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Pacemakers

Pacemakers may prevent sudden death in children, adolescents and young adults. In 1986, Dr. Villafañe organized the first formal pacemaker clinic in the Commonwealth of Kentucky. During the past 25 years he has participated in clinical research, scientific presentations and lectures at the local, national and international level.

 

What is a pacemaker?

A pacemaker has two components: 1) the battery, which is called a pulse generator and 2) the pacemaker leads or wires which permits communication between the pulse generator and the human heart.

 

A pacemaker is a device used to stimulate the heart to contract in an organized fashion.

 

Pacemaker indications include heart block and very slow heartbeats, enough to produce symptoms.

 

How is the pacemaker implanted?

Pacemakers are either endocardial or epicardial systems. In an epicardial system, the generator will be placed in the abdomen and the wire(s) are attached to the outside of the heart. If an endocardial system is implanted, the wire(s) will be passed into a vein on the left (or right) neck or upper chest vein and then advanced into the inside part of the heart. The generator is then connected to these wires and placed under the muscle (or skin) under the shoulder.

 
ENDOCARDIAL SYSTEM

How does the pacemaker work?

The pacemaker generator or battery will deliver an electrical impulse through the pacemaker wires to the heart.

 

A pacemaker will usually last between 5 to 12 years. The longevity of the pacemaker depends on how often it is used, type of pacemaker system and the amount of energy required to stimulate the patient’s heart. Most systems are dual chamber pacemakers, which means that it will sense and pace (stimulate) the upper chamber (right atrium) and lower chamber (right ventricle) of the heart in a synchronized way. Some patients have a single-chamber unit, which will only pace the ventricle (or atrium).

 

The type of pacemaker system, whether it is epicardial or endocardial, or single or dual chamber pacemaker, will be determined and explained to you by Dr. Villafañe and the surgeon involved.

 

What to do after a pacemaker implantation?

Please keep the incision site clean and dry. Check the incision site for swelling, wound separation, drainage or unusual tenderness. Please notify us for any of these signs or if you develop any fever. The incision site may show some local redness for a few days. We should be notified if it becomes too red or if it involves a large area.

 

Any restrictions to exercise?

Most patients with pacemakers should avoid contact sports such as football, soccer, lacrosse, hockey, karate, boxing, etc. They should avoid weight lifting, dirt biking, high intensity skate boarding, jumping from heights or trampolines. A blow to the chest or abdomen next to the pacemaker can affect its function. A specialized protector over the pacemaker may help prevent trauma to the device. You should check with Dr. Villafañe before engaging in sports.

 

Precautions:

You should avoid MRI scanners and high-energy electrical fields, arc welders, big radar installations, melting furnaces, electric steel furnaces, chain saws, high-output radio transmitters and other high-current industrial equipment or working near radio and television transmitting towers and antennas. Cellular phones, microwave ovens and magnets should be kept at least 6 inches away from your pacemaker. Abstain from diathermy (the use of heat in physical therapy). You should turn off large motors (such as cars or boats) when working on them. When traveling you should take your pacemaker ID card and notify security personnel at airport metal detectors. If you experience any symptoms such as fatigue, dizziness or irregular heartbeats you should move away from the equipment that may cause interference with your pacemaker. If you are having a dental or surgical procedure performed you should let the surgeon or dentist be aware that you have a pacemaker. There might be electrical interference with their equipment or electrocautery. There are certain medical procedures that may rarely affect your pacemaker such as lithotripsy (a procedure that dissolves kidney stones), ablation, transcutaneous electrical nerve stimulation (a device used to relieve pain) or therapeutic radiation treatments for cancer. MP3 players and I-Pods seem to be compatible with pacemakers.

 

Pacemaker check-ups:

Your pacemaker will be checked on a bi-weekly, monthly or bi-monthly basis by means of a transtelephonic transmitter. You will be notified in advance of your pacemaker transmission date and it is vital that you keep that appointment. Many of the warnings that a pacemaker needs to be replaced are detected by means of the transtelephonic system. You should not take any risk by missing any appointments. If you think that your pacemaker has not been checked in the past two months you should call us immediately.

In addition, your pacemaker will be analyzed at our pacemaker clinic on an annual or semi-annual basis (depending on the age and model of your pacemaker). The pacemaker clinic is managed by Dr. Villafañe, who has specialized training in pacemakers. We are able to get stored information on your pacemaker by means of a special analyzer, which will give us additional data beyond the one that we can get from the transtelephonic pacemaker transmissions. In addition, your pacemaker system will be checked for any malfunctions by means of the analyzer, Holter recordings and annual chest x-rays.

 

When you should call us?

You should call 911 and our office in case of fainting and/or seizure activity. You should check your pulse and call us in case of lethargy or unusual fatigue, difficulty in waking up, dizziness, shortness of breath, electrical shocks, and persistent hiccups. Symptoms of pacemaker malfunction in infants include poor feeding, irritability, lethargy, fainting, respiratory distress, paleness or grayish skin color.

 

You should know what your pacemaker’s “low-rate” settings are and check your pulse rate (for a whole minute) regularly or if you are experiencing any of the above symptoms or any other unusual symptoms like just “feeling weird.” Please call us if your pulse rate in a whole minute is less than the programmed pacemaker “low rate.”

 

You should notify a family member if you are experiencing any of the above symptoms. In addition, we strongly recommend CPR training for the caretakers and immediate family members.

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