PACEMAKERS AND DEFIBRILLATORS
There are a variety of devices that a physician may prescribe to assist your heart to function and extend your life.
There are two major categories of pacemakers.
- The most common type is used to regulate heart rhythm.
- A specialized pacemaker (biventricular pacemaker) was developed to treat the electrical abnormalities (Left Bundle Branch Block or LBBB) that can develop in DCM, and by doing so can improve the EF and improve survival. The type of therapy this specialized pacemaker delivers is called Cardiac Resynchronization Therapy or CRT. Most biventricular pacemakers also have a defibrillator function as well. In this case, the therapy is CRT-D.
Defibrillators are devices that have the primary function to detect and treat life-threatening heart rhythm abnormalities. When they detect fast life-threatening heart rhythms, defibrillators can perform appropriate functions to restore the heart to a normal rhythm. Much of the time the patient is not aware that the defibrillator may be performing some of these functions. However, sometimes it may be necessary for the defibrillator to deliver an electrical shock to the heart in order to restore a normal rhythm. In this case, most people are aware of a delivered shock as it is uncomfortable.
There are special defibrillator concerns during end-of-life and/or for those in hospice care. The patient may wish to “turn off” their defibrillator in order to avoid getting shocks. The patient should discuss this with their physician while the patient can communicate and make a competent decision.
Both pacemakers and defibrillators have two major components — the battery part and the electrical wires that deliver the electrical signal to the heart muscle. These electrical wires are called leads.
HOW ARE PACEMAKERS AND DEFIBRILLATORS IMPLANTED?
Pacemakers and defibrillators are implanted in much the same manner. The battery part is most commonly implanted below one of the collar bones, under the skin and fat but above the muscle, while the patient is under a local or general anesthetic. Leads are placed into the heart through large blood vessels in the chest. The leads are placed at specific locations within the heart (the particular location of placement is dependent on the type of pacemaker being implanted) and are attached to the battery part (pulse generator) of the device. See diagram under Conduction Abnormalities on DCM Foundation website
HOW LONG WILL THE BATTERY LAST, AND HOW IS IT EXCHANGED?
The life of device batteries depends upon the type of device one has and how often the battery is being used to deliver electrical energy. The battery for the most common type of pacemaker can last for many years, sometimes 10 years or longer. The battery life of the pacemaker used for CRT is much shorter, commonly around four years, but sometimes less. When the battery of the device is nearly drained, the battery part of the device is disconnected from the leads and removed. A new battery is implanted, in the same manner as it was originally, and the leads are connected to it.
Rarely, the leads may fail or need to be replaced. If this happens to you, your doctor can explain what caused this and what options are available.
LIVING WITH A PACEMAKER
Immediately following surgery, it is common to temporarily restrict movement of your arm on the side of your body the pacemaker was implanted. This is due to allowing the leads, which were inserted into your heart, to bond properly. Your doctor will advise you how long motion should be restricted, and it is vital that everyone receiving a pacemaker follow their doctor’s instructions. It is common to restrict driving, to reduce the possibility of quick and sharp pressure on the implantation site, during this period.
After the movement restrictions have been removed, one can resume a normal level of activity. Ask your physician for any activities that should be avoided. You may hear from many people and read about a whole series of activities you should avoid with a pacemaker. Some are accurate, some aren’t. Your physician and his or her medical staff are your best and most reliable resource persons for advice in this area.
Your device will be monitored by the doctor’s office as long as you have it. This is typically accomplished by a home monitor. The operation of a home monitor will vary according to manufacturer, but all have similarities. Home monitors record data from your pacemaker and transmit to your doctor’s office on a periodic basis, usually no less than every three months, but can be more often, depending on the circumstances. Your doctor’s office will advise you on how to use this device.
Some people may send a transmission from their home monitor to the doctor’s office when they have symptoms believed to be serious. You should ask your doctor when to do this, and what type of episode should be transmitted from the monitor to your physician.
Traveling with a Pacemaker You should have been given an implant card by your pacemaker nurse or cardiologist at the time of your implant. This card has important information about your device. You should carry it with you, especially when traveling. If traveling by air, it is recommended that people with pacemakers and defibrillators tell the TSA agent that they have a pacemaker. It is always a good idea to ask your pacemaker nurse or cardiologist if they advise any specific travel precautions for you. Your pacemaker nurse is an excellent source for you regarding travel issues.
It is always a good idea to ask your pacemaker nurse or cardiologist if they advise any specific travel precautions for you. Your pacemaker nurse is an excellent source for you regarding travel issues. There are excellent videos about walk-through metal detectors found in airports and the use of magnets close to your pacemaker.
Psychological Impact of having a Pacemaker Some patients react negatively to having a pacemaker, others, not at all. If you have negative views about your device, join a support group and discuss your concerns with others. There are many groups available in person and online.
To join device-related Facebook support groups, please visit:
– “Living with an ICD (Support Group)”
– “Pacemaker Support Group”
– “Living with a Medtronic Pacemaker, ICD, or CRT Device”
There are apps that can be used on smartphones and smartwatches to monitor heart rate, cardio function, and so forth. Do your own research to determine if any of these might be useful to you.
There are also medic alert bracelets or necklaces that some patients wear to inform others of their diagnosis. They commonly contain emergency phone numbers, medical contact information, and sometimes critical medications. Some patients find these items very comforting, others not so much. Personal preference will determine if one uses a medic alert.
Click here to review device-related questions and answers from our “Devices” webinar.
Click here to search for recorded webinars regarding “Devices.”
VENTRICULAR ASSIST DEVICES (VADs)
Ventricular assist devices assist your heart in pumping blood throughout your body and are used as a bridge to prolong life pending a heart transplant. They can also be used as the last major treatment for people with advanced heart failure who are not transplant candidates and have exhausted all other available therapies.