How To Avoid Getting A Pacemaker

Pacemakers use low-energy electrical pulses to control the rate and rhythm of your heartbeat. Traditional pacemakers send the electrical pulses through wires, also known as leads. Wireless pacemakers are a newer kind of pacemaker without wires.

Learn more about your heart's electrical system in our How the Heart Works Health Topic.

Traditional transvenous pacemakers

Traditional pacemakers (also called transvenous pacemakers) have three main parts.

A pulse generator creates the electrical pulses.
Wires (also called leads) are implanted inside the veins and carry the pulses to your heart.
Electrodes sense your natural heartbeat. When your heartbeat is slower than normal, the electrodes deliver electrical impulses to your heart to make it beat normally.

The device can send data to your doctor remotely. Your doctor will use these recordings to set up your pacemaker so it works better for you.

cross section of a pacemaker — The image shows a cross-section of a chest and heart with a traditional pacemaker, which has wires (leads). Figure A shows a double-lead pacemaker (also called a double-chamber pacemaker) in the upper chest. Figure B shows an electrode using electrical signals to activate the heart muscle. Figure C shows a single lead pacemaker (also called a single-chamber pacemaker) in the upper chest. Wireless pacemakers (not pictured) are placed inside the right ventricle.

A traditional pacemaker generator is placed outside of your heart, either in your chest or abdomen. It is connected via wires to electrodes inside one to three heart chambers.

Single- and double-lead pacemakers send pulses to the right side of the heart. A biventricular pacemaker sends pulses to both ventricles and an atrium . The pulses help coordinate electrical signaling between the two ventricles to help your heart pump blood. This type of pacemaker is also called a cardiac resynchronization therapy (CRT) device.

Wireless pacemakers

Wireless, or leadless, pacemakers are smaller than traditional types (about the size of a large pill capsule). The pulse generator and electrodes are all in one device that is placed inside a chamber of your heart through a small tube inserted in one of your veins. No surgery is needed. Once in place, the pacemaker then sends pulses to the right ventricle.

Your doctor may recommend a wireless pacemaker if you have a slow heartbeat, or if you have an electrical block, which is when the flow of electricity to the heart is delayed between the upper and lower chambers of your heart. Depending on the type, this kind of pacemaker may sense the right atrium (upper chamber), which allows it to match the signals that it sends to the ventricle. This helps the two chambers beat in sync.

Other types

In another type of pacemaker, the electrodes are placed on the surface of your heart rather than inside your heart. This type of pacemaker requires surgery.

Learn more about the different types of pacemakers in How Is a Pacemaker Placed?

Doctors also treat life threatening arrhythmias with a similar device called an implantable cardioverter defibrillator (ICD). The device constantly tracks your heart rate. If your heart shows an irregular and very fast rhythm, the ICD delivers an electric shock to reset your heart rhythm to prevent sudden cardiac arrest. Visit our Defibrillators Health Topic to learn more.

Before deciding to get a pacemaker, discuss your options with your doctor. You can bring along these and other questions you may have:

What are the benefits and risks of a pacemaker?
What other treatment options do I have?
How will a pacemaker affect my life?
What kind of pacemaker is best for me?
What happens during the procedure?
How long will the pacemaker last?

Children can outgrow their pacemakers. If your child needs a pacemaker, ask what will happen as they grow.

Preparing for the procedure

Unless it's an emergency, you and your doctor will plan for the procedure. Tell your doctor if you have an allergy to medicines or latex and if you are taking blood thinners or other medicines. Before your procedure, make sure you and your doctor discuss the following questions.

When should I stop eating or drinking before the procedure?
Should I continue taking my regular medicines?
When should I arrive at the hospital and where should I go?
How long should I expect to stay at the hospital?
How long will my recovery be? Will I be sore or not able to move?
What medicines should I take after the procedure?

If you will get medicine to relax or sleep during the procedure, plan to have someone to take you home. You may go home the same day or after a few days, depending on the procedure and your health.

Learn more about living with your pacemaker and how to check for problems.

The procedure may be planned ahead of time, or it may be done during an emergency (temporary pacemaker). You will be given medicine to make parts of your body numb or make you sleep during the procedure.

You may receive antibiotics to prevent infection and blood thinning medicine to prevent blood clots during the procedure. Different types of pacemakers require different procedures to place them.

Wired transvenous pacemakers

Many traditional, and all temporary, pacemakers are transvenous pacemakers, meaning the wires and electrodes are threaded through your veins. A doctor will thread the electrodes and wires through the veins in your neck, chest, or thigh, to the chambers of your heart. The electrodes are put in your heart muscle. The doctor may use echocardiography or X-ray to guide the process.

Once the wires are in place, your doctor will make a small cut into the skin of your chest or abdomen. He or she will slip the device with the generator just under the skin, then connect it to the wires that lead to your heart. Your doctor will test to see if it the device works properly and then sew the cut up. The entire surgery may take up to a few hours. Watch the video below to learn more.

You probably will not be allowed to move your arm for at least 12 hours after the procedure. This will help prevent disturbing the lead and the device and let your chest heal.

Epicardial pacemakers

With epicardial pacemakers, the electrodes are attached to the surface of the heart rather than inside its chambers. This is a surgical procedure done under general anesthesia. Your doctor will make a cut below your ribs or armpit to place the pacemaker. Epicardial pacemakers are used as a standard precaution during heart surgery.

They may also be used:

When a vein is blocked by a blood clot or plaque
When it would be difficult to insert the wires inside your heart chamber because of the structure of your heart or veins
When they are needed by newborns or children, who are the most common users
If you have a heart infection

Wireless pacemakers

Wireless pacemakers are a newer type of pacemaker. The pulse generator and electrodes are all in one small device that is placed inside the heart.

A doctor will thread a tube (called a catheter) through a vein in your thigh up to your heart. The catheter moves the pacemaker using X-ray images to place it in a heart chamber.

The procedure often takes less than an hour, and you may be able to leave the hospital the same day. Typically, the recovery time is faster and the risk of infection is lower. The battery life of the device is between 8 and 13 years .

A pacemaker can improve daily life for many people. Once you have a pacemaker, you will need regular doctor visits to check your health condition and the pacemaker. Carry your pacemaker ID card with you for emergencies. Show it to airport security, new doctors, or other people who need to know about your device. The card should have information on the type of pacemaker and leads you have, when you got the pacemaker, and your doctor's contact information.

Get your pacemaker checked

You may need to visit your doctor several times a year to check your pacemaker. In between visits, your doctor may be able to check that the battery and wires are still working.

You may also need to come in if your doctor needs to reprogram the pacemaker. You can check with your doctor regularly about device software updates and upgrades.

Avoid devices that interfere with pacemakers

If you have a pacemaker, avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields. These devices can disrupt the electrical signaling of your pacemaker and stop it from working properly. You may not be able to tell when this happens.

To be safe, keep your pacemaker at least 6 inches away from such devices or only use them briefly, when needed.

Cell phones. Use your speaker phone setting or hold the cell phone to the ear on the opposite side of your body. For example, if you have an ICD on the left side of your chest, hold your cell phone to your right ear. Avoid putting your cell phone in your shirt pocket.
Electronic cigarettes
Headphones. Most headphones have a magnet in them. Wear them as far away from your ICD as possible. Do not carry your headphones in a chest pocket.
Household appliances, such as microwave ovens, major appliances, electric blankets, and heating pads are usually safe if they are working properly.
Metal detectors, such as those used for airport security. The risk of harm is low, but your device may set off the metal detector. Body scanners used at airports appear to be safe for people with pacemakers, but you can show your ID card and ask for a separate screening.

If something disrupts your pacemaker, step away from whatever is disturbing it to help your pacemaker return to normal. Talk to your doctor right away about what else to avoid, as any kind of powerful electrical or industrial equipment can interfere with your pacemaker. This includes welding machines or electric fences for pets.

Medical and dental procedures that can affect your pacemaker include:

Electrocautery used during surgery to stop blood vessels from bleeding
Magnetic resonance imaging (MRI)
Microwave diathermy for physical therapy
Radiation therapy to treat cancer
Shock-wave lithotripsy to treat kidney stones
Transcutaneous electrical nerve stimulation (TENS) to treat pain

The effects depend on what type of device you have. Always tell your doctor or dentist that you have a pacemaker and show them the device ID card. They may be able to make certain changes if you need the procedure or test.

Learn how to manage problems with your pacemaker

It is important to pay attention to any changes or unusual patterns in your pacemaker. Call your doctor if you think there is a problem.

Know what to do if the device stops working. Pacemakers usually last for several years, but a part or the entire device may need to be replaced. Call your doctor immediately if you think your pacemaker may not be working properly. If it's not working, you may start feeling short of breath, dizzy, or faint.
Know your options and rights. You have the right to request the pacemaker be turned off or removed if it is no longer beneficial. For example, you may wish to turn it off if you are seriously ill or nearing the end of life. Discuss your options and plans with your healthcare team, caregivers, and loved ones. Your doctor may have you take part in an ethics consultation first to make sure you understand the risks. Visit the National Institute on Aging's Understanding Healthcare Decisions at the End of Life for more information.
Software updates. Talk to your doctor about how to regularly check for software updates that make the pacemaker more secure from hacking. When you visit the doctor, ask whether the manufacturer has announced any problems with your device.
Watch for signs of infection. Signs include fever, chills, and pain or redness where the pacemaker was placed. You may get these symptoms 6 months or more after surgery.

The National Heart, Lung, and Blood Institute (NHLBI) leads or sponsors many studies aimed at preventing, diagnosing, and treating heart, lung, blood, and sleep disorders.

Metabolic Mapping and Cardiac Resynchronization

This study will test whether a type of pacemaker called a cardiac resynchronization device can help the heart pump more blood in people who have mild heart failure (HF) and left bundle branch block. In the study, participants will have a cardiac resynchronization device implanted. To participate in this study, you must be at least 18 years old and have mild heart failure and a left bundle branch block.

Are you an adult living in Beijing, China, with a heart conduction disorder?

This study will investigate health outcomes among people with a heart conduction disorder that is sometimes treated with an implantable cardioverter defibrillator. To participate in this study, you must be between 18 and 60 years old and have complete left bundle branch block. The study takes place in Beijing, China.