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Keeping the beat: Pacemaker implantation

» How can a muscle be so smart?

» How they work

» The procedure in brief

» Before you go home

» Adjusting to the pace

Dodging interference

Pacemaker wearers should avoid the following, which can interfere with the device’s function:

  • strong electromagnetic fields such as those found near a high-voltage transmission line or substation, magnetic resonance imager or arc welder
  • contact sports
  • shooting a shotgun or rifle from the shoulder where the pacemaker is located
  • leaving an activated cell phone in a shirt or jacket pocket near the site of the pacemaker

When you take your dog for a brisk walk or challenge your opponent to a game of tennis, your heart speeds up to keep pace. Yet as you relax with a game of gin rummy, your heart “rests,” slowing the number of beats per minute.

How can a muscle be so smart?

Your heart has its own electrical system controlled by a group of cells called the sinus node. Also known as the heart’s natural pacemaker, the sinus node emits the electrical signals that cause your heart to beat.

But if your natural pacemaker becomes defective, proper communication is lost, causing your heart to beat too slowly, too quickly or irregularly. In many cases, medication may be enough to correct the problem. But when it’s not, a small battery-operated device known as an artificial pacemaker can take the place of your heart’s natural one.

How they work

Pacemakers emit tiny electrical impulses that sense your heartbeat and respond as needed. The instant your heart rhythm slows abnormally or stops, the device stimulates your heart to contract. Once your heart resumes beating at a regular pace, the pacemaker automatically goes on standby until needed again.

In the past, pacemakers regulated the heart at one single rate. But today’s rate-adaptive pacemakers react to your activity level and adjust the heart’s pace accordingly.

The procedure in brief

Pacemaker implantation usually is an overnight procedure performed under local anesthesia. With the help of a special X-ray machine, your doctor will guide the pacemaker’s lead wires into a large vein beneath your collarbone and thread them into the right side of your heart. Then tests are done to make sure the wires are in the best position to help your specific condition. When the placement is satisfactory, the wires are attached to a pulse generator, which is then placed in a small “pocket” of skin and fat just under the chest wall. Your doctor will program the pulse generator to meet your heart’s pacing needs.

Before you go home

Your nurse or doctor will talk to you about your pacemaker and show you how to check your pulse and care for your incision. Your healthcare team may recommend a specific diet or prescribe medication to complement the pacemaker’s activity. This is a good time to ask about an exercise program and pose any other questions you may have. Once you’re accustomed to your pacemaker, you’ll find that you can enjoy just about all your usual hobbies.

Adjusting to the pace

For several weeks after implantation, you should avoid driving; performing vigorous above-the-shoulder activities such as swimming, golf, tennis and bowling; and lifting anything heavier than 15 pounds. These activities may destabilize the pacemaker while it is still in the process of securely attaching itself to your heart’s wall.

Because pacemakers are battery-driven, they eventually wear out. Depending on your type of pacemaker, the batteries will last five to 15 years. You’ll be able to check the pacemaker’s battery status and function by using a special telephone system that lets you transmit an electrocardiogram to your hospital’s central monitoring office every two or three months.

© 2014 Dowden Health Media