If the need to have a pacemaker fitted arises, a small electrical device known as a pacemaker will be surgically implanted in your chest.

The pacemaker sends electrical pulses to your heart to maintain its regular beat and not too slowly. Having a pacemaker can drastically improve your quality of life if you have problems with a slow heart rate. The piece of equipment can be lifesaving for some people.

In Nigeria, pacemaker implantation is one of the main types of heart surgery carried out, with lots of pacemakers fitted each year.

How a pacemaker works
A pacemaker is a small device around the size of a matchbox or smaller that weighs 20 to 50g.

It consists of a pulse generator, a battery, a tiny computer circuit, and one or more wires known as pacing leads, which is attached to your heart.

The pulse generator sends out electrical impulses through the wires to your heart. The rate at which the electrical impulses are emitted is called the pacing rate.

Roughly all modern pacemakers work on demand. This implies they can be programmed to adjust the discharge rate in response to your body’s requirements.

If the pacemaker senses that your heart has omitted a beat or is beating too slowly, it sends signals at a steady rate.

If it senses that your heart is beating normally, it doesn’t send out any signals.

Most pacemakers have a unique sensor that recognizes body movement or your breathing rate.

This allows them to accelerate the discharge rate when you’re active. Doctors express this as rate responsive.

Implantable cardioverter defibrillators (ICDs)
An implantable cardioverter defibrillator (ICD) is a device like a pacemaker.

It sends a larger electrical shock to the heart that effectively “reboots” it to get it pumping again.

Some devices contain both a pacemaker as well as an ICD.

ICDs are regularly used as a preventative treatment for people thought to be in danger of cardiac arrest at some point in the future.

If the ICD senses the heart is beating at a potentially risky abnormal rate, it’ll send an electrical shock to the heart.

This often aids in returning the heart to a normal rhythm.

A conventional ICD has a pacing lead that’s implanted next to a vein (transvenous).

There’s also a newer model of ICD where the pacing lead is implanted under the skin (subcutaneously).

Why do I need a pacemaker?
The heart is a pump made of muscle, which is controlled by electrical signals.

These signals can turn out to be disrupted for several reasons, which can cause some potentially dangerous heart conditions, such as:

An oddly slow heartbeat (bradycardia)
An oddly fast heartbeat (tachycardia)
Heart block (where your heart beats irregularly due to the electrical signals that control your heartbeat aren’t transmitted correctly)
Cardiac arrest (when a crisis with the heart’s electrical signals makes the heart stop beating altogether).

How is a pacemaker fitted?
Having a pacemaker implanted is a moderately straightforward process.

It’s typically carried out under local anaesthetic, which means you’ll be awake during the procedure.

The generator is typically placed under the skin close to the collarbone on the left side of the chest.

The generator is joined to a wire that’s guided through a blood vessel to the heart.

The surgery often takes about an hour, and most people can leave the hospital on the same day or a day after the procedure.

After pacemaker surgery
You should be able to return to regular physical activities soon after surgery.

As a precaution, it’s normally recommended that strenuous activities are avoided for about 4 to 6 weeks after having a pacemaker fitted.

After this, you should be able to get involved in most activities and sports.

You’ll be able to feel the pacemaker but sooner or later, you’ll get used to it. It may seem a bit weighty at first and may feel uncomfortable when you lie in certain positions.

You’ll be required to attend regular check-ups to ensure your pacemaker is working properly. Most pacemakers save information about your natural heart rhythms.

When you go for follow-up appointments, your doctor can retrieve this information and use it to check how well your heart and the pacemaker are functioning.

Using electrical equipment
Anything that generates a strong electromagnetic field, like an induction hob, can get in the way of a pacemaker.

But most common home electrical equipment like the hairdryers and microwave ovens, won’t be a problem provided that you use them at least 15cm (6 inches) far from your pacemaker.

If you have an induction hob, maintain a distance of at least 60cm (2ft) between the stovetop and your pacemaker.

If this is a trouble, you may want to consider replacing the appliance with something more appropriate.

If you feel dizzy or feel your heart beating faster when making use of an electrical appliance, simply move away from it to allow your heartbeat to come back to normal.

Safety
Getting a pacemaker implanted is usually a very safe procedure with a minimal risk of complications.

The biggest worry is the pacemaker losing its ability to control the heartbeat, either because it malfunctions or the wire moves out of the right position.

It’s sometimes possible to reprogram the pacemaker to correct a malfunction using wireless signals.

However additional surgery may be required if the pacemaker moves out of position.

Alternatives to a pacemaker
In some cases, it may be possible to control an irregular heartbeat (arrhythmia) without having a pacemaker fitted.

For instance, Atrial fibrillation can sometimes be treated with medication or a non-surgical procedure known as catheter ablation.

However not everybody with an arrhythmia can be treated in this way, and in many cases, a pacemaker is considered to be the most efficient alternative.

If your cardiologist recommends having a pacemaker fitted, ask them why they think it’s the best choice and talk about any possible alternative treatments you could have.

New Technology
A new, smaller pacemaker around the size of a pill has been developed and is presently being tested in a global clinical trial.

The new device makes use of wireless technology and can be implanted directly into the heart, where it sends electrical impulses from an electrode.

This means a pacing lead isn’t necessary, which lowers the risk of infection and reduces the recovery time associated with implanting traditional pacemakers.