Pacemaker and Defibrillator Department

Cardiac pacemakers may be inserted into patients with symptoms resulting from excessively slow heart rates or blocked electrical signals in the heart. Pacemakers correct this problem by electronically stimulating the heart muscle to contract at a normal heart rate. Our practice implants pacemakers and provides for follow-up of patients with pacemakers.

Cardiac defibrillators are placed into people at risk for life-threatening rhythm disturbances. These devices may initially attempt to pace the heart out of the life- threatening rhythm disturbance or if needed, shock the heart back to a normal rhythm. Some patients are candidates to receive a defibrillator (or pacemakers) that can actually strengthen a weak heart. Our practice arranges implants and provides follow-up for patients with defibrillators. Heart rhythm disturbances can be evaluated by monitoring the rhythm of a patient for 24 to 48 hours by a holter monitor or for several weeks by a cardiac event recorder.

Pacemakers & Defibrillator Services

• Cardiac pacemaker implant
  
• Pacemaker testing and reprogramming
  
• Implantable cardiac defibrillator
  
• Implantable cardiac testing and reprogramming
  
• Biventricular pacing

How Does a Pacemaker Work

A pacemaker system consists of a battery, a computerized generator, and wires with sensors called electrodes on one end. The battery powers the generator, and both are surrounded by a thin metal box. The wires connect the generator to the heart.

A pacemaker monitors and helps control your heartbeat. The electrodes detect your heart’s electrical activity and send data through the wires to the computer in the generator.

If your heart rhythm is abnormal, the computer will direct the generator to send electrical pulses to your heart. The pulses then travel through the wires to reach your heart.

Newer pacemakers also can monitor your blood temperature, breathing, and other factors and adjust your heart rate to changes in your activity.

The pacemaker’s computer also records your heart’s electrical activity and heart rhythm. Your doctor will use these recordings to adjust your pacemaker so it works better for you.

Your doctor can program the pacemaker’s computer with an external device. He or she doesn’t have to use needles or have direct contact with the pacemaker.

Pacemakers have one to three wires that are each placed in different chambers of the heart.

• The wires in a single-chamber pacemaker usually carry pulses between the right ventricle (the lower right chamber of your heart) and the generator.
• The wires in a dual-chamber pacemaker carry pulses between the right atrium (the upper right chamber of your heart) and the right ventricle and the generator. The pulses help coordinate the timing of these two chambers’ contractions.
• The wires in a biventricular pacemaker carry pulses between an atrium and both ventricles and the generator. The pulses help coordinate electrical signaling between the two ventricles. This type of pacemaker also is called a cardiac resynchronization therapy (CRT) device.

The illustration shows a cross-section of a chest with a pacemaker. Figure A shows the location and general size of a double-lead, or dual-chamber, pacemaker in the upper chest. The wires with electrodes are inserted into the heart's right atrium and ventricle through a vein in the upper chest. Figure B shows the electrode electrically stimulating the heart muscle. Figure C shows the location and general size of a single-lead, or single-chamber, pacemaker in the upper chest. The wire with the electrode is inserted into the heart's right ventricle through a vein in the upper chest.

Types of Pacemaker Programming

The two main types of programming for pacemakers are demand pacing and rate-responsive pacing.

A demand pacemaker monitors your heart rhythm. It only sends electrical pulses to your heart if your heart is beating too slowly or if it misses a beat.

A rate-responsive pacemaker will speed up or slow down your heart rate depending on how active you are. To do this, the rate-responsive pacemaker monitors your sinus node rate, breathing, blood temperature, and other factors to determine your activity level.

Most people who need pacemakers to continually set the pace of their heartbeats have rate-responsive pacemakers.

Information provided by National Heart Lung and Blood Institute