Introduction

Heart rhythm problems (arrhythmia) occur when the electrical impulses produced by your heart that coordinate heartbeat do not function properly, causing your heart to beat too quickly, too slowly, or irregularly.

Age increases the probability of experiencing an arrhythmia. It can occur in people who do not have heart disease.

Some heart arrhythmias are harmless, though some types, such as ventricular tachycardia (fast heart rates), are serious and even life threatening.

Pacemakers represent one of the earliest and most successful nonpharmacological therapy for arrhythmias. Millions of pacemakers have been implanted since the very first pacemaker was implanted in 1958 by Elmquist and Senning. Drugs are no longer used except in the very acute setting before implantation of a temporary or permanent pacemaker.

How is it done

The procedure is done under local anesthesia. A skin incision is made below the collar bone, usually on the left side. A pocket to contain the pacemaker is then created. The vein behind the collar bone is punctured and via this vein, the pacing leads are advanced to the designated heart chambers. The pacing leads are then connected to the pulse generator and the whole system placed within the created pocket. The skin incision is then closed with absorbable sutures. It takes approximately 1 hour to implant a pacemaker. Most patients are discharged from the hospital within 24 to 48 hours after pacemaker implantation.

Pacemaker implantation can be performed with minimal morbidity and virtually no mortality. The risk of the procedure is generally about 1%, including bleeding, pneumothorax (airleak in the lung), cardiac perforation, long term risk of infection and device malfunction. It is now routinely implanted in almost all patients regardless of age as long as they have an appropriate indication and is expected to survive for at least the next 6 months.

Aftercare

A patient will need to carry pacemaker identification card to indicate the type of pacemaker that has been implanted. Devices such as anti-theft systems in stores, airport screening devices and metal detectors may interfere with the device’s performance although these occurrences are rare.

Microwave ovens and other common household appliances usually do not interfere with the function of these devices. However, mobile phones should be placed more than 15 cm from the ICD to prevent possible interferenced.

A patient with a pacemaker implanted should always inform his doctor or dentist before going for procedure which utilises medical or electronic devices for fear of potential interferences.