What is a Pacemaker and How Does It Work?

A pacemaker is a small device that produces electricity placed under the skin on your chest. It is used to treat diseases in which your heart beats too slowly, some abnormal heart rhythms (arrhythmia), and in some cases to eliminate the risk of sudden cardiac arrest. In addition, some pacemakers, called Cardiac Resynchronization (CRT) pacemakers, help the chambers of your heart beat stronger and at the same time (resynchronization, resynchronization) and treat heart failure in suitable patients.

How does a pacemaker work?

There is a structure in your heart called the sinus node, located in the right atrium, that produces electricity. Your sinus node sends electrical impulses to keep your heart beating, a kind of electrical generator. You can think of it as your heart’s natural battery.

One function of the implantable pacemaker is to take over the role of your sinus node if it is not working properly.

The pacemaker device sends electrical impulses to tell your heart to produce a heartbeat. Most pacemakers work only when needed and are motion-sensitive, allowing your heart rate to increase as you need it. Sometimes, if set, it sends continuous warnings called constant speed. Today’s pacemakers are multifunctional and can be programmed according to need and many different features can be activated.

By the way, standard pacemakers that do not have a defibrillator feature do not give an electric shock to your heart.

What does a pacemaker look like?

Pacemakers are usually 5 x 4 centimeters (smaller than a matchbox) and weigh around 20 to 50 grams.

It is usually placed in the area just below your collarbone, between your skin and muscle tissue. And it will have one or more wires that reach your heart through a vein in that area. In rare cases, it may be placed lower under your ribs (near your abdomen).

Most pacemakers, which are products of today’s technology, work reliably and smoothly.

What are the diseases that require a pacemaker?

A pacemaker may need to be implanted in the following cases:

1) If you have a specific heart block (a disease that reduces your heart rate, that is, your pulse)

2)If your heart is beating too fast (a type of arrhythmia) and cannot be controlled with medication

3)If you have heart failure

It should not be forgotten that, if necessary, implanting a pacemaker improves your quality of life and is life-saving for some people.

 How are pacemakers inserted?

Insertion of a pacemaker is a commonly performed procedure throughout the world and our country. It is usually performed without any problems by experienced centers and experts. However, like all operations, it is normal to feel anxious about this procedure.

It may be comforting to learn what to expect before, during and after the procedure. You should discuss this issue in detail with your doctor during the preparation phase.

An average standard pacemaker implantation procedure takes about an hour. However, if other procedures such as angiography will be performed at the same time and multi-cable batteries will be placed, it may take a little longer.

There are different ways to perform the pacemaker implantation procedure. The most common procedure is called transvenous implantation.

Local anesthesia is given to numb the area where the incision will be made. This means you are awake but will not feel any serious pain. You may also be given sedation (a type of medication) to help you relax. In this way, you will feel semi-conscious (drowsy) throughout the entire procedure.

A small incision of about 5 to 6 centimeters is made on the underside of your left or right collarbone. The wires connecting the pacemaker to your heart are inserted into a vein and guided to your heart. Your pacemaker is then placed in a small space between your skin and chest muscle. And then all the incision layers are closed with stitches.

Usually, after a pacemaker is inserted, you stay in the hospital overnight and go home the next day. Your pacemaker will be checked before you are discharged to make sure it is working properly.

What are the types of pacemakers?

There are different types of pacemakers. Which one you need depends on your disease condition.

All pacemakers have wires that connect the pacemaker to your heart. The number may vary depending on need and disease. Batteries with one, two, three and sometimes four wires are available today.

Yet another point, some people need a special pacemaker called a cardiac resynchronization pacemaker (CRT). This battery is implanted when the chambers of your heart work incompatibly with each other and improves the performance of the heart by making them work in harmony, that is, simultaneously. In this way, your heart failure is treated.

1)Standard Pacemaker: It is used in cases where the heart beats at a very slow pace, cannot accelerate enough when needed, or serious irregular heart rhythms develop because it beats too fast from time to time. It has one or two wires and works by giving only small electrical impulses at the volt level when needed. It is motion sensitive. It increases your pulse by giving more frequent warnings in situations such as moving fast or running, and increases the performance of your heart within physiological limits.

2)Defibrillator Battery: There is a risk of sudden cardiac arrest in heart failure, some rhythm disorders and some heart muscle diseases. And to minimize this risk, a defibrillator-enabled battery is used. This battery automatically detects the electrocardiographic waves that cause cardiac arrest and treats them when necessary, sometimes by giving small electrical stimulations and sometimes by giving shocks.

3)Cardiac Resynchronization Battery: It is used in a type of heart failure in which the chambers of your heart work asynchronously. And in appropriate cases, it treats heart failure. It usually has 2 or 3 wires.

4)Cardiac resynchronization and defibrillation (CRT-D) pili: If you have both heart failure and need a CRT pacemaker and are at risk for a dangerous, abnormal heart rhythm (arrhythmia), a CRT-D (CRT pacemaker+defibrillator) with implantable defibrillator (ICD) feature should be implanted.

You should discuss in detail with your doctor which type of pacemaker is most suitable for you.

Living with pacemakers

It is normal to feel tired for a few days after your pacemaker is inserted. You may feel some pain in the area where the pacemaker was inserted. However, most patients can return to normal daily activities after a few days.

You will need to avoid driving for about a week.

Your doctor will inform you about what is safe for you.

You will be given a “pacemaker identification card”. It is important to keep this with you at all times so that your healthcare provider knows about your pacemaker if you need any medical treatment. It’s normal to be concerned about living with a pacemaker, and you may have questions. You should definitely discuss the issues you are curious about with your doctor.

Can a cell phone affect my pacemaker?

Some cell phones may interfere with defibrillator batteries (ICDs) and standard pacemakers.

Because cell phones often contain magnets and other elements that produce electromagnetic fields, they can interfere with defibrillator batteries (ICDs) and standard pacemakers. Electromagnetic fields can affect your pacemaker’s ability to sense your heart’s electrical activity. Therefore, it should not be placed in the breast pocket where the battery is located, and you should use it with the other ear while talking or use it with headphones.

Apple devices and your implanted device

Apple’s iPhone 12 and later generation phones have been the subject of some news about the magnets they contain. If you have a device such as a pacemaker, you can use these phones, but you need to be more careful.

Apple’s and pacemaker manufacturers’ recommendation is to keep these products (including MagSafe accessories) 15 cm away from the pacemaker and 30 cm away while the phone is charging. Other manufacturers have published similar guides on mobile phones.

Best tips to protect your pacemaker device

• When using your phone, always use the ear opposite your implanted device and do not put the phone in the breast pocket on the same side as your pacemaker.
• If your phone comes close to your device, don’t panic. Pacemakers and ICDs are designed to return to their normal settings when the electronic equipment acting on the device is removed.

When should you see your doctor?

If you experience new symptoms that you think may be related to your defibrillator pacemaker (ICD) or pacemaker, such as dizziness or palpitations, see your physician to have your device checked.

Do smart watches affect pacemakers?

Many publications report that recent research shows that smartwatches and other wearable fitness trackers can disrupt pacemakers and defibrillator batteries (ICDs) and put people at risk.

Researchers from the American University of Utah investigated this using laboratory tests and computer simulations to examine the possible effects of selected smartwatches, smart scales and smart rings on pacemakers and ICDs.

The results confirmed that these monitoring devices pose a risk of disrupting pacemakers and ICDs, and that interference levels exceed the standard recognized by the US Food and Drug Administration (FDA). They also found that smart watches disrupted pacemakers more than smart scales and smart rings. Only wearable devices that use a specific technology called ‘bioimpedance delivery’ have been examined by researchers. Bioimpedance involves sending small, painless electrical signals to the body and reading the signals that come back. Essentially, they can predict things like body fat percentage, heart rate, and stress levels, helping people take precautions for their health. But so far, little research has been done on the safety of these fitness trackers in people who use life-saving cardiac devices such as pacemakers.

While we already know that smartphones can interfere with pacemakers and defibrillator batteries (ICDs), this study is a step forward in clarifying what we know about smartwatches and other devices that use bioimpedance technology.

Ultimately, we conclude that people with devices such as implantable pacemakers should avoid wearable fitness trackers that use bioimpedance technology due to the potential for interference. Whether a particular wearable device uses bioimpedance is listed in the product brochure under ‘production information’.

I have a pacemaker and can I have an MRI?

Now, most modern pacemakers and defibrillator batteries (ICDs) are MRI (EMAR) compatible and you can easily have them scanned. However, if you have a pacemaker or other potentially metal device in your body, you should always tell the medical staff before the shot. If we know this, we can prevent any risks and make sure that it will not affect the quality of the scan. However, one point that should not be forgotten is that before taking an MRI (EMAR), your battery must be programmed to MR (EMAR) mode and returned to its previous settings after the shooting.

I have a pacemaker and can I have a Tomography (CT) scan?

Because tomography (CT) scans use radiation instead of magnetic fields, they are not affected by your pacemaker or other metal implanted devices. You can have it removed safely and without making any adjustments to your battery beforehand.

Can I use an induction cooktop if I have a pacemaker?

Pacemakers are small electrical devices that regulate the electrical activity in the heart. Anything that produces a strong electromagnetic field can interfere with the pacemaker.

Induction cooktops produce electromagnetic fields, so keep a distance of at least 60cm between the cooktop and your pacemaker. Most people can use a stovetop if they follow these precautions, but if you’re choosing a new stovetop, it’s safer to choose a non-induction stovetop.

Devices that contain magnets and can interact with pacemakers

Other devices containing magnets include;

• Handheld hair dryers,
• Old electric corded shavers,
• large stereo speakers,
• Electric toothbrushes and ultrasonic toothbrushes have base chargers.

If you use any of these, keep them 15 cm away from your pacemaker. If you get too close, don’t panic and move away. Moving away means that your pacemaker settings will return to the correct and previous level.

Devices to avoid if you have a pacemaker

If you have a pacemaker, you should avoid these devices completely:

• Abdominal stimulants (used to build muscle)
• Electronic body fat scales
• Magnetic mattress pads or pillows
• Welding equipment (currents above 130 amperes).

If you have questions about a particular device, you can also consult your clinic. The important thing is this: If in doubt, be sure to ask.

Does the heart need to be stopped during pacemaker surgery?

No, it is not necessary. The heart continues to beat at its normal current rate during the procedure.

Do I need anesthesia for the procedure?

The majority of pacemakers are placed under local anesthesia. There is usually an option for sedation (semi-consciousness) if you need it and it is safe to do so. The procedure is generally very well tolerated and there is little pain when local anesthesia is injected. Sometimes we need to perform the procedure under general anesthesia (for example, for those diagnosed with dementia, young children), but we generally do not prefer this because general anesthesia has additional risks, albeit small.

How long does a pacemaker last? What happens when your battery runs low?

The average lifespan of a pacemaker battery is approximately 10-12 years, and the procedure for replacing the battery when it dies is much simpler than the procedure when pacemakers are installed. It is performed as a day case under local anesthesia.

The wound is reopened and the pacemaker battery is removed, but the electrodes remain in place. After the new battery is connected with the old cables, it is placed in the same place and the wound is stitched. Most people go home the same day. There is ample warning before the battery dies, and patients are also checked at regular intervals (usually every 6 months or 1 year) to determine how much battery life is left. Therefore, it is not possible for the battery to suddenly run out of power and you do not need to worry about it.

How often should my pacemaker be checked?

Your pacemaker will be checked the day after implantation and then four weeks later. It will be checked every year thereafter and more frequently towards the end of the battery life.

What should I do after a pacemaker is installed?

You should not get the wound wet until it has healed, and you will be given special dressings to help keep it dry.

We recommend that you do not do any strenuous activity for the first four weeks to allow the wound to heal and the cables to remain in place. This means especially avoiding contact sports or anything where you lift, push or pull heavy objects.

We also ask patients not to lift their arms close to their heads over their heads for these four weeks. The reason for this is to prevent the cables and battery from moving.

Other gentle arm movements such as cooking, doing housework, or carrying groceries; It’s usually okay as long as you don’t raise your arm above your head.

Can I exercise with a pacemaker? Will the battery drain faster if I exercise more?

For the vast majority of people, the impact of exercise on battery device life is negligible. You will not need to restrict exercise.

What are the risks during pacemaker and defibrillator battery insertion?

As with any procedure, there are risks, but the risks are low with pacemaker implantation. About 1 in 100 people experience serious complications during or immediately after the procedure. These complications can include bleeding around the heart, collapse of the lung on one side, or movement of the electrodes after they are fixed in place, but these are all treatable and very unlikely.

A small amount of bleeding and bruising is normal after this type of procedure and may be slightly worse if patients are on effective blood thinners, but generally it is not a problem because equipment and techniques to stop bleeding are available today.

What is the difference between a CRT pacemaker and a normal pacemaker?

 The CRT pacemaker is a 3-wire pacemaker that can electrically stimulate the left ventricle (left ventricle), right ventricle (right ventricle) and right atrium (right atrium) of the heart.

CRT pacing is used in patients with a very specific type of heart failure in which the heart chambers contract in an uncoordinated manner. This battery re-coordinates the heart’s pumping function, allowing it to become more efficient. Therefore, it improves heart failure in suitable patients.

Can I drive after having a pacemaker or defibrillator battery (ICD) installed?

You cannot drive for a short time after a pacemaker is installed. Your doctor will tell you when you can drive again depending on the type of battery installed and the status of your other accompanying heart diseases.

The present and future of pacemaker technology

A new type of pacemaker in use today is “Wireless (leadless pacemaker) Pacemakers”, which are placed into the heart through the groin vein without any incision. This very small (coin-sized) battery does not have any cables. The pacemaker is placed in the right ventricle of your heart and in the right atrium of your heart. It functions just like standard pacemakers.

With developing technology, the size of pacemakers is decreasing day by day and their battery life is increasing. Another development that is still in the trial phase and is expected to come into use in the future will be the ability to charge batteries with low batteries externally without the need for battery replacement.

Our message to pacemaker patients

Today, living with a pacemaker allows you to live a completely normal life, and your entire life, including exercise, sleep, and travel, will continue in the same quality as before.