Dual-Chamber Pacemaker

A pacemaker is a small, lightweight, battery-powered device that is implanted under the skin in the upper chest. Your caregiver may place a pacemaker if your heartbeat is too slow (bradycardia) or if you experience symptoms from a slow heartbeat. A dual-chamber pacemaker has 2 leads (electrodes) that are connected in your heart. One lead is placed in the upper chamber of the heart, called the right atrium. The second lead is placed in the lower part of the heart, called the right ventricle. Dual-chamber pacemakers may pace in both the upper chamber and lower chamber. By doing so, correct rhythm and function are often maintained. When the heart rate is too slow, the pacemaker senses the heartbeat and will pace the heart at a programmed rate.

CAUSES

Different conditions can cause a slow heart rate. Some of these can include:

  • Sick sinus syndrome. This is a type of slow heart rate where the "pacemaker" of the heart does not work very well. It is often related to aging.

  • Heart attack (myocardial infarction). This can damage the heart muscle and cause a slow heart beat.

  • Heart block. This is a condition where the signal that causes the heart to beat does not communicate very well between the upper chambers of the heart and the lower chambers of the heart.

  • Some heart medications that control fast heart rates or other abnormal heart rhythms can also cause a slow heart rate.

SYMPTOMS

A very slow heart rate results in the heart not pumping enough blood to your body. Symptoms of a slow heart rate can include:

  • Passing out (fainting).

  • Confusion.

  • Shortness of breath.

  • Tiredness (fatigue).

  • Ankle swelling.

  • Chest discomfort or pain.

DIAGNOSIS

Tests will be done to look at how your heart works and beats. This can include:

  • A physical exam.

  • An electrocardiogram (ECG). An ECG records your heart beat on a strip of paper for your caregiver to look at.

  • Continuous ECG monitoring:

  • Holter monitor or an Event monitor. These devices record your heart rhythm and can be worn for 24 or more hours at a time. Your caregiver can then look at the recorded history of your heartbeat.

  • An electrophysiology study. This is a test to study the heart's electrical system. If your heart has a disruption in its electrical pathway, a slow heart beat can occur.

PACEMAKER IMPLANTATION

  • Do not eat or drink for 6 hours before the procedure or as told by your caregiver.

  • Pacemaker implantation usually takes about one hour.

  • Your skin on your upper chest will be cleaned with germ-killing soap.

  • Sedation will be given through an IV. This will help you relax during the procedure.

  • The site of the incision, often just below a collarbone, will be injected with numbing medicine.

  • The insulated electrode is inserted through a large vein in your chest. Then, using a special type of X-ray (fluoroscopy), the tip is positioned in the target area of your heart. The end of the pacemaker lead is fixated to your heart by a corkscrew tip or by small "tines" (soft anchor hooks).

  • The connection between the pacemaker electrode and the heart is checked to ensure optimal contact and placement.

  • After your pacemaker is implanted, you will need to stay in the hospital to make sure the pacemaker is working correctly. You will be able to go home when your caregiver feels it is safe for you to do so.

HOME CARE INSTRUCTIONS

  • Excessive movement of the arm next to the new pacemaker can cause the electrodes to dislodge. Your caregiver will determine how many days the upper arm should not be moved excessively. It is usually three or more days.

  • The incision needs to be kept dry as told by your caregiver. As with any surgery, if the incision becomes swollen, red or pus (yellow or tan drainage) appears, call your caregiver right away.

  • Your caregiver may use small strips of tape hold the incision closed. They should be allowed to fall off naturally. Do not pull the strips of tape off.

  • Digital cell phones should be kept 12 inches away from the pacemaker. Hold them at the ear on the side opposite of the pacer.

  • Never leave a cell phone in a pocket over the pacemaker.

  • Avoid strong electro-magnetic fields. You will not be able to have an MRI scan because of the strong magnets.

  • The pacemaker battery should last several years. The pacemaker needs to be checked at regular intervals as told by your caregiver.

RISKS AND COMPLICATIONS

An implanted pacemaker has risks. Some of these can include:

  • Infection.

  • The pacemaker electrode can become dislodged. If this should happen, a second surgery would be needed to reposition it.

  • During pacemaker implantation, it is possible to puncture the lung. This is a very rare occurrence.

SEEK MEDICAL CARE IF:

  • You have dizziness or pass out.

  • You feel your heart "skipping" beats or feel your heart "racing."

  • Hiccups that do not go away.

  • You develop redness, swelling or pain at the pacemaker insertion site.

  • The pacemaker insertion site has yellow drainage or there is a bad odor coming from the insertion site.

  • An unexplained temperature of 102° F (38.9° C) or above develops.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.