Pacemakers electrically stimulate your heart to make it contract and produce a heartbeat. They differ from implantable cardioverter defibrillators (ICD) in that they do not have the ability to give your heart an electric shock. Pacemakers can be helpful if you have problems with the electrical activity in your heart which causes it to beat too slowly. Pacemakers can either work only when they are needed (‘on-demand’), or they can send out electrical impulses all of the time. However they are usually programmed to start producing heart beats only if needed, when your heart rate drops below a certain rate.
Most pacemakers are smaller than a matchbox. Like ICDs, pacemakers are implanted under the skin below the collar bone, usually on the left hand side. They can have one, two or three leads that go to the heart. When you have your pacemaker fitted, you will have a local anaesthetic around the region of your collar bone so you will not feel any pain. You may also be sedated if you wish, which will make you feel very relaxed and sleepy and may mean that after the procedure you remember very little or nothing about it. However giving sedation will also mean that you will need someone to stay with you overnight if you go home the same day.
Some people who have pacemakers fitted stay the night in hospital afterwards. You will not be allowed to drive for at least one week after your pacemaker is fitted. If you drive, it is very important that you inform the DVLA (Driver and Vehicle Licensing Agency) that you have a pacemaker (which it is legally your responsibility to do). You will also have to be very careful with movement of your arm and upper body on the side the pacemaker is fitted for the first 2 weeks or so, to stop the box and/or the leads moving out of position whilst they are still settling in.
You pacemaker will have a code which describes what it does. Most pacemakers have three letters, but some may have up to five:
Letter 1: indicates the chamber of the heart that is paced(A=atria, V=ventricles, D=dual-chamber)
Letter 2: indicates the chamber that is sensed by the pacemaker (A=atria, V=ventricles, D=dual-chamber, 0 = none).
Letter 3: indicates the response to a sensed event (T = triggered, I = inhibited, D = dual – T and I, R =reverse).
Letter 4: indicates an activity sensor. This detects bodily movement, temperature and other parameters, and increases the pacing rate accordingly – for example for those who need the pacemaker all the time, when they exercise.
Letter 5: an anti-tachycardia feature – this is really only relevant if you have an ICD or biventricular ICD.
If your pacemaker has one lead, it will be called a single chamber pacemaker. If your pacemaker has two leads, it will be called a dual chamber pacemaker. If it has three leads, it will be called a biventricular pacemaker. Sometimes, biventricular pacemakers can be combined with ICDS – ‘biventricular ICDs.’
After your pacemaker is fitted, you should avoid sport and strenuous activity for 3 to 4 weeks. If after this time you play contact sports, it is important to avoid damaging the pacemaker.
You should always tell any doctor or dentist treating you that you have a pacemaker. Before you leave hospital, you will usually be given a card that indicates the type of pacemaker you have fitted, which you should carry around with you everywhere (e.g. somewhere visible in your wallet). If you are not given one, ask for it!
You should use your mobile phone on the opposite side of the body from your pacemaker. Do not put your phone in a pocket near the pacemaker, as it may interfere with it.
Antitheft systems in shops and airport security equipment may sometimes cause problems, and there is a chance that the pacemaker may make the alarms go off. There are some situations at work (for example if your job involves working with or near arc welding or if you work with powerful magnets) that might interfere with your pacemaker, and in some cases you will not be allowed to operate certain equipment (mainly arc welding / powerful magnet related devices) at all after your pacemaker is fitted.
Remember – it is important that you always carry your pacemaker card with you to let people know that you have a pacemaker fitted! Please click here more information on alerting people to your diagnosis in an emergency.