Answers to Common Questions About Pacemaker Surgery

A pacemaker is a battery-powered medical equipment which is used to regulate heart rhythm in patients suffering from an irregular heartbeat. A pacemaker is slightly bigger than the size of a small capsule and is surgically implanted into the chest cavity to stabilise rapid or slow heart rhythm. A pacemaker works by sending electrical signals to the heart and synchronising the rhythm of the atria and ventricles in a pattern that closely resembles the natural heartbeat. 

Patients with severe arrhythmia and heart rhythm problems often benefit from pacemaker surgery for an improved quality of life. If you are looking to undergo pacemaker surgery, you might have some questions in your mind regarding the same. This blog can provide references to all your questions so you can be prepared before the surgery. However, please note that this blog is for informational purposes and does not replace the importance of a doctor’s consultation.

A pacemaker is required to stabilise your heartbeat when your heart is unable to function properly due to electrical malfunction. Cardiologists often recommend pacemaker surgery either for medical conditions such as congenital heart disorder, heart attacks, etc. or if the following symptoms do not improve with time - 

• Chest pain (angina)
• Tachycardia (unusually fast heartbeat; more than 100 beats per minute)
• Bradycardia (unusually slow heartbeat; fewer than 60 beats per minute)
• Arrhythmia (Irregular heartbeat)
• Frequent heart palpitations 
• Shortness of breath, especially when you are physically active
• Dizziness, lightheadedness, or nausea

Pacemakers are classified into different types based on the functionality and severity of the condition. Based on the severity of the condition, the doctor may suggest a temporary or permanent pacemaker. Temporary pacemakers are implanted for a short while after the surgery. Permanent pacemakers are battery-operated devices that are surgically implanted into the chest cavity and can last for 5 to 15 years before being replaced. Additionally, other types of pacemakers include -

Single-chamber pacemaker - Stimulates a single chamber of the heart (either atrium or ventricle).

Dual-chamber pacemaker - Sends electrical impulses to both chambers of the heart.

Biventricular pacemaker (cardiac resynchronization therapy) - Stimulates both lower heart chambers (left and right ventricles) for a more efficient heartbeat. It is usually recommended for patients with heart failure issues. 

Leadless Pacemaker - Small catheter-based pacemaker which is about the size of a large pill. This device is attached to the heart’s inner wall and doesn’t require any wires. 

Cardiologists often recommend pacemaker surgery to treat several cardiac disorders for improved quality of life. Some conditions are congenital and cannot be managed with medications and other non-surgical methods. Pacemaker surgery immensely benefits patients who are diagnosed with the following medical conditions - 

• Certain heart arrhythmias
• Heart blocks due to disruption of the heart’s electrical signals
• Heart failure
• Enlarged or thickened heart muscles
• History of heart attack

Pacemaker surgery at BM Birla, Kolkata is performed by experienced cardiologists. The patient is initially given local anaesthesia to reduce the pain and discomfort during the procedure. Once the patient is sedated, the surgeon makes a tiny incision just under the collarbone to place the pacemaker and the electrodes. 

The wires are inserted intravenously and threaded into the heart under the guidance of fluoroscopy. The surgeon connects one end of the wire to the heart muscles and the other to the pulse generator. Subsequently, the incision is closed using sutures and bandages.

Recovery after pacemaker surgery mostly involves the healing of the incision and some bruising around it. Depending on the type of surgery and the extent of the heart condition, the recovery period is usually 7 to 10 days.

The doctor may provide certain precautionary measures after the surgery to reduce the recovery time and ensure smooth healing. Doctors do not recommend raising your left arm above the shoulder for at least 6 weeks after the procedure to prevent the leads from dislodging from their position.

Patients who undergo pacemaker implantation surgery often experience improved quality of life along with greater life expectancy. Depending on their medical health and daily activities, patients live longer with a pacemaker. 

Under normal circumstances, a pacemaker can last for approximately 5 to 15 years until the discharged batteries are to be replaced. However, if the heart is stable enough and requires fewer electrical impulses to work, the batteries can last longer. The procedure to replace batteries is very similar to the original insertion. The leads can stay in the body as long as they’re working effectively which usually never needs replacing and can last the rest of your life.

You can tell that your pacemaker is beginning to malfunction if you are experiencing symptoms of arrhythmia (chest pain, breathing issues, dizziness, lightheadedness, etc.) Apart from that, seek medical care if you are experiencing the following - 

• Persistent hiccups
• Twitching of muscles in your abdomen or chest
• Pain, swelling, redness, or drainage at the implantation site due to infection
• Persistent feeling of a fluttering heart
• Sensation that your generator is loose in the pocket under your skin

There are mild precautions that you are required to follow after your pacemaker implantation to ensure the smooth functioning of the device. Here are some precautions that you must follow after your pacemaker surgery - 

• Do not hold any electronic gadgets like mobile phones, laptops, or tablets close to the chest where the pacemaker is implanted. 
• Avoid passing through metal detectors, as it may cause an alarm for the security machine.
• Stay away from magnetic equipment or machinery with a powerful magnetic field as it can interfere with the pacemaker. 
• Inform the doctor of your pacemaker if you are undergoing tests such as MRI scans, x-rays and therapies like extracorporeal shockwave lithotripsy and the use of TENS machines.