Other abnormal Heartbeats
Two or three of my friends now have a pacemaker. Although I have ‘funny’ heartbeats, I have not been offered one. When are they used?
Pacemakers will be used when the heart goes too slow. The heart can alternate between fast and slow; a pacemaker will still be needed as medication given to stop the heart beating too fast will make the slowing worse. A slow heart rate is known as a bradycardia. When the electrics of the heart fail to connect up, this is called heart block. There seem to be a lot of different methods of helping abnormal heartbeats.
Why was I offered electric shock treatment and not a pacemaker?
Shock treatment corrects a rapid abnormal heartbeat whereas a pacemaker corrects a slow abnormal heartbeat. If you have a mixture of fast and slow beats, you may need both treatments. If your heart occasionally speeds up, medication may be needed in addition to a pacemaker, to stop rapid palpitations or keep them under control.
I am going to have a pacemaker fitted next month – are there different types?
There are two types that your cardiologist will choose from, depending on which is most suitable for your problem.
• A temporary pacemaker will be needed sometimes after a heart attack if the electrics are bruised and a block occurs – it is fitted in an emergency.
• If the electrics are permanently slower or malfunctioning consistently, you will need a permanent pacemaker. If you don’t have this problem corrected, your body will lack oxygen and food; you will be tired and lethargic, and risk falling down from a blackout. These pacemakers are small and very reliable computers which can identify your normal heartbeats and the need to fill any gaps.
You may need a permanent system if your heart does not recover when the temporary system is switched off. You may be advised that one is needed when you are seen in the outpatient clinic, because your heart has been found to go too slowly at times.
I am rather nervous about having a pacemaker fitted. What will it involve?
For a permanent system, you will usually stay one night in hospital, although your hospital may undertake to fit the pacemaker as a day case. You will be told how long your stay is likely to be so that you can prepare a night bag if necessary.
For a temporary pacemaker, a wire is passed via a vein in the arm, neck or below your collarbone (most often) to the right ventricle (pumping chamber) and connected to a box at the bedside or attached to your arm. It is fitted under local anaesthesia. This senses normal beats and fills any gaps with pacemaker beats. When the electrics recover, it is removed by simply pulling the wire out; this is not painful.
For a permanent pacemaker, you will be given a local anaesthetic and sedation; then one or two wires are passed to your heart via a vein under the collarbone (the subclavian vein), or the one running on the inside of your shoulder (cephalic vein). The pacemaker box is attached and buried under the skin. The wires are positioned with X-ray guidance and the procedure takes about one hour. A small cut is needed on the front of your chest below the collarbone and stitches will be used to close it up at the end of the procedure. Stitches that do not dissolve will be removed 7 to 10 days later, usually by the nurse at your doctor’s surgery. Before you leave hospital, a chest X-ray will check that all is well, and the technician will use a computer placed on the skin over the pacemaker box to make sure that it is working properly.
Before my heart started to play up, I was very active. Will I be able to go back to that sort of activity when I have had my pacemaker inserted?
The short answer is yes. A pacemaker is all about correcting a problem and allowing you to lead a normal active life. You will need the stitches out a week after the insertion and you will have beengiven a course of antibiotics to protect you from infection. You will not be allowed to drive a car for a week, and you must inform the Drive License Department and your car insurance company. You may be able to hold a Group II licence if there are no other disqualifying conditions, but you will need to wait 6 weeks. Group I licences are for motorcyclists, car and light goods vehicle drivers; group II relates to drivers of vehicles in excess of 3.5 metric tonnes laden weight, and bus or coach drivers.
Group II standards apply to emergency police, firemen, ambulance drivers and taxi drivers in usual.
You will be given a check of your pacemaker function at 1 month and then once a year. This yearly check is to monitor its battery life. If the batteries begin to run down (many last over 10 years), the box will be unplugged from the wires and a new box implanted under sedation and local anaesthetic.
You will be given a card to carry with you at all times. You will need to tell airport security as you will set off the alarms. Modern household microwaves and electricity do not affect it but mobile phones may do if placed close to the box (about 10 cm). Avoid placing them in shirt or jacket pockets on the pacemaker side. You will not be able to have a magnetic resonance imaging scan.
Life should not be restricted just because of a pacemaker. Can pacemakers be troublesome?
Not usually, but occasionally they can cause soreness and, very rarely, become infected (it will then need to be removed). They may need adjusting from time to time – this is done via a computer placed over the box on the outside of the skin. Some early pacemakers developed faults and needed replacing. The wires in the heart do not usually displace after the first 24-48 hours. You can damage the wire or box in a heavy fall or accident, and it should be checked if this happens. Contact sports such as soccer or rugby should be avoided.
Most people have no problems at all but, if you do have concerns, contact your pacemaker clinic for advice.
When I went to see the cardiologist, he was very frank with me and said that the type of heart rhythm that I had was rather dangerous. He wants to insert an implantable defibrillator. Is this a type of pacemaker?
The official name for this is an automatic implantable cardio verter defibrillator or AICD and, yes, it also acts as a pacemaker. Some people have a very dangerous rhythm tendency which could cause them to drop dead suddenly. For people like you pacemaker wires are passed into the heart, under general or local anaesthetic, through the top of your chest wall through a big vein which runs under your collarbone (subclavian). The defibrillator box is attached and then buried under the skin of your chest wall; sometimes it is placed in the abdomen in your stomach area. It recognises normal beats but, if abnormal dangerous beats occur, it shocks your heart immediately. This may be felt as a slight thump. The machine needs checking at regular intervals to make sure that the battery life is satisfactory and, because it is a type of computer, it can also keep a check on how often it has been used. It is an expensive option but a definite lifesaver.
The British Heart Foundation book Implantable cardioverter defibrillators are a superb guide for patient and family.
A friend of mine has a defibrillator for atrial fibrillation – is this a new treatment?
Atrial defibrillators are rarely used. They are used in people who get very occasional attacks of atrial fibrillation – say, two or three a year. They are inserted under local anaesthetic similar to a pacemaker, and provide a shock to correct the atrial fibrillation when an attack occurs.
