Pacemaker: Basic Knowledge

Pacemakers are small, battery-powered devices that are implanted near the collarbone and serve as the heart’s artificial “timekeeper”. A pacemaker system consists of a pulse generator as well as one or two special wires, called leads, that connect the heart with the pulse generator. When they sense a missed or irregular heartbeat, they can carry small electrical impulses from the device to the heart, and relay information about the heart’s rhythm back to the pulse generator. By sending those small electrical signals to the heart, a pacemaker helps to restore a normal heart rate. The device also stores information about your heart rhythm and rate that your physician can use to adjust your treatment.  

Pacemakers are usually implanted when patients experience a too slow heart rate (bradycardia) that fails to supply the body with enough blood and oxygen. With the advancements of pacemaker technology, pacemakers have gotten smaller and smaller with many years of longevity and the possibility to be monitored remotely. 

In case your physician has recommended a pacemaker to you, you will receive detailed instructions about how to prepare for the surgery. Your cardiologist may advise the following among other things: 

• To stop taking blood-thinning medication several days before surgery.

• If you take other medication regularly, ask your physician if you should continue taking the medication before your procedure. 

In addition to the information your healthcare professional will provide, we have put together frequently asked questions and a checklist that you might want to take a look at and go over with your physician.

Implanting a pacemaker is a relatively simple surgery and is not performed on an open heart. It is carried out under local anesthesia, and sometimes, short-term sedation. You will also be given antibiotics to reduce the risk of inflammation or an infection. 

After preparing the incision site, the physician will make a small cut in your upper chest, well below your shoulder. The surgeon will insert special wires, called leads, into a major vein near your collarbone. Using X-ray for visibility, the surgeon will guide the leads through your veins and place them in the heart’s upper and/or lower chambers. Then, the physician will implant the pacemaker in the “pocket” beneath the skin at the incision site. The surgeon will then connect the leads to the device and program it to meet your medical needs. After a test to ensure the pacemaker is working correctly, the physician will close the incision with a few stitches. 

Usually, you will stay in the hospital for one or two days after the implantation. Listen carefully to and follow your physician’s instructions. At home, monitor how the incision is healing. Your arm’s range of motion will probably be limited until the wound is completely healed. Please refer to our checklist of helpful things that you can do to help you recover quickly.  

From now on, you will have regular follow-up appointments where your physician checks the information your pacemaker has stored. He or she will also make necessary therapy adjustments in case they are needed. Always carry your patient identification card with you in case of a medical emergency. 

Of course, you will need some time to get used to living with a pacemaker and may have many questions regarding working, traveling or practicing sports with a pacemaker. Please also familiarize yourself with how magnetic fields can influence your pacemaker’s functionality and what to bear in mind when undergoing medical examinations such as an MRI.