A pacemaker is a battery-powered device about the size of a pocket watch that sends weak electrical impulses to "set a pace" so that the heart is able to maintain a regular heartbeat.
Some people who have atrial fibrillation need a pacemaker. The pacemaker does not treat atrial fibrillation itself. The pacemaker is used to treat a slow heart rate (bradycardia) that happens in some people who have atrial fibrillation.
There are two basic types of pacemakers.
- Single-chamber pacemakers stimulate one chamber of the heart, either an atrium or, more often, a ventricle.
- Dual-chamber pacemakers send electrical impulses to both the atrium and the ventricle and pace both chambers. A dual-chamber pacemaker synchronizes the rhythm of the atria and ventricles in a pattern that closely resembles the natural heartbeat.
All new pacemakers are rate-response, or physiologic, pacemakers. They can sense when your activity increases and respond by increasing your heart rate.
Rate-responsive pacemakers are often the ideal choice for active people. These pacemakers closely reproduce natural heart rhythms and are able to raise heart rate in response to physical activity. Your doctor can decide how fast the pacemaker should respond and how quickly your heart rate should return to a resting rate.
Permanent pacemakers are surgically implanted into the chest. The procedure to implant a pacemaker is considered minor surgery. It can usually be done using local anesthesia. The procedure takes about an hour. Permanent pacemakers are powered by batteries. The batteries usually last 5 to 15 years before they need to be replaced.
Temporary pacemakers are attached to the heart by a wire threaded through a neck vein, a leg vein, or through the chest wall. Temporary pacemakers are most commonly used for a short time following heart surgery or when waiting for a permanent pacemaker to be implanted.
What To Expect After Treatment
Most people stay overnight in the hospital after they have a pacemaker implanted. And they typically go home the next day. But sometimes the surgery is done as an outpatient procedure, which means you do not need to stay overnight in the hospital.
Most people return to normal activities after a few weeks. For several weeks after having a pacemaker implanted, avoid driving or doing vigorous physical activity that involves the upper body.
Some activities and situations can interrupt the signals sent by the pacemaker to the heart. You may need to adapt some of your activities. Follow your doctor's specific instructions about care and precautions.
Once or twice a year your doctor will check your pacemaker and adjust it, if needed.1 In between checkups at your doctor's office, you will probably send information from your cardiac device to your doctor. You will do this by using a telephone or the Internet.
Why It Is Done
Pacemakers are used to treat a slow heart rate (bradycardia) that can happen in people who have atrial fibrillation. You may need a pacemaker if:
- You have atrial fibrillation that comes and goes. And you have a fast heart rate when you are in atrial fibrillation and a slow heart rate when you are not in atrial fibrillation. This is called tachy-brady syndrome.
- You had an AV node ablation procedure that destroyed the AV node in your heart.
- You have a problem with the natural pacemaker of the heart (AV or SA node).
- You take a medicine for atrial fibrillation that slows your heart rate too much.
How Well It Works
Pacemakers stimulate the heart to speed up when it beats too slowly or reset the rate when the heart beats too fast. They can also substitute for the natural pacemaker of the heart (AV or SA node).
There are several risks to getting a pacemaker. But risks vary for each person. The chance of most problems is low.
The procedure to implant a pacemaker is safe, and most people do well afterward. You will see your doctor regularly to check your pacemaker and make sure you don't have any problems.
During the procedure. If problems happen during the procedure, doctors can likely fix them right away.
- A lung could collapse (pneumothorax). This happens if air builds up in the space between the lung and the chest wall. But a pneumothorax can be treated, and people recover well. This problem may happen about 1 to 5 times out of 100 procedures.2
- Serious problems during the procedure are very rare. These problems include heart attack, stroke, or the need for an emergency surgery. They might happen 1 time out of 1000.3
After the procedure. Problems after the procedure can be minor, like mild pain, or serious, like an infection. But your doctor can solve most of these problems. And most people do not have long-term issues with their pacemakers.
- Pain, bleeding, or bruising soon after the procedure.
- Blood clots in your arms, which cause a lot of swelling.
- Infection in your chest near the pacemaker. An infection might happen about 1 time out of 100. This means that about 99 times out of 100 there is no infection.4
- Device problems that need another procedure to fix them. This might happen if a pacemaker lead breaks or a lead moves out of place. A lead might move out of place about 1 time out of 100.5
What To Think About
In rare cases, people feel throbbing in the neck, chest fullness, or lightheadedness when the pacemaker sends out impulses. Talk to your doctor about what types of side effects you may expect from your pacemaker.
In rare cases, pacemakers are recalled by the maker of the pacemaker. A recall means that the pacemaker has a problem that needs to be watched closely or fixed. For more information on what happens if a device is recalled, see:
Wilkoff BL, et al. (2008). HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDS): Description of techniques, indications, personnel, frequency, and ethical considerations. Heart Rhythm, 5(6): 907-925. Available online: http://www.hrsonline.org/Practice-Guidance/Clinical-Guidelines-Documents/HRS-EHRA-Expert-Consensus-on-the-Monitoring-of-Cardiovascular-Implantable-Electronic-Devices/2008-Monitoring-of-CIEDs.
Baddour LM, et al. (2010). Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association. Circulation, 121(3): 458-477.
Swerdlow CD, et al. (2012). Pacemakers and implantable cardioverter-defibrillators. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 745-770. Philadelphia: Saunders.
Other Works Consulted
January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical ReviewerJohn M. Miller, MD, FACC - Cardiology, Electrophysiology
Current as ofFebruary 20, 2015