What to know about variable heart rhythms and AFib
An Ohio State cardiac electrophysiologist shares what to know about heart rhythms and AFib.
A pacemaker is a surgically implanted electronic device used to prevent your heart rate from becoming too slow, a condition known as bradycardia or bradyarrhythmia. When your heart rate becomes too slow, the pacemaker will provide an unnoticeable and painless electrical impulse that will cause your heart to beat and thus keep your heart rate from dropping too low.
There are several types of pacemakers but all provide an unnoticeable electrical current that cause your heart to beat and to prevent your heart rate from going too slowly. The electrical current is delivered from the pacemaker generator through an electrical wire (lead) to your heart muscle. The most appropriate pacemaker for you will be determined by your electrophysiologist after considering your health and medications. There are three main types of pacemakers:
If you have symptoms of slow heart rate, you may need a pacemaker. These symptoms include loss of consciousness, a slow heart rate while you exercise or if your heart stops beating for several seconds. An electrical heart test, known as an electrophysiology study, may be performed to help determine if you need a pacemaker. Even if you have a slow heart rate, a pacemaker may not be the best treatment option for you.
The Ohio State University Wexner Medical Center is one of the leading medical centers in electrophysiology. Electrophysiology is a specialization of cardiology that focuses on the electrical system of the heart. Ohio State’s Ross Heart Hospital has a dedicated staff of heart rhythm experts (called electrophysiologists), nursing staff, a device management team, research scientists and pharmacists that provide a complimentary team approach to evaluating individuals who may need a pacemaker. We are the largest electrophysiology group in central Ohio and have one of the highest patient implantation experiences with devices in the U.S. Ohio State has been a leading pioneer in pacemaker technology and this experience provides additional expertise and insight for the electrophysiologists and added benefit for the care of our patients. Our electrophysiology program is the largest program in Ohio, and one of the top in the nation, with extensive experience in managing a wide spectrum of heart rhythm problems.
Before your procedure
You need to have blood work done within 14 days of your procedure. The day before and the morning of your procedure, you will need to use a special soap called CHG. It is sold by the brand name of Hex-A-Clens or Hibiclens and is available at most pharmacies. Please scrub from the neck down, avoiding your eyes and ears.
You will be asked to not eat or drink anything after midnight the evening before your procedure. Your physician will give you specific instructions on which medicines, if any, you should stop taking before the test. If you are not given specific instructions, please take your medicines as you normally would with a small amount of water. Do not smoke or use tobacco products for 24 hours before your procedure.
During your procedure
On the day of pacemaker implantation, you will be brought into the electrophysiology laboratory. The electrophysiology nursing staff will prepare you for the procedure placing special adhesive patches on your chest and monitoring your heart rhythm, oxygen level and blood pressure. The skin at the site where your pacemaker will be implanted will be cleaned. You will receive intravenous (IV) medications to help you feel more comfortable and relaxed as well as antibiotics that will minimize your risk of infection.
The basic parts of a pacemaker are the pacemaker generator and lead (wire). Most pacemakers are inserted under the skin just below the clavicle (collar bone) on either the right or left side of your chest. The skin incision is small and a pocket is made under the skin to insert the pacemaker and the pacing leads.
The pacemaker leads are then inserted through a vein and positioned inside the heart using X-rays as a guide. The pacemaker generator will be attached to these leads.
Once in place, the leads and the pacemaker will be tested. When your physician confirms that they are working correctly, the incision will be closed with absorbable suture material.
After your procedure
After your pacemaker implantation, you will return to your hospital room and will be monitored overnight. Instructions on how to manage your pacemaker and adjust your medications will be reviewed with you and your family before leaving the hospital. Written instructions will also be provided.
Pacemaker implantations are extremely successful, with rates greater than 99 percent. For a 3-lead pacemaker system, the success rates are about 97 percent.
The risks of major complications from a pacemaker implant are low. Complications may include injury to blood vessels, heart muscle or lung tissue; bleeding complications; an infection that requires device removal; and, extremely rarely, death. There is also the chance that your pacemaker device could have a random component failure. If this happens, the pacemaker generator or lead may need to be replaced.
Monitoring your pacemaker
Your pacemaker will need to be periodically evaluated. At these evaluations, the health of your pacemaker will be checked, including the leads and the battery function. Pacemakers can also store information about your heart rhythm. This information will be reviewed as well.
Transtelephonic Monitoring: Transtelephonic Monitoring (TTM) is a method to assess if there is adequate battery function in your pacemaker. Transtelephonic Monitoring does not provide any other information about the pacemaker, nor does it provide the ability for the pacemaker to be adjusted or reprogrammed. Transtelephonic Monitoring is completed over the phone.
At-Home Monitoring: Some pacemakers can be evaluated with a home monitoring system. This system uses a unique monitor that sends the pacemaker information over the internet. This information can then be reviewed by staff at The Ohio State University. All information sent over the internet is reviewed only during normal business hours.
If your pacemaker is capable of being monitored from home, the device nurse will enroll you in the program. As with transtelephonic monitoring, home monitoring cannot change the pacemaker parameters, but more information about the leads and heart rhythm can be obtained from the system. Home monitoring and the transtelephonic monitoring do not treat any medical condition.
What should I do if I notice my pacemaker incision is red, swollen or fluid is leaking?
If you notice any of these changes, do not probe the incision with a cotton swab or apply any lotion or topical antibiotic. Please contact The Ohio State University Device staff at 614-293-8916. These changes may indicate that there is an infection.
When can I return to work?
The decision of when to return to work is based on several factors and should be discussed with your physician before you are discharged from the hospital. If you need return-to-work slips or paperwork completed, please do not hesitate to ask us for help.
What will I feel when the pacemaker is working?
You should not feel anything. The tiny electrical impulse from the pacemaker should not be noticed by anyone.
What happens when the pacemaker battery becomes low?
The battery of your pacemaker will be monitored through routine follow-up. A pacemaker battery lasts about five to seven years. When the battery becomes low, you will be notified and scheduled for a replacement of the pacemaker generator. Replacement of the pacemaker generator is generally a simple outpatient procedure. Your electrophysiologist will open the pacemaker skin pocket and unplug the leads. The leads will be tested to make sure they function properly. After testing, the leads are connected to the new pacemaker generator, and the pocket is closed. The entire operation often takes less than an hour.
Can a pacemaker prevent a heart attack?
No, a pacemaker cannot prevent a heart attack. A heart attack is due to a blockage in the blood flow to the heart.
How long will my pacemaker device and leads last?
A pacemaker battery usually lasts about five to seven years. The life of a pacemaker is based on how frequently the device is used and the amount of battery it takes to make the heart beat. The pacemaker leads can last for 10 to 18 years.
Does a pacemaker treat other heart rhythm abnormalities like atrial fibrillation, or can it shock my heart like a defibrillator?
Pacemakers do not treat rapid rhythms from the top chamber of the heart, such as atrial fibrillation. Likewise, they do not treat rapid rhythms from the bottom chamber of the heart, such as ventricular tachycardia or fibrillation. A pacemaker does not shock the heart like a defibrillator.
What items can interact with my pacemaker?
There is no interaction between a microwave and a pacemaker. The likelihood of adverse interactions when using your cell phone is quite low. However, we do recommend talking on the opposite side of your pacemaker when using your cell phone.
When going through airport security, it is important to notify the security personnel that you have a pacemaker. They may ask you to show them the defibrillator card, and we recommend that you ask to be hand-searched.
A pacemaker may be sensitive to anti-theft systems often found in stores and public libraries. These systems will not adversely affect the pacemaker if you walk through them in a normal manner without lingering.
Arc welding or other devices that can emit electronic magnetic signals can interfere with pacemakers. If you have hobbies or your work involves interaction with devices that can emit large magnetic fields or electromagnetic interference, it is best that you discuss this with your physician before returning to work.
We do not recommend that an MRI be performed on patients who have a pacemaker.
How can you alter the settings on my pacemaker?
Pacemaker settings can be changed through use of a handheld device. The device is placed on top of your pacemaker and reprograms it. This is a painless process.
Ohio State was one of the first in the country to implant a tiny, high-tech pacemaker, only 24 millimeters long, directly into the heart of patients, without surgery.
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