Cardiac pacemaker surgery - Medical specialists

A pacemaker is a small instrument with two parts – a generator plus attached leads – that sits under the skin in the chest region, where it helps to regulate your heartbeat.

A pacemaker may be recommended for many reasons, but it is most commonly associated with arrhythmias – a group of conditions in which the heart beats with an abnormal rhythm.

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Cardiac pacemaker surgery - Further information

The heart’s normal ageing process may disrupt your heart and cause it to beat more slowly. In addition, a heart attack may cause damage to your heart muscle, which may subsequently disrupt your heart’s ability to maintain a regular rhythm.

Furthermore, some medications can also affect your heart rate, and a range of genetic conditions has the potential to cause your heart to beat at an abnormal rate. Whatever the underlying reason for your heart rate malfunction, a pacemaker could well be a recommended solution.

Implanting a pacemaker in your chest usually requires a minor surgical procedure, and you may need to observe some sensible lifestyle precautions once it has been fitted.

What does pacemaker treatment help with?

The installation of a pacemaker is often advised for conditions that are likely to disrupt your natural heartbeat rhythm. They can also be installed temporarily – for instance, to compensate for a slow heartbeat following a heart attack, surgical procedure or overdose of medication.

A pacemaker can also be permanently installed to overcome a slow heartbeat (bradycardia) or to help treat certain cases of heart failure.

An ICD (implantable cardioverter defibrillator) is a similar device to a pacemaker, which can be surgically installed, primarily to prevent the occurrence of cardiac arrest – a life-threatening condition in which the heart may stop beating. When an ICD detects abnormal heart signals, it can transmit an electrical shock, which has the effect of forcing the heart to reset to its normal rhythm.

pacemaker in hand

When is pacemaker treatment used?

Pacemakers are sometimes recommended for people with conditions that cause the heart to beat abnormally (arrhythmia). Here are some of the most common causes.

Sick sinus syndrome

This condition is thought to be caused by a malfunction of the sinus node, the heart's natural pacemaker. As a result, there may be either bradycardia (an abnormally slow heartbeat), tachycardia (an abnormally rapid heartbeat), or perhaps a combination of both. In addition to these symptoms, sick sinus syndrome can cause:

  • fatigue
  • fainting (or nearly fainting)
  • feeling dizzy or light-headed
  • breathlessness
  • chest pain
  • palpitations (an irregular or fluttering heartbeat)

Sick sinus syndrome is generally thought to be a consequence of age-related hardening and scarring of heart tissues, though it is also known to occur as a side effect of some medications.

Atrial fibrillation

Atrial fibrillation causes an abnormally fast heartbeat. Though this can often be treated via medication, a pacemaker may be recommended in some instances, for example, when a person is also experiencing occasional slowing of the heart rate.

Heart block

Those suffering heart block will experience a delayed natural pulsing, or no natural pulse at all. This condition can be inherited (congenital heart block) or occur through heart damage (acquired heart block) and often requires a pacemaker to provide essential heartbeat regulation.

What are the risks of pacemaker treatment?

Difficulties with the surgical procedure to install your pacemaker are quite rare, but could include:

  • infection caused by the implant procedure
  • an allergic reaction to anaesthesia or dye used during the operation
  • swelling, bleeding or bruising at the pacemaker location (especially if you are on blood-thinning medication)
  • damage to nerves or blood vessels close to the pacemaker
  • collapsed lung due to a small, accidental lung puncture
  • blood clots
  • pacemaker malfunction (you may notice a slower/faster heartbeat, feel dizzy and faint, and perhaps develop hiccups)

If you think your pacemaker is failing you should seek medical advice immediately.

Are there alternatives to pacemaker treatment?

In some instances, an abnormal heartbeat can be controlled without the use of a pacemaker. For example, atrial fibrillation, which causes a quivering or unstable heartbeat, is sometimes treated via medication or catheter ablation, which is a non-surgical procedure. However, these procedures are not suitable for all such conditions and a pacemaker implant is often regarded as the most effective treatment option.

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