Irregular heartbeats can take a toll on your daily life. But a pacemaker can help improve the quality of life.

Ever felt your heart skipping a beat? A missing beat by itself might not be significant but if you notice other symptoms like fatigue, weakness, fainting spells, and an inability to cope with the normal routine then you need to see your cardiologist for a complete assessment of your heart’s functions.

Prema Raman* was in her sixties, an active woman who could multi-task with ease. But episodes of irregular heartbeats was taking an toll of her life. Prema’s cardiologist put her on a holter, which records one’s ECG for 24 hours during normal activity and the pulse as well. To her horror, the doctor told her that she needed a pacemaker. Apart from irregular heartbeats, she also bradycardia (slow heartbeat), which could be dangerous, with her pulse dipping to 35 at night when she was asleep. She was traumatised and terrified but felt better after her doctor explained what was happening.

When the heart’s two upper chambers, the atria, contract, blood is pumped into the two lower chambers, the ventricles. The ventricles then contract and pump blood to the rest of the body. The combined contraction of the atria and ventricles is a heartbeat. The heart has its own internal electrical system to control the rate and rhythm of heartbeats. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom.

Each electrical signal normally begins in a group of cells called the sinus node or sinoatrial (SA) node. As the signal spreads from the top of the heart to the bottom, it coordinates the timing of heart cell activity. Faulty electrical signaling in the heart causes arrhythmias.

Pacemakers use low-energy electrical pulses to overcome this faulty electrical signalling.

A pacemaker is a small device that is placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers are used to treat arrhythmias. A fast heartbeat is called tachycardia A slow heartbeat is called bradycardia. During an arrhythmia, the heart may not be able to pump enough blood to the body. This can cause symptoms such as fatigue (tiredness), shortness of breath, or fainting. Severe arrhythmias can damage the body's vital organs and may even cause loss of consciousness or death.

Pacemakers can be temporary or permanent. Temporary pacemakers are used to treat short-term heart problems, such as a slow heartbeat that is caused by heart attacks, surgery or an overdose of medicine. They are also used during emergencies. They might be used until your doctor can implant a permanent pacemaker or until the temporary condition goes away.

When is a pacemaker recommended? “Due to an atrio-ventricular block the heart rate may be low or absent resulting in momentary block or loss of consciousness, occasionally even seizures. Then pacemaker implantation is mandatory. A pacemaker is also useful when the pumping efficacy of heart is low,” says Dr. S. Thanikachalam, Chairman and Director of Cardiac Care Centre, Sri Ramachandra University, Chennai.

Aging or heart disease damages your sinus node’s ability to set the correct pace for your heartbeat. This can cause slower than normal heartbeats or long pauses between heartbeats. This condition is called sick sinus syndrome and also warrants implantation of a pacemaker.

What precautions are advised post-surgery?

“Since we keep our patients for a week following the procedure, we make sure the wound is healing well, and dressed regularly,” says Dr. T.R. Muralidharan, Electro-Physiologist, Professor of Cardiology, Cathlab-in-Charge SRMC who does about 70-80 pacemaker implants a year. “The patient is advised not to shower for the first two or three days, and not lift the arm above the head or carry even small weights, or stretch the arm for about six weeks. After a month, if there is any discomfort it should be reported.”

Regular check ups once in 4-6 months are advised. The patient is advised to get into mainstream activity gradually like travelling, driving the car, swimming, resuming the job, golfing, and walking which will make you return to normal. Even sex is not barred. But there are some things to be avoided like entering an electromagnetic field. One should keep away from transformers, electric arc welding equipment and airport screening devices. The pacemaker identification card helps. MRIs are definitely to be avoided.

“Generally, we tell patients to avoid induction cooking, but the risks I believe are fairly small,” says Dr. Girish Narayan, Cardiac Electrophysiologist and Cardiologist, Palo Alto Medical Foundation and Staff Physician, Stanford University Hospital, “but you can check with the manufacturer of the device.”

“You should use the mobile phone on the opposite ear, and at least six inches away from the implant,” says Dr Muralidharan. “Other household appliances like microwave oven, electrical appliances, computers can be safely used.”

Pacemakers do improve the quality of life and the implant is a small procedure, but check with the doctor before taking any decision.

What does a pacemaker do?

Relieves arrhythmia symptoms, such as fatigue and fainting

Helps a person with abnormal heart rhythms resume a more active lifestyle

Monitors and records heart's electrical activity and rhythm

Newer pacemakers also monitor blood temperature, breathing rate, and other factors and also adjust heart rate to changes in activity.