for signs of infection (fever, redness, swelling)
Long-term:
- Keep mobile phones at least 6 inches away from the device
- Avoid strong magnetic/electromagnetic fields (e.g., MRI unless device is MRI-compatible, industrial welders). Inform airport security about your pacemaker (carry ID card)
- Maintaining regular pacemaker checkups is essential. Every 6 months, an ECG with a Magnet should be done to check the pacemaker function and battery status.
A pacemaker is a life-enhancing device for people with certain heart rhythm disorders, but it requires careful post-surgical care and awareness of potential complications and device interactions.
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