Pacemakers

Pacemakers use low-energy electrical pulses to control the rate and rhythm of your heartbeat. Traditional pacemakers send the electrical pulses through wires, also known as leads. Wireless pacemakers are a newer kind of pacemaker without wires.

Learn more about your heart’s electrical system in our How the Heart Works Health Topic.

Traditional transvenous pacemakers

Traditional pacemakers (also called transvenous pacemakers) have three main parts.

• A pulse generator creates the electrical pulses.
• Wires (also called leads) are implanted inside the veins and carry the pulses to your heart.
• Electrodes sense your natural heartbeat. When your heartbeat is slower than normal, the electrodes deliver electrical impulses to your heart to make it beat normally.

The device can send data to your doctor remotely. Your doctor will use these recordings to set up your pacemaker so it works better for you.

A traditional pacemaker generator is placed outside of your heart, either in your chest or abdomen. It is connected via wires to electrodes inside one to three heart chambers.

Single- and double-lead pacemakers send pulses to the right side of the heart. A biventricular pacemaker sends pulses to both ventricles and an atrium. The pulses help coordinate electrical signaling between the two ventricles to help your heart pump blood. This type of pacemaker is also called a cardiac resynchronization therapy (CRT) device.

Wireless pacemakers

Wireless, or leadless, pacemakers are smaller than traditional types (about the size of a large pill capsule). The pulse generator and electrodes are all in one device that is placed inside a chamber of your heart through a small tube inserted in one of your veins. No surgery is needed. Once in place, the pacemaker then sends pulses to the right ventricle.

Your doctor may recommend a wireless pacemaker if you have a slow heartbeat, or if you have an electrical block, which is when the flow of electricity to the heart is delayed between the upper and lower chambers of your heart. Depending on the type, this kind of pacemaker may sense the right atrium (upper chamber), which allows it to match the signals that it sends to the ventricle. This helps the two chambers beat in sync.

Other types

In another type of pacemaker, the electrodes are placed on the surface of your heart rather than inside your heart. This type of pacemaker requires surgery.

Learn more about the different types of pacemakers in How Is a Pacemaker Placed?

Doctors also treat life threatening arrhythmias with a similar device called an implantable cardioverter defibrillator (ICD). The device constantly tracks your heart rate. If your heart shows an irregular and very fast rhythm, the ICD delivers an electric shock to reset your heart rhythm to prevent sudden cardiac arrest. Visit our Defibrillators Health Topic to learn more.

Pacemakers are used to treat certain types of arrhythmias, as well as heart failure, a condition that occurs when the heart cannot pump enough blood to the body. Not everyone with an arrhythmia needs a pacemaker.

Pacemaker for arrhythmias

The most common reason people get a pacemaker is their heart beats too slowly (called bradycardia), or it pauses, causing fainting spells or other symptoms. In some cases, the pacemaker may also be used to prevent or treat a heartbeat that is too fast (tachycardia) or irregular. These problems may be caused by:

• Problems with electrical signaling in your heart. Learn more in our Conduction Disorder Health Topic.
• Beta blockers, which are medicines to lower blood pressure but also can slow your heartbeat too much. A pacemaker helps prevent a slow heartbeat when you need to keep taking this medicine.
• Certain congenital heart defects
• Heart attack
• Heart transplant

Pacemakers for a weak heart

Pacemakers may also be used to help your heart chambers beat in sync if your heart isn’t pumping enough blood to your body. This can happen because of:

• Certain congenital heart defects
• Enlarged or thick heart muscle that makes it harder to pump blood out of your ventricles. Learn more in the Cardiomyopathy Health Topic.
• Heart attack
• Heart failure

The procedure may be planned ahead of time, or it may be done during an emergency (temporary pacemaker). You will be given medicine to make parts of your body numb or make you sleep during the procedure.

You may receive antibiotics to prevent infection and blood thinning medicine to prevent blood clots during the procedure. Different types of pacemakers require different procedures to place them.

Wired transvenous pacemakers

Many traditional, and all temporary, pacemakers are transvenous pacemakers, meaning the wires and electrodes are threaded through your veins. A doctor will thread the electrodes and wires through the veins in your neck, chest, or thigh, to the chambers of your heart. The electrodes are put in your heart muscle. The doctor may use echocardiography or X-ray to guide the process.

Once the wires are in place, your doctor will make a small cut into the skin of your chest or abdomen. He or she will slip the device with the generator just under the skin, then connect it to the wires that lead to your heart. Your doctor will test to see if it the device works properly and then sew the cut up. The entire surgery may take up to a few hours. Watch the video below to learn more.

This animation shows how a wired transvenous pacemaker is placed. Medical Animation Copyright © 2020 Nucleus Medical Media, All rights reserved.

You probably will not be allowed to move your arm for at least 12 hours after the procedure. This will help prevent disturbing the lead and the device and let your chest heal.

Epicardial pacemakers

With epicardial pacemakers, the electrodes are attached to the surface of the heart rather than inside its chambers. This is a surgical procedure done under general anesthesia. Your doctor will make a cut below your ribs or armpit to place the pacemaker. Epicardial pacemakers are used as a standard precaution during heart surgery.

They may also be used:

• When a vein is blocked by a blood clot or plaque
• When it would be difficult to insert the wires inside your heart chamber because of the structure of your heart or veins
• When they are needed by newborns or children, who are the most common users
• If you have a heart infection

Wireless pacemakers

Wireless pacemakers are a newer type of pacemaker. The pulse generator and electrodes are all in one small device that is placed inside the heart.

A doctor will thread a tube (called a catheter) through a vein in your thigh up to your heart. The catheter moves the pacemaker using X-ray images to place it in a heart chamber.

The procedure often takes less than an hour, and you may be able to leave the hospital the same day. Typically, the recovery time is faster and the risk of infection is lower. The battery life of the device is between 8 and 13 years.

After getting a permanent pacemaker, you will recover in the hospital for a few hours or overnight. Your healthcare team will tell you about any precautions or problems to watch out for during your recovery. You will receive a card with information about the device and its settings, your doctor, and the hospital where you got it. Be sure to carry this card with you at all times.

Recovery at the hospital

If you have a permanent pacemaker, you may have to stay in the hospital overnight so your healthcare team can check your heartbeat and make sure your device is working well. Your healthcare team may help you get up and walk around.

The day after the procedure, you may get an X-ray to check that the pacemaker and wires stay in place. Your team may also suggest an electrocardiogram to look at your heart rhythm. They will check to make sure the device is programmed correctly for you before you leave. They may also make sure the device can send data remotely.

Recovery at home

Your doctor will give you instructions to follow as you heal at home, such as: 

• What medicines to take
• When to return to normal activities. Your doctor will probably ask you to avoid driving or heavy lifting for at least a week. Most people return to other daily activities within a few days of having surgery.
• How to prevent wires from moving. Your doctor may ask you to use caution or avoid heavy lifting, intense physical activity, or lifting your arms above your head. These activities could shift the device or a wire out of place.
• When to make a follow-up appointment. Typically, the first appointment is one month after implant, with follow-up visits every 6 to 12 months.

Possible complications from a pacemaker

The procedure to place a pacemaker is generally safe. However, complications can happen from the procedure or the pacemaker itself. Talk with your doctor about the benefits and risks of a pacemaker. Complications may include:

• Allergic reaction to the device or medicines used during the procedure
• Blood clots that block blood flow. Your doctor may give you blood thinners to reduce this risk.
• Device problems. The device may stimulate muscles other than the heart. Sometimes wires break, stop working, or get knocked out of place. Displaced wires can block a blood vessel or heart valve or poke through the heart muscle. Wireless pacemakers can also move out of place.
• Heart problems. Some people may develop arrhythmia, heart attack, or other heart problems after surgery or the device placement.
• Infection around the pacemaker wires or device. The infection may spread, causing problems in other parts of the body. Call your doctor right away if you develop a fever in the days and weeks after the procedure.
• Pacemaker syndrome, which is when the pacemaker stimulates only one ventricle. The upper and lower chambers don’t beat in rhythm and blood flows in the wrong direction. Symptoms include fatigue (extreme tiredness), difficulty breathing, and low blood pressure.
• Tissue scarring. Over time, tissue around the device can scar and stiffen, or tissue can grow around the wires or device. This can make it harder for your heart to work.
• Trapped fluid or air around the lungs, known as pleural disorder or possible pneumothorax, or fluid that collects around the heart, called pericarditis.

A pacemaker can improve daily life for many people. Once you have a pacemaker, you will need regular doctor visits to check your health condition and the pacemaker. Carry your pacemaker ID card with you for emergencies. Show it to airport security, new doctors, or other people who need to know about your device. The card should have information on the type of pacemaker and leads you have, when you got the pacemaker, and your doctor’s contact information.

Get your pacemaker checked

You may need to visit your doctor several times a year to check your pacemaker. In between visits, your doctor may be able to check that the battery and wires are still working.

You may also need to come in if your doctor needs to reprogram the pacemaker. You can check with your doctor regularly about device software updates and upgrades.

Avoid devices that interfere with pacemakers

If you have a pacemaker, avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields. These devices can disrupt the electrical signaling of your pacemaker and stop it from working properly. You may not be able to tell when this happens.

To be safe, keep your pacemaker at least 6 inches away from such devices or only use them briefly, when needed.

• Cell phones. Use your speaker phone setting or hold the cell phone to the ear on the opposite side of your body. For example, if you have an ICD on the left side of your chest, hold your cell phone to your right ear. Avoid putting your cell phone in your shirt pocket.
• Electronic cigarettes
• Headphones. Most headphones have a magnet in them. Wear them as far away from your ICD as possible. Do not carry your headphones in a chest pocket.
• Household appliances, such as microwave ovens, major appliances, electric blankets, and heating pads are usually safe if they are working properly.
• Metal detectors, such as those used for airport security. The risk of harm is low, but your device may set off the metal detector. Body scanners used at airports appear to be safe for people with pacemakers, but you can show your ID card and ask for a separate screening.

If something disrupts your pacemaker, step away from whatever is disturbing it to help your pacemaker return to normal. Talk to your doctor right away about what else to avoid, as any kind of powerful electrical or industrial equipment can interfere with your pacemaker. This includes welding machines or electric fences for pets.

Medical and dental procedures that can affect your pacemaker include:

• Electrocautery used during surgery to stop blood vessels from bleeding
• Magnetic resonance imaging (MRI)
• Microwave diathermy for physical therapy
• Radiation therapy to treat cancer
• Shock-wave lithotripsy to treat kidney stones
• Transcutaneous electrical nerve stimulation (TENS) to treat pain

The effects depend on what type of device you have. Always tell your doctor or dentist that you have a pacemaker and show them the device ID card. They may be able to make certain changes if you need the procedure or test.

Learn how to manage problems with your pacemaker

It is important to pay attention to any changes or unusual patterns in your pacemaker. Call your doctor if you think there is a problem.

• Know what to do if the device stops working. Pacemakers usually last for several years, but a part or the entire device may need to be replaced. Call your doctor immediately if you think your pacemaker may not be working properly. If it’s not working, you may start feeling short of breath, dizzy, or faint.
• Know your options and rights. You have the right to request the pacemaker be turned off or removed if it is no longer beneficial. For example, you may wish to turn it off if you are seriously ill or nearing the end of life. Discuss your options and plans with your healthcare team, caregivers, and loved ones. Your doctor may have you take part in an ethics consultation first to make sure you understand the risks. Visit the National Institute on Aging’s Understanding Healthcare Decisions at the End of Life for more information.
• Software updates. Talk to your doctor about how to regularly check for software updates that make the pacemaker more secure from hacking. When you visit the doctor, ask whether the manufacturer has announced any problems with your device.
• Watch for signs of infection. Signs include fever, chills, and pain or redness where the pacemaker was placed. You may get these symptoms 6 months or more after surgery.