Pacemaker Technology and Insertion

Dr. Paul Khairy, MD, FRCP, Cardiologist, talks about how pacemakers work and how they are implanted to treat patients with irregular heart rates.

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Dr. Paul Khairy, MD, FRCP, Cardiologist, talks about how pacemakers work and how they are implanted to treat patients with irregular heart rates.
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Video transcript

Featuring Dr. Paul Khairy, MD, FRCP, Cardiologist

Duration: 6 minutes, 35 seconds

A pacemaker is a sophisticated medical device that is typically implanted under the skin in the chest or abdomen to manage a slow heart rate. The pacemaker system consists of two main components. The first is the pacemaker generator, the pulse generator. It houses the battery and the electronics that are required to analyze information and control the impulses that are sent to the heart to manage the heart rate.

The second component consists of one or more or these electrical wires that we call pacemaker leads, and these wires are connected to the pulse generator, and they carry electrical impulses to and from the heart. Some patients require one, two or three pacemaker leads depending on the clinical situation. Some patients need a pacemaker to replace the normal electrical conduction system of the heart that is not functioning properly.

When the heart beats too slowly or there are excessive pauses, it can give rise to symptoms such as fatigue, shortness of breath or dizziness. More serious symptoms include a loss of consciousness, injury and occasionally sudden death. Now some patients with electrical conduction problems that also have heart failure require a special type of pacemaker that allows the two sides of the heart to beat in sync – a biventricular pacemaker. So this allows the two sides of the heart to beat in a more coordinated and efficient manner.

Pacemakers are typically implanted in a specialized operating room for arrhythmias. An entire team is present to ensure that the person is comfortable and well-sedated during the intervention, and a local anesthetic is injected at the surgical site to numb the area. Typically a three- to four-centimetre incision is made in the pectoral region, and then a small pocket is created under the skin to house the pulse generator. And then one or more of the pacemaker leads are then inserted through a vein near the collarbone and into the heart. The leads are then connected to the pulse generator, which is placed in the surgical pocket that was created, and the surgical incision is closed with absorbable sutures.

Pacemaker surgeries are considered a low-risk intervention. Nevertheless, as with any intervention complications can occur. The overall rate of complications is less than three percent. This includes allergic reactions to anesthesia, to antibiotics, bleeding at the surgical site, a collapsed lung due to a needle puncture when inserting the pacemaker leads, a punctured heart and infections that could occur weeks after the procedure.

After pacemaker surgery, patients typically will leave the hospital the day after. And then over the next month or so they should avoid vigorous exercises, especially those involving the arms, as well as heavy lifting – so no more than five to ten kilograms. Now after patients have fully recovered from the surgery they could resume their normal activities, with few restrictions such as avoiding full contact sports.

Now modern pacemakers are much less sensitive to electromagnetic interference than older models, but nevertheless electromagnetic interference can occur. Home appliances are not generally problematic, with the exception of induction cooktops that could interfere with certain types of pacemakers.

From a work perspective, patients should avoid industrial welding and exposure to high intensity electromagnetic fields. So if the person has a concern about potential electromagnetic interference in the workplace, it should be discussed with the medical team. Sometimes a more detailed evaluation is required to ensure safety.

After the pacemaker is implanted, patients will be given an appointment four to eight weeks later at a specialized pacemaker clinic. There we check the incision site to ensure that it looks good, and we verify all the components of the pacemaker to ensure that it is functioning properly. Patients will be relieved to know that we do not need to open up the surgical site to take out a pacemaker in order to check it. It is done using specialized programmers wirelessly, and patients do not need to undress for this procedure.

Now several different models of pacemakers have the capacity to be followed at a distance. So if a patient has this type of pacemaker and is willing, we will equip them with a small monitor free of charge that we recommend placing at the bedside. And this monitor interrogates the pacemaker at regular intervals and it sends that information to us. So it allows us to detect problems early, and it avoids the need for regular in-person visits.

One of the elements that we follow during these regular pacemaker checkups is the battery life. On average pacemaker batteries last about 10 years or more, and having these regular pacemaker checks allows us to ensure that we change the pulse generator before the battery becomes depleted. This also has the advantage of not having a pacemaker last a lifetime, because a pacemaker is a sophisticated computer, and it benefits from upgrades in technology. So changing a device every 10 years or so with the new features that are developed could actually be an advantage.

If you have any fears or anxieties or any other questions related to your pacemaker, contact your doctor, cardiologist or pacemaker clinic.

Presenter: Dr. Paul Khairy, Cardiologist, Montreal, QC

Local Practitioners: Cardiologist

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.