Understanding Pacemaker Implantation: Types, Procedure, and Success Rate

15 April,2024

Pacemaker implantation is a standard medical procedure for treating individuals with abnormal heart rhythms or arrhythmias. Studies reveal over 60% of sudden cardiac arrests are due to irregular heartbeats.

Pacemakers can prevent 1 to 2 million annual deaths worldwide. The procedure involves placing a small device into the chest to help regulate and stabilize the heart's electrical signals. 

Understanding the different aspects of pacemaker implantation can be crucial for patients and their healthcare providers. This blog aims to shed light on what a pacemaker is, how it works, the benefits of pacemaker implantation, and the risks associated with it.

What is a Pacemaker?

Pacemakers are small, lightweight devices implanted under the skin near the collarbone. They send electrical impulses to the heart to help maintain a regular heart rate. It weighs about 20 to 50 grams and is the size of a matchbox (or even smaller)!

Pacemaker consists of two parts.

• Pulse generator: This device contains the battery and the computer circuit and emits electrical impulses.
• Leads are thin wires that deliver the generated electrical impulse to the heart muscles.

Cardiologists can program pacemakers according to the patient's needs. If the heart skips a beat or beats slowly, the pacemaker can identify it and steadily send electrical signals. If the heart beats normally, the pacemaker won't send any signals.

What are the Different Types of Pacemakers?

Several types of pacemakers are available, each designed to cater to specific needs. The three main types are –

• Single-chamber pacemakers are used when only one chamber of the heart needs pacing. They use one lead, usually placed in the lower right chamber of the heart (right ventricle).
• Dual-chamber pacemakers are used when both chambers require pacing. They have one lead in the right atrium and one in the right ventricle.
• A biventricular pacemaker, or CRT - cardiac resynchronization therapy, is used for individuals with heart failure. It uses three leads placed in the right ventricle, right atrium, and left ventricle.

Pacemakers also vary in their features and capabilities. Some pacemakers have programmable settings to adjust the pacing rate according to a person's needs. In contrast, others have advanced sensors that can detect changes in a person's activity level to optimize heart rate response. 

In addition to the main types mentioned, leadless pacemakers are implanted directly into the heart without the need for leads. These devices are smaller in size and reduce the risk of lead-related complications. Leadless pacemakers are particularly beneficial for patients at a higher risk of infection or with limited vascular access to traditional pacemaker placement.

What Conditions Do Pacemakers Treat?

Diseases and disorders that cause abnormal heart rhythms lead to improper blood supply to the body. It is due to the inadequate amount of blood pumped by the heart. Pacemaker implantations help in rectifying such diseases. Some common heart conditions treatable by pacemaker include –

• Bradycardia: Bradycardia, characterized by a heart rate lower than 60 beats per minute, can lead to symptoms such as dizziness, fatigue, and fainting. In severe and symptomatic cases, a pacemaker can help regulate the heart rate and improve the patient's quality of life. 
• Tachycardia: Tachycardia, on the other hand, is defined by a heart rate surpassing 100 beats per minute and can result in palpitations, chest pain, and shortness of breath. Pacemakers with additional defibrillator functions may be used to treat certain types of tachycardia that pose a risk of sudden cardiac arrest.
• Atrioventricular block: Atrioventricular block disrupts the electrical signals between the heart's upper and lower chambers, causing symptoms like fatigue, light-headedness, and even syncope. In such cases, a pacemaker can help restore the coordination of heart contractions and ensure adequate blood flow to the body. 
• Sick sinus syndrome: Sick sinus syndrome involves an irregular heartbeat due to dysfunction of the sinus node, leading to symptoms such as dizziness, chest pain, and confusion. Pacemakers can effectively manage this condition by providing the necessary pacing support to maintain a stable heart rhythm.

Who Needs Pacemaker?

Whether a patient needs a pacemaker is based on thoroughly evaluating their medical history, symptoms, and diagnostic test results. Pacemaker implantation is indicated for individuals with certain heart conditions or abnormal heart rhythms. These include –

• Bradycardia (slow heart rate)
• Tachycardia (fast heart rate)
• Atrioventricular block (impaired conduction between the atria and ventricles)
• Sick sinus syndrome (impaired sinus node function)

Additionally, doctors may recommend pacemakers for individuals at risk of sudden cardiac arrest or for those who have undergone heart surgery and require temporary pacing support during the recovery period. 

Common symptoms that can warrant the need for pacemaker implantation are –

• Chest pain (angina)
• Irregular heartbeat (arrhythmias)
• Heart palpitations
• Shortness of breath
• Unexplained dizziness, nausea, light-headedness, confusion, fainting
• Swelling in legs or ankles

Please note that these symptoms can also indicate other disorders requiring different treatments. Consulting a skilled cardiologist is vital to establishing whether you are the right candidate for pacemaker implantation.

What is the Success Rate of Pacemaker Implantation?

• Pacemaker implantation has a high success rate and is considered safe. The success of the implantation depends on factors such as the surgeon's experience, the patient's overall health, and adherence to post-operative care instructions. 
• The overall success rate of pacemaker implantation is 90-95%. The rate of complications is low, ranging about 2-3%.
• The procedure itself is performed under local anesthesia, and most patients can go home on the same day or the day after the surgery.
• Pacemakers have been used for decades and have significantly evolved. Modern-day pacemakers have a battery life of 10-15 years.
• Technological advancements have led to the development of wireless remote monitoring systems for pacemakers. These systems allow healthcare providers to remotely check the device's function and the patient's heart rhythm.

What to Expect Before a Pacemaker Implantation?

• Patients scheduled for pacemaker surgery will have a pre-operative consultation with their cardiologist or electrophysiologist. During this consultation, the healthcare provider will explain the particulars of the procedure, including the risks and benefits. 
• Before pacemaker implantation, patients undergo tests and evaluations to ensure suitability. These may include an electrocardiogram (ECG), echocardiogram, and blood tests. 
• Patients must inform their healthcare team about any medications, allergies, or medical conditions they have, as these may affect the surgery or post-operative care.
• Patients must avoid eating or drinking for a few hours before the surgery. 
• A cardiac surgeon may also ask patients to temporarily stop certain medications that could hamper the surgery or the pacemaker's function. 
• To ensure a successful procedure, following all the pre-operative instructions the healthcare team provides is essential.
• Furthermore, Patients are encouraged to ask questions and address concerns to feel more confident and prepared for the surgery.
• In addition to the medical preparations, patients undergoing pacemaker surgery should make practical post-operative care arrangements. 
  • It may involve arranging for someone to drive them home after the procedure, as they may be unable to drive themselves. 
  • Patients should also ensure a comfortable and supportive recovery environment at home, with necessary items within reach to aid recovery.

What Happens During Pacemaker Implantation?

• The procedure begins by numbing the area where the pacemaker will be implanted, usually near the collarbone. 
• The surgeon then makes a minor incision to create a pocket under the skin where the pacemaker generator will be placed. 
• Next, the leads or wires that carry the electrical signals to the heart will be carefully inserted into suitable positions within the heart, guided by imaging techniques.
• Once the leads are in place, they will be connected to the pacemaker generator, secured in the pocket created earlier. 
• The surgeon finally closes the incision with stitches or surgical adhesive. 
• The entire procedure generally takes one to two hours, depending on the case's complexity. 
• Patients will be monitored after the surgery to ensure the pacemaker functions correctly before discharge.

What Happens After Pacemaker Implantation?

After pacemaker implantation, patients receive comprehensive post-operative care instructions from their healthcare providers. Following these guidelines is essential to promoting proper healing and optimizing the pacemaker's functioning.

• Once the surgery is over, a nurse will take you to the monitoring room, where your vitals, such as heart rate, blood pressure, and breathing, will be monitored.
• Once you are awake, you will able to eat and drink.
• The doctor will prescribe a few pain medications to manage the pain and soreness at the insertion site.
• You could be discharged on the same day or asked to stay at the hospital for one day, depending upon your stability.
• In the first few weeks after surgery, patients should avoid activities that involve extensive use of the arm on the side of the pacemaker implantation. It is to allow the leads to attach to the heart tissue properly. 
• During this initial recovery period, the doctor advises patients to avoid vigorous exercise or lifting heavy objects.
• Routine follow-up appointments with the healthcare team are crucial for monitoring the pacemaker's function and making necessary adjustments. 
• The pacemaker battery will eventually need to be replaced, typically every 10 to 12 years, depending on usage and battery life. Patients should be aware of this and consult their healthcare provider when needed.

What are the Risks and Benefits of Pacemaker Implantation?

Pacemakers help improve patients' quality of life and prevent complications arising from heart rhythm problems. Benefits of pacemaker implantation include – 

• Alleviates symptoms such as chest pain, confusion, palpitations, nausea, etc.
• Prevents symptoms such as fainting and dizziness caused by arrhythmias
• Lesser shortness of breath
• More energy
• Slow the progression of heart disease

However, pacemaker implantation has potential risks and complications like any medical procedure. These can include –

• Infection
• Bleeding
• Allergic reactions
• Blood clots
• Damage to the heart or blood vessels
• Pneumothorax (collapsed lung)

Precautions to Take After Pacemaker Implantation

If you have a pacemaker, you may wonder how to use everyday devices safely. As discussed earlier, pacemaker implantation is a safe procedure. However, you must take a few precautions since it is a battery-operated device. Here are some tips to help you avoid any problems:

• Mobile phones: When using your mobile phone, hold it to the ear opposite the side of your pacemaker. Keep your phone at least 6 inches from your pacemaker, and avoid keeping it in a shirt pocket.
• Security systems: It's safe to pass through an airport metal detector with a pacemaker, but the metal in the device may trigger the alarm. To avoid this, spend less time near metal-detection systems, and carry an ID card that indicates you have a pacemaker.
• Medical equipment: Let your healthcare team know that you have a pacemaker. Some tests and treatments, such as MRI or CT scans, radiation therapy for cancer, and sound wave therapy to break up large gallstones or kidney stones, may interfere with the device.
• Power-generating equipment: If you work around welding equipment, high-voltage transformers, or motor-generator systems, stay at least 2 feet away. Ask your healthcare team if a safety test can be performed at your workplace to check whether the equipment affects your pacemaker.

To Conclude

In conclusion, understanding pacemaker implantation is crucial for individuals with certain heart conditions or abnormal heart rhythms. Knowing the types of pacemakers available, the indications for implantation, the success rates, and the procedure itself can help patients make informed decisions about their healthcare. Ongoing advancements in pacemaker technology also promise improved treatment options in the future. Consultation with healthcare providers is essential to address specific concerns and ensure the best possible outcomes for pacemaker patients.