Having a pacemaker

So pacemakers are usually used to treat patients who have slow heart rhythm, so slow heart rates and some of the symptoms that these patients might complain of just feeling generally tired, feeling breathless when you're trying to exert themselves and most commonly patients complain of feeling dizzy or actually pass out when their heart rate's too slow and unfortunately there are no drugs that are available to increase a patient's heart rate. There are drugs that we can use to slow someone's heart rate but at the moment there are no drugs that patients can take on a daily basis to increase your heart rate. So how we overcome this or how we increase the patient's heart rate is by putting in a pacemaker. So what the pacemaker entails is that it has a generator or what we call a battery box which we place just under the left collarbone and it will have either one or two wires or sometimes even three wires that goes into a vein into the heart and these wires are able to stimulate the heart and make the heart beat faster and this normally improves the patient's symptoms quite dramatically. I'm just going to run through how exactly we do the procedure. These procedures are normally done as a day case, so the patients can come in during the day, get admitted in the morning, have their procedure done. They normally have a short recovery time from some of the sedation that we give or the painkillers that are given through the veins and they normally can go home the same day. So in terms of the actual procedure itself, this procedure is done in the cardiac catheter lab. Patients are done usually under sedation and also local anesthetic. Conventionally the pacemaker is put underneath the left collar bone or the right collar bone depending on the handedness of the patient. We make a small cut under the collar bone and then we make a pocket just underneath the skin where we'll be able to place the pacemaker. The wires are then introduced into one of the large veins, what we call the subclavian vein and this then passes and leads into the heart and there are various different types of pacemakers. The most simple pacemakers just involve one lead or one wire that goes into the main pumping chamber of the heart and that stimulates the heart and you have what we call dual chamber pacemakers where you have a lead that goes into the ventricle which is the main pumping chamber and also the atrium and this allows what we call the heart to beat in a synchronous manner. Your physician will tell you whether you need a single or a dual chamber pacemaker. The procedure itself normally takes any time between half an hour to an hour and unfortunately there are again complications involved with anything that's invasive, but again the complications rates are very small. The main complications are either bleeding or an infection and where we put the wires, the vein or the vessel that we go in runs very close to the lung and there's a small risk of puncturing the lung as we get the wire into the vein, but all these risks are again small. I would quote the risk of less than one in a hundred. There's also potential of the leads or the wires moving after the procedure and unfortunately when they do move the pacemaker won't function as well and the only option we have most occasions is actually to go back in and reposition the wires and that means that the patients will have to go undergo a second procedure. Patients again are discharged the same day. There are driving restrictions too when the patients had a pacemaker depending on the specific condition that they have. It may well be that they are restricted to drive for a week after having a pacemaker but sometimes it can even be longer depending once again whether they've had symptoms where they've passed out etc and the DVLA does give some guidance to this. So what happens after you have a pacemaker is that we'll bring you back in four to six weeks after that to have a check to make sure that the pacemaker is functioning well and to make sure that the wound has healed nicely. And thereafter you have checks in the pacemaker clinic every six months and thereafter yearly depending on how well your pacemaker is working. And most pacemaker has a battery life of approximately between 7 to 9 years. And the battery life really depends on how much you're using the pacemaker. Because some patients might be using the pacemaker all the time and some patients might only be using the pacemaker when their heart drops below a certain rate and hence the battery life might be longer in those patients. And when the battery does deplete, the pacemaker team, the pacemaker clinic will let you know when this is the case and you'll be brought in electively. And you have a very similar procedure to when you have a pacemaker put in, but in this instance the wires stay in and we don't need to put new wires. What we do is just we make a cut over where we've placed the pacemaker, remove the battery of the generator and reconnect it to a new generator and then so you back up. Again this procedure is quite routine, it probably takes 15 to 20 minutes and again it's done as a day case.