If you have a heart rhythm disorder, you may have considered getting a pacemaker — but you’re wary of having a small electronic device implanted inside your chest. Is it worth it?
Ongoing heart rhythm problems make some patients faint and blackout. They can sap people’s strength and sideline them from activities like sports. In these cases, pacemakers may allow them to participate more fully in life. Here are some device basics and how life changed for three people with pacemakers:
Wake-Up Call on the Tilt Table
Bill Rushmore, 44, a software engineer in Pittsburgh, had his first fainting spell in his mid-20s while serving in the Navy. With unexplained fainting several times a year, he was discharged from the military and his Pennsylvania driver’s license was revoked — even though most episodes occurred while he was in bed.
In November 2013, Rushmore traveled to the autonomic laboratory at Cleveland Clinic, where he underwent a tilt table test. “I ended up passing out, and they found my heart had stopped for about 38 seconds,” he says. He was immediately scheduled for pacemaker implantation for his condition, called vasovagal syncope. “Obviously, at first I was pretty frightened,” he says. “I figured life would change forever.” But when the staff showed him the result from his electrocardiogram — including the flat lining — it was hard to argue.
The pacemaker is contained in his chest, up near his shoulder, and a keloid scar marks the insertion site. A monitor beside his bed automatically tests the pacemaker every so often — he doesn’t need to hook it up — and the results go directly to Cleveland.
Rushmore is sleeping better and can drive again. He’s been able to resume CrossFit workouts with minor adaptations. He’s a little bummed that he’s had to give up super-heavy weightlifting of more than 400 pounds a pop — but he’s glad to be free of heart-stopping episodes at night, and the aftermath of feeling weak, nauseous and “lousy.”
[See: The Facts on Heart Disease .]
Is a Pacemaker Right for You?
In a healthy heart, electrical currents stimulate the muscle to beat properly. A normal resting rate is about 60 to 100 beats per minute, although a very fit person might have a rate in the range of 40 to 60.
But when the timing of the electrical circuit isn’t working right — causing the heart to beat erratically, too slowly or too quickly — that’s when a pacemaker can help. Slow cardiac rhythm conditions are the most common reason people get pacemakers, says Daniel Cantillon, a physician who specializes in cardiac electrophysiology at the Cleveland Clinic.
The sinus node, in the right upper chamber of the heart, is where normal electrical activity begins. Sinus node dysfunction (sometimes called sick sinus syndrome) is the most common reason for pacemaker implantation in the U.S.
Other possible indications include heart block, atrial fibrillation, congestive heart failure and some childhood heart conditions. In tachy-brady syndrome, the pulse can race up to 160 beats per minute (tachycardia), pause and drop to a much lower pace (bradycardia).
Even if you have one of these diagnoses, that doesn’t necessarily mean you should have a pacemaker.
“Pacing for vasovagal syncope is somewhat controversial,” Cantillon says. “Not all patients are going to benefit.” In the condition, “the brainstem sends inappropriate messages to the heart to cause it to slow down to the point where patients can actually blackout or lose consciousness,” he explains. At issue, however, is whether the primary problem is a drop in heart rate or a drop in blood pressure. A pacemaker wouldn’t help for low blood pressure. To further evaluate, you might undergo the noninvasive test tilt table test.
The Device
In size, pacemakers compare to a couple half-dollar coins. Newer models weigh between 1 and 2 ounces. Pacemakers fit entirely within your chest, in a surgically created pocket. You may have a slight visible bulge beneath the skin.
Two basic components make up the pacemaker: the pulse generator — the electronics and lithium battery — and the lead wires — one or more — which are surgically attached to the heart. Pacemaker batteries last five to 10 years on average. When the battery is low, patients need to undergo surgical replacement.
Pacemakers can be single-chambered, with the lead wire attached either to the heart’s upper or lower chamber. Dual-chamber pacemakers are being used more and more often. Rate-responsive pacemakers use special sensors to monitor and adapt to a person’s changing activity levels.
In some cases, people with congestive heart failure can benefit from cardiac resynchronization therapy, With CRT, a more advanced pacemaker with three leads is used. Women with heart failure are most likely to benefit from CRT than men (but less likely to receive it), according to a June study from the Food and Drug Administration.
After determining whether you need a pacemaker, your cardiology team will choose the best device for you based on your medical condition.
[Read: Are You at Risk for Heart Failure? ]
Pacemaker Surprise
Wilma Martino, 61, of Akron, Ohio, had her pacemaker inserted in June, and she still isn’t quite sold. The only symptom she had ever noticed was a stronger heartbeat when she rode her bike uphill. Martino learned she had second-degree heart block, but the question was whether it was more severe Mobitz type II block. She underwent an electrophysiology study to find out — and woke up with a pacemaker.
“It felt like I had a hard-boiled egg in my chest,” she recalls. And she says the cardiologist’s brochure wording that recipients “might experience a slight discomfort for a few days” was a bit too understated. For three days, she says, her arm was too sore to move. “It’s uncomfortable to sleep on your side; it feels like a knife digging in you,” she says. “And [the pacemaker] moved around a lot. For a week or two you go up and down the steps and you feel it bouncing in your chest.”
Martino’s pronounced heart beat continued after pacemaker insertion, even with several readjustments to the settings, which the doctor makes by placing a special magnet over the pacemaker to reprogram it. Eventually, she went for a second opinion and her settings were completely changed.
Now, she stays active, playing racquetball once a week, hiking and walking. And she rode 950 miles on her bike this summer. She’s ready to start picking up her grandson again. “I feel fine, Martino says, “but I felt fine before.”
For other patients new to or considering a pacemaker, she recommends checking visiting the Pacemaker Club online.
[See: Exercising After You’ve Gone Under (the Knife, That Is) .]
Where Do You Go?
About 400,000 pacemakers are implanted in the U.S. each year. “A basic pacemaker — a single- or dual-chamber pacemaker — is a fairly simple procedure,” Cantillon says. “It is performed routinely at community hospitals and centers which are not [specialized] referral centers or academic medical centers, and I think that’s perfectly appropriate,” he says. The procedure for CRT with the three-lead pacemaker is more complex, he adds, and it’s not offered in all community hospitals.
Complications to Ask About
Some hospitals, like Cleveland Clinic, publicly report their complication rates for procedures like pacemaker insertion. If you can’t look these up for local hospitals, you can ask your surgeon directly. Life-threatening complications are very low for Cleveland Clinic, at or slightly above zero percent. Lead wire dislodgements requiring surgical replacement — sometimes caused by leads getting jostled loose by patients not following weightlifting restrictions after surgery — are below 2 percent.
Two concerns with pacemaker implantation are bleeding of the pacemaker pocket and infection. A minority of patients with bleeding require reoperation. Studies from different hospitals have reported infection rates at about 2 to 3 percent or above.
With deep infection involving the pacemaker, “the only way to manage that infection is to remove all the hardware components of the body, treat the infection and then start all over again by re-implanting a pacemaker on the opposite side of the body,” Cantillon says.
To prevent infections, patients receive IV antibiotics during surgery, and the staff educates them on incision care and signs of complications before they leave the hospital.
Microwaves are Fine
With a pacemaker, you can use a microwave, get a full-body airport scan or use your smartphone — although it’s recommended that you hold it on the opposite side from your implant. Patients are told to avoid high-voltage interference from arc welders and stay away from strong magnetic fields.
Caution is needed for any future surgical procedures involving electrocautery, which can interfere with pacemaker function, Cantillon says. The cardiologist can temporarily reprogram your pacemaker, and then change the settings back after surgery.
Pacemaker Believer
Tracey Eller, of Jupiter, Florida, received her first pacemaker — of four — when she was 27. She was born with complete heart block, diagnosed at age 5. “I basically had no stamina,” she says, and sports were forbidden. Eller’s heart rate didn’t respond to exertion, and her pulse never rose above 44. She recalls passing out a couple times as a child.
As a young adult, she says she completely lost her energy over a two-year period, and she felt dizzy all the time. “And then one day, my heart rate dropped to 22,” Eller says. “I got the pacemaker that day.”
After she recovered, she went on a shopping spree — at the local sporting goods store. “I went and bought in-line skates, I bought a tennis racket — and I haven’t really slowed down since,” she says. “I discovered zip lining’s really fun.”
Pacemaker replacement is a lot easier than the original procedure, she says, because most of the pain comes with creation of the pocket to hold the pacemaker.
“I don’t define myself by my heart condition,” Eller says. “It’s something I was born with. Yeah, it sucks, and yeah, I wish I didn’t have it — but there are a lot of worse things that could go wrong. So you fix the problem, focus on the good stuff and move on with your life.”
[See: 10 Lessons From Empowered Patients .]
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So You’re Getting a Pacemaker originally appeared on usnews.com
