What are they and do I need one?
A pacemaker is an implantable device which is positioned typically underneath your left collarbone. It consists of a battery with a computer circuit connected to one or more pacing electrodes (electrical wires) which attach to your heart.
The battery of the pacemaker is able to generate an electrical impulse which is transmitted to your heart, which leads to a heart contraction, leading to a pulse or heartbeat.
Pacemaker Implantation
Pacemakers are typically implanted in patients with low heart rates. The typical normal heart rate at rest is between 60 and 100 beats per minute.
Certain heart conditions such as heart attacks, heart failure, cardiomyopathy, thyroid abnormalities (hypothyroidism) premature conduction tissue disease, use of drugs that slow heart rates (such as beta-blockers or calcium blockers) or simply an “ageing” heart may lead to progressive slowing of the heartbeat.
Symptoms of a slow heartbeat may include:
It is rare to be able to reverse a slow heartbeat. However, there are certain drugs which may predispose you to a lower heart rate such as:
If you are not on any of these drugs and have a low heartbeat which causes you to feel the symptoms described above, please seek medical advice.
If you experience symptoms of a low heart rate, your doctor will perform a physical assessment and listen to your heart with a stethoscope.
He will also check for signs and symptoms of medical conditions that might be the cause of your symptoms, such as an enlarged thyroid gland.
Blood Test. A medical technologist draws blood from your forearm to check for anaemia (haemoglobin) and an overactive thyroid gland (thyroid function)
Electrocardiogram (ECG). It is a noninvasive test wherein a technician places ECG leads on your trunk so it could record the electrical impulses of your heart.
An ECG helps detect irregularities in the heart’s structure and rhythm that cause palpitations. This test may be performed either one is at rest or during exercise (Stress Test).
Holter monitoring. Also called an ambulatory ECG, this battery-powered portable device works as ECG albeit using electrodes with fewer leads.
It records a continuous ECG, measuring the heart’s rhythm and rate typically between 24 to 72 hours, while the patient keeps a journal of palpitations felt.
Holter monitoring may be advised if your doctor wants to detect palpitations that don’t show on a routine ECG test.
Event recording. This device is also called a cardiac event recorder and it’s similar to a Holter monitor in purpose. However, this device only records short periods of one’s heartbeat.
You need to wear the event recorder throughout the day and push a button to record when you experience irregular heart rhythms. If you don’t experience such while you wear a Holter monitor, or if the cardiac events occur less than once in a week, your doctor might advise you to wear an event recorder for several weeks.
Echocardiogram. Also known as diagnostic cardiac ultrasound. This is also a noninvasive test which uses ultrasound waves via a transducer that is passed all over your chest to show a detailed image of the heart’s structure and function.
The images are then transmitted on a video monitor so your doctor can view your heart’s valves, chambers, and blood vessels (arteries, aorta & veins).
Thru the echocardiogram, your doctor can also check if you have abnormal holes and blood clots (inside the heart chambers), or problems with your pericardium (outer lining of your heart).
A pacemaker is usually implanted in a cardiac catheter laboratory (cathlabs) under sterile conditions. You will be instructed to be fasted from 6 hours prior to the procedure and will be asked to lie down on a table.
The procedure is usually conducted under local anaesthesia with sedation if needed, and can usually be completed in 60 to 90 minutes.
The procedure steps are outlined below:
The immediate aftercare involves understanding that you have had a device implanted underneath your collarbone connected with leads which insert into the heart.
The following principles apply:
If you have been told you have a slow heartbeat and may need a pacemaker, please consider getting a referral to a cardiologist who is skilled and experienced in pacemaker implants.
Dr Boon Lim is a consultant Cardiac Electrophysiologist who offers comprehensive assessment and treatment for pacemaker implantation in London. He is a regular lecturer and trainer in pacing and electrophysiology, and lectures in courses on best clinical practices within London and internationally.
Book an appointment with Dr Lim today.