Heart Rate Problems: Should I Get a Pacemaker?

Pacemakers are small electrical devices that help control the timing of your heartbeat. The pacemaker sends out mild electrical pulses that keep your heart beating normally.

Most pacemakers are implanted under the skin of your chest wall. These pacemakers have wires that pass through a vein into the chambers of your heart. Some pacemakers are placed inside the heart and do not have wires.

There are different types of pacemakers, so your doctor will work with you to decide what kind will be best for you.

A pacemaker can help restore a normal heart rate when certain problems have damaged the heart's electrical system, which normally keeps your heart beating steadily. These problems include:

• Changes in the heart that are the result of aging.
• Coronary artery disease.
• Heart attack.
• Heart block (such as an AV block), which is an abnormality in the way electricity passes through the heart's normal electrical pathways.

Pacemakers allow people to return to normal, active lives. Most people have very few limitations, if any.

Most pacemakers are surgically implanted under the skin of the chest.

The procedure to implant a pacemaker is considered minor surgery. It can usually be done using local anesthesia. Your doctor will make a small incision in your chest wall just below your collarbone. The doctor puts the leads in a vein and threads them to the heart. Then your doctor connects the leads to the pacemaker. Your doctor programs the pacemaker and then puts it in your chest and closes the incision. You may be able to see a little bump under the skin where the pacemaker is placed.

Some pacemakers don't have leads that connect to the heart. These leadless pacemakers are placed directly inside the heart.

To implant a leadless pacemaker, the doctor uses a thin tube called a catheter. The pacemaker is placed inside the catheter. He or she puts the catheter into a blood vessel in your groin. You will get a shot to numb the skin where the catheter goes in. Then the doctor moves the catheter through the blood vessel to a lower chamber of your heart. The doctor moves the pacemaker out of the catheter. He or she attaches the pacemaker to the heart tissue. Then the catheter is removed from your body.

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery. But sometimes the procedure is done as an outpatient procedure, which means you don't need to stay overnight in the hospital.

There are several risks to getting a pacemaker. But risks vary for each person. And risks vary based on the type of pacemaker you get. The chance of most problems is low.

The procedure to implant a pacemaker is safe, and most people do well afterward. Afterward, you will see your doctor regularly to get your pacemaker checked and to make sure you don't have any problems.

During the procedure. If problems happen during the procedure, doctors likely can fix them right away. Examples include:

• A lung could collapse (pneumothorax). This happens if air builds up in the space between the lung and the chest wall. But a pneumothorax can be treated and people recover well. This problem may happen about 1 to 5 times out of a 100.^{footnote 1}
• A tear in the heart could happen. Or a person might need emergency medicine or surgery. Based on rates of complications from patients, these problems happen about 1 time out of 100. So about 99 times out of 100, these problems do not happen.^{footnote 2}

After the procedure. Problems after the procedure can be minor, like mild pain, or serious, like an infection. But your doctor can solve most of these problems. And most people do not have long-term issues with their pacemakers.

Problems include:

• Pain, bleeding, or bruising soon after the procedure.
• Blood clots in your arms, which cause a lot of swelling.
• Infection in your chest near the pacemaker. An infection might happen about 1 time out of 100. This means that about 99 times out of 100 there is no infection.^{footnote 3}
• Device problems that need another procedure to fix them. For example, this might happen if a pacemaker lead breaks or a lead moves out of place.

Daily precautions. You'll need to use certain electric devices with caution. Some electric devices have a strong electromagnetic field. This field can keep your pacemaker from working right for a short time. Check with your doctor about what you need to avoid and what you need to keep a short distance away from your pacemaker. Many household and office electronics do not affect your pacemaker.

Your doctor might recommend that you get a pacemaker if:

• You have a problem with your heart rate that could be helped by a pacemaker.
• You have trouble doing everyday activities, or you can't do them at all.