If you are living with certain heart conditions, treatment can help relieve symptoms, improve your quality of life, and help protect against serious health problems, including heart failure and cardiac arrest. Often, lifestyle changes and medications are effective. But for many of my patients, a pacemaker or implantable cardioverter defibrillator (ICD) is needed to regulate the heartbeat or correct life-threatening arrhythmias.
Still, I know that recommending a pacemaker or an ICD can make patients and their loved ones feel overwhelmed or even scared. While these devices can be lifesaving, pacemakers and ICDs can also trigger a lot of questions. They often wonder how the device is implanted, how having one might affect their daily routines, and whether they will be able to resume or begin exercise or play a favorite sport.
If a doctor recommends an electrical heart device, it is extremely important for patients to have detailed discussions with their heart care team. By better understanding how these devices work, patients and their families can feel more comfortable and have a better outlook.
When these conversations happen in my office, here are some of the most common questions patients ask and what I tell them. You may have the same questions too.
Why might I need a pacemaker or an ICD?
Arrhythmias — heartbeats that are too fast, too slow or irregular — can be dangerous. They can cause symptoms such as fatigue, lightheadedness, shortness of breath, and fainting. Some arrhythmias, such as atrial fibrillation, raise the risk of heart failure or stroke if they are not corrected. Ventricular fibrillation, a serious arrhythmia, causes the heart to beat so fast that it cannot pump blood through the body, a potentially fatal condition called cardiac arrest.
Implantable cardiac devices such as pacemakers and ICDs can eliminate symptoms, protect against potentially fatal rhythm problems, and improve a patient’s quality of life.
Both pacemakers and ICDs use electrical pulses to keep the heart beating at a healthy, steady rate. Pacemakers keep the heart from beating too slowly by delivering electrical impulses through wires, also called leads, that are placed in the ventricles (chambers) of the heart. These electrical signals stimulate the heart muscles to pump blood at a normal rhythm and coordinate the beats between the heart's top and bottom halves. ICDs do this too, but they have the added function of treating rapid dangerous heart rhythms. They use more powerful electric shocks to stop abnormal heart rhythms and restore a normal heartbeat.
Will getting a pacemaker or ICD cure my heart arrhythmia?
A pacemaker or ICD stands in for the heart's natural electrical system when it is functioning abnormally. Both are highly effective treatments for heart arrhythmias, and they can help relieve symptoms, such as fatigue, shortness of breath, or fainting episodes, but neither device can permanently eliminate an arrhythmia. I tell my patients they may still require frequent monitoring, and they may still need to take medications.
My heart problem doesn't cause symptoms. Do I really need an implantable device?
I often recommend pacemakers and ICDs to patients with abnormal heartbeats — and individuals at risk for abnormal heartbeats. While an arrhythmia may not cause obvious symptoms, it can still trigger life-threatening emergencies without any warning. An implantable device acts as a valuable form of defense against these risks.
Can you feel or see a pacemaker or ICD?
The answer is different for different devices. Pacemakers and ICDs are usually inserted beneath the skin below the clavicle or collarbone. Neither device can typically be seen from the outside, but the implantation procedure may leave a small scar.
Patients don't notice the feeling of their pacemaker at work, as they put out very small electrical pulses. ICDs, on the other hand, can deliver a strong shock in response to an abnormal heartbeat. A serious arrhythmia, such as ventricular fibrillation or ventricular tachycardia, often causes patients to lose consciousness, so the shock isn’t felt. If a person is awake when their ICD delivers a shock, it can be uncomfortable, but that strong shock may also save their life.
Will my device wear out or need to be replaced?
Rest assured — batteries last for many years, and as long as you keep up with your checkups, you don't have to worry about your device suddenly stopping or running out of power. Your doctor will assess the function of your device at regularly scheduled checkups and determine if and when the battery needs to be replaced. You'll also learn how to check the function of your device at home.
How are these devices implanted?
Most pacemakers and ICDs are placed during minor surgeries under partial sedation. They require a one- to three-inch incision that causes some soreness for a few days. Patients generally recover very quickly and are often able to return to most normal activities within a few days. I always go over the procedure with my patients beforehand, answering their questions and addressing any concerns, so they feel comfortable and know exactly what to expect on the day of the procedure.
Does the procedure come with any risks?
Implanting a pacemaker or ICD is considered safe, and recovery is rapid. The procedure is an outpatient procedure, meaning my patients are not required to spend the night in the hospital. However, every surgical procedure carries some risks. It’s not common, but it is possible to develop complications from the implantation, such as infection. Your doctor will discuss the risks of your specific procedure.
What do I need to know about recovering after my implant?
It can take around eight weeks for your device to firmly settle into place. During this period, I tell my patients to avoid making sudden movements in which their arms are pulled away from their body (like swinging a tennis racket) and to limit pressure around the area where the pacemaker was implanted. Heavy lifting and high-impact activities are also off limits. Taking a shower is OK, but fully submerging under water is not permitted for six to eight weeks.
Can I do normal activities with my device?
Most patients are able to go about their day as usual within several weeks of their implantation procedure. Moderate physical activity and sexual activity are both OK. In fact, exercising regularly can help support healthy blood circulation.
Start slow, and step up your exercise routine gradually. Being active should help you feel invigorated, not exhausted. Ask your doctor for help choosing an exercise routine that’s right for you. I encourage my patients to find activities they enjoy, but, in most cases, I caution them to avoid contact sports, such as ice hockey or football. A hard fall or hit could cause a pacemaker or ICD to shift position. Activities that involve repetitive arm motions, such as golf, may put pressure on your device and risk damaging it. Ask your doctor about how your type of device and its placement may be affected.
Are there things I can or should do to support my device?
I emphasize to my patients the importance of understanding their device's programming. If you have a pacemaker, your doctor will program the device to keep your heart beating at a healthy rate. Your heart rate changes depending on your activity level. For example, your heart will likely beat faster during exercise than it does when you are sitting. Your doctor will choose a lower heart rate that is safe for you, as well as the maximum acceptable heart rate above the pacemaker rate. The pacemaker will follow those settings to determine when to send electrical signals to ensure your heart beats at a healthy rate. Your doctor will make sure you are fully aware of this information prior to you leaving the hospital.
After that, patients should regularly check their pulse to see that their heart rate is in the acceptable range and confirm that the pacemaker is working effectively. If arrhythmia medications have been prescribed, it's important to take those regularly as well.
Can I drive with a pacemaker or an ICD?
Most people can still drive with either a pacemaker or an ICD, however, restrictions may apply to hold a commercial driver’s license. Arrhythmias such as ventricular tachycardia and ventricular fibrillation can cause a person to faint, you may need to refrain from driving for a few months after the device is first placed and after receiving a shock from an ICD. You may also need to avoid driving temporarily if you're prescribed pain medication for the days following surgery. Rules and restrictions vary from state to state, the type of device and the indication, so it is best to speak to your doctor regarding driving restrictions.
Can I travel or go through airport security with a pacemaker or an ICD?
It's perfectly safe for people with pacemakers or ICDs to fly. Walking through a metal detector at airport security could set the detector off, so you should alert a TSA agent about your pacemaker, as they may request you to undergo a hand-wand screening.
Do I have to take care with cell phones or other devices?
Some electrical devices or those with strong magnetic fields can potentially disrupt a pacemaker or an ICD's electrical signal. I tell my patients that it's safe to use cell phones, but they should avoid placing their phone in shirt pockets. It is safe to use common household appliances like microwaves, heating pads, or remote controls.
Meet with an expert
Getting a pacemaker or an ICD can feel like a big step. But it's one that can protect your heart's function and even save your life. To learn more about electrical heart devices, schedule an appointment with one of our highly experienced cardiologists at the Temple Heart & Vascular Institute.
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