What is an artificial pacemaker?
A small battery-operated device that helps the heart beat in a regular rhythm. There are two parts: a generator and wires (leads). View an animation of a pacemaker.
- The generator is a small battery-powered unit.
- It produces the electrical impulses that stimulate your heart to beat.
- The generator may be implanted under your skin through a small incision.
- The generator is connected to your heart through tiny wires that are implanted at the same time.
- The impulses flow through these leads to your heart and are timed to flow at regular intervals just as impulses from your heart's natural pacemaker would.
- Some pacemakers are external and temporary, not surgically implanted.
Why do I need one?
Your doctor may recommend an artificial pacemaker to make your heart beat more regularly if:
- Your heartbeat is too slow and often irregular.
- Your heartbeat is sometimes normal and sometimes too fast or too slow.
How does it work?
It replaces the heart's defective natural pacemaker functions.
- The sinoatrial (SA) node or sinus node is the heart's natural pacemaker. It's a small mass of specialized cells in the top of the right atrium (upper chamber of the heart). It produces the electrical impulses that cause your heart to beat.
- A chamber of the heart contracts when an electrical impulse or signal moves across it. For the heart to beat properly, the signal must travel down a specific path to reach the ventricles (the heart's lower chambers).
- When the natural pacemaker is defective, the heartbeat may be too fast, too slow or irregular.
- Rhythm problems also can occur because of a blockage of your heart's electrical pathways.
- The artificial pacemaker's pulse generator sends electrical impulses to the heart to help it pump properly. An electrode is placed next to the heart wall and small electrical charges travel through the wire to the heart.
- Most pacemakers have a sensing mode that inhibits the pacemaker from sending impulses when the heartbeat is above a certain level. It allows the pacemaker to fire when the heartbeat is too slow. These are called demand pacemakers.
Modern pacemakers are built to last. But as with any electronic device, they require some care. Do your part to help your pacemaker manage your heart rhythm. View an animation of a pacemaker
Learn about living with your pacemaker
Understand your heart rate
...to avoid unnecessary worry
- Before you leave the hospital, discuss with your doctor the specific maximum acceptable heart rate above your pacemaker rate.
- Discuss the programmed lower and upper rate for your pacemaker.
- A sudden, major slowing down of your heart rate, which you may detect, probably indicates a more serious problem. If that occurs, call your doctor.
Monitor and record your heart rate
...to check that your heart is pumping correctly.
- Take and record your pulse as often as your healthcare professional recommends.
- Place your index and middle fingers on the inside of opposite wrist or over the artery in your neck just below the jaw.
- Feel for the beat (pulse).
- Count the number of beats for one full minute and write it down.
- Compare it to the acceptable range from your healthcare professional.
- Follow your healthcare professional's instructions or these guidelines for when to call:
- If your pacemaker is beating regularly and at or above its proper rate, it's OK.
- If your pulse is beating faster than you've noticed before — but below 100 beats per minute — don't be alarmed.
- If your heart is beating close to or within the accepted rate but has an occasional irregularity, don't worry. Every now and then your own heart's natural pacemaker competes with the man-made one. Some extra beats that the pacemaker can sense electrically won't result in a pulse that you can feel.
- If your pulse rate suddenly drops below the accepted rate or increases dramatically, call your healthcare provider immediately and follow his or her instructions. It may be possible to program your pacemaker so it resumes working normally, or there may be some other problem.
- If your pacemaker is installed for a fast-slow type of heartbeat and your pulse is rapid and irregular (above 120 beats per minute), call your healthcare provider for more instructions.
...exactly as instructed.
Follow activity instructions
- Follow activity restrictions and recommendations from your healthcare professional.
- Allow about eight weeks for your pacemaker to settle firmly in place. During this time, avoid sudden, jerky or violent actions that will cause your arm to pull away from your body.
- Car, train or airplane trips should pose no danger.
- Be physically active every day. Do whatever you enjoy - take a short walk or just move your arms and legs to help your circulation.
- Ask your healthcare professional about how and when to increase activity.
- You may be able to perform all normal activities for a person of your age.
- Don't overdo it — quit before you get tired. The proper amount of activity should make you feel better, not worse.
Carry your pacemaker ID card
Don't leave home without it.
- Download a printable pacemaker ID card.
- In case of accident so emergency personnel can treat you appropriately.
- Security devices in public places may detect the metal in your pacemaker, although they won't damage it. Showing your card may save you some inconvenience.
Keep pacemaker checkup appointments
- To work properly, your pacemaker should be checked periodically to find out how the leads are working and how the battery is doing.
- Show your pulse records to your healthcare provider.
- Make sure medications are working as they should and you're taking them properly.
- Ask questions and discuss your concerns. Make sure you understand your condition and all instructions.
- Avoid causing pressure over the area of your chest where your pacemaker was put in.
- Women may find it more comfortable to wear a small pad over the incision as protection from their bra strap.
- Feel free to take baths and showers. Your pacemaker is completely protected against contact with water.
- People with pacemakers can continue their usual sexual activity.
As they wear down, your pacemaker will slow but won't stop right away.
- Your doctor uses a special analyzer to detect the first warning that the batteries are running down, before you can detect any changes yourself.
- Sudden, major slowing down of your heart rate (which you may detect) probably indicates a more serious problem. Call your doctor immediately.
- Eventually your pacemaker will need to be replaced in a minor surgical procedure. Your healthcare provider can explain it to you.
When to call your healthcare provider
Contact your doctor immediately if:
- You have difficulty breathing.
- You begin to gain weight and your legs and ankles swell.
- You faint or have dizzy spells.
- Your pulse rate suddenly drops below the accepted rate or increases dramatically
- Your pacemaker is installed for a fast-slow type of heartbeat and your pulse is rapid and irregular (above 120 beats per minute).
Modern pacemakers have built-in features to protect them from most types of interference produced by other electrical devices you might encounter in your daily routine.
If you have an artificial pacemaker, always:
- Be aware of your surroundings and the devices that may interfere with pulse generators.
- Carry your pacemaker ID card to prove that you have a pacemaker.
- Tell healthcare professionals before they start any test or procedure using medical or electronic devices.
- Notify the doctor or nurse where you work that you have a pacemaker.
- Household appliances such as microwave ovens, televisions, radios, stereos, vacuum cleaners, electric brooms, electric blankets, electric knives, hair dryers, shavers, gardening machinery, toasters, food processors and can openers won't affect your pacemaker.
- If you suspect interference with your pacemaker, simply move away or turn off the equipment. Your pacemaker won't be permanently damaged and will resume its normal activity.
Learn more about devices that may interfere with a pacemaker:
Devices with risk
Anti-theft systems (also called electronic article surveillance or EAS): Interactions with EAS systems are unlikely to cause clinically significant symptoms in most patients. However, the American Heart Association recommends that you:
- Be aware that EAS systems may be hidden or camouflaged in entrances and exits in many businesses.
- Don't stay near the EAS system longer than is necessary.
- Don't lean against the system.
Metal detectors for security: Interactions with metal detectors are unlikely to cause clinically significant symptoms in most patients. However, the American Heart Association recommends that you:
- Don't stay near the metal detector longer than is necessary.
- Don't lean against the system.
- If scanning with a hand-held metal detector is necessary, tell the security personnel that you have a pacemaker. Ask them not to hold the metal detector near the device any longer than is absolutely necessary. Or ask for an alternative form of personal search.
Cell phones: Currently, phones available in the United States (less than 3 watts) don't appear to damage pulse generators or affect how the pacemaker works.
- Technology is rapidly changing as the Federal Communications Commission (FCC) makes new frequencies available.
- Newer cellphones using these new frequencies might make pacemakers less reliable.
- A group of cellphone companies is studying that possibility.
- Bluetooth® headsets do not appear to interfere with pacemakers.
MP3 player headphones: Most contain a magnetic substance and research has documented that placing the headphones too close to the pacemaker caused interference.
- Keep your headphones at least 1.2 inches (3 cm) away from your pacemaker.
- Never rest your head on the chest of a person with pacemaker while you're wearing headphones.
- Both the earbud and clip-on types of headphones can cause interference.
- Do not place headphones in a breast pocket or drape them over your chest.
Extracorporeal shock-wave lithotripsy (ESWL): a noninvasive treatment that uses hydraulic shocks to dissolve kidney stones.
- This procedure may be done safely in most pacemaker patients, with some reprogramming of the pacing.
- You'll need careful follow-up after the procedure and for several months to be sure your pacemaker is working properly.
- ESWL should be avoided in patients with certain kinds of pacemakers implanted in the abdomen.
- Discuss your specific case with your doctor before and after the treatment.
Magnetic resonance imaging (MRI): a noninvasive diagnostic tool that uses a powerful magnet to produce images of internal organs and functions.
- Metal objects are attracted to the magnet and are normally not allowed near MRI machines.
- The magnet can interrupt the pacing and inhibit the output of pacemakers.
- If MRI must be done, the pacemaker output in some models can be reprogrammed.
- Discuss with your doctor the possible risks and benefits before you undergo MRI scanning.
Power-generating equipment, arc welding equipment and powerful magnets: Such as found in some medical devices, heavy equipment or motors can inhibit pulse generators.
- If you work closely with or near such equipment, be aware of the risk that your pacemakers may not work properly in those conditions.
- Follow your healthcare provider's instructions about being around such equipment.
Radiofrequency ablation (RFA): A medical procedure that uses radio waves to manage a wide variety of arrhythmias.
- RFA is usually performed before the pacemaker is implanted.
- Studies have shown that most permanent pacemakers aren't adversely affected by radio frequencies during catheter ablation.
- However, if RFA is performed with a pacemaker, a variety of changes in your pacemaker are possible during and after the treatment.
- Your doctor should carefully evaluate your pacing system after the procedure.
Short-wave or microwave diathermy: A medical procedure that uses high-frequency, high-intensity signals for physical therapy. These may bypass your pacemaker's noise protection and interfere with or permanently damage the pulse generator.
Therapeutic radiation (such as for cancer treatment): May damage the pacemaker's circuits.
- The degree of damage is unpredictable and may vary with different systems.
- The risk is significant and builds up as the radiation dose increases.
- The American Heart Association recommends that the pacemaker be shielded as much as possible and moved if it lies directly in the radiation field.
- If you depend on your pacemaker for normal heart pacing, your electrocardiogram (ECG) should be monitored during the treatment, and your pulse generator should be tested often after and between radiation sessions.
Transcutaneous electrical nerve stimulation (TENS): A medical device used to relieve acute or chronic pain with electrodes placed on the skin and connected to a pulse generator.
- Most studies have shown that TENS rarely inhibits bipolar pacing.
- It may sometimes briefly inhibit unipolar pacing. This can be treated by reprogramming the pulse generator
Devices with little or no risk
Consumer appliances and electronics: in general, have not been shown to damage pacemaker pulse generators, change pacing rates or totally inhibit pacemaker output. Several of these devices have a small chance of causing interference by occasionally inhibiting a single beat. However, most people can continue to use these household devices without significant worry about damage or interference with their pacemakers.
- CB radios or amateur ("ham") radios
- Electric drills
- Electric blankets
- Electric shavers
- Heating pads
- Metal detectors for recreational use
- Microwave ovens
- TV transmitters and remote control TV changers
- MP3 players (but headphones should be kept at least 1.2 inches or 3 cm away from the device)
Office and light shop equipment: most pose no risk to your pacemaker.
- Copy machines
- Woodworking shop tools
- Light metalworking tools
Medical equipment: These devices do not appear to interfere with artificial pacemakers, but you should always tell your healthcare professional that you have a pacemaker before testing with electronic devices.
- Dental equipment: Some patients may feel an increase in pacing rates during dental drilling.
- Diagnostic radiation (such as screening X-ray)
- Electroconvulsive therapy (such as for certain mental disorders)
- Pills swallowed for video endoscopy