DEAR DR. GOTT: Please talk about pacemakers. I recently had to get one and would like to know as much about them as possible.
DEAR READER: Shame on your surgeon for not answering all your questions and putting your fears to rest before the surgery was ever performed! While I don’t know your medical history, age, medications and a host of other essential information, I will do my best to fill in the blanks.
A pacemaker is an electrical unit about the size of a pocket watch placed in the chest or abdomen to help the heart beat normally. It is used to treat arrhythmias — fast, slow or otherwise irregular beats. Without your pacemaker, when arrhythmias occurred, the heart may have been unable to pump sufficient blood throughout the body, causing symptoms of shortness of breath, fatigue and fainting.
Pacemakers are either temporary or permanent. Your surgeon may have inserted a temporary one because of a heart attack or inadvertent medication overdose. Once the condition resolves, the temporary pacer may be removed. If it fails to resolve problems, a permanent pacer may be appropriate. Permanent pacemakers control long-term problems with heart rhythms. The most common reasons for a permanent pacer are heart block or bradycardia. Heart block occurs because of a heart attack, aging, or some medical disorders. Bradycardia is a slow heartbeat, sometimes detected as a normal finding in athletes. This condition can even result if you are on a beta-blocker medication.
You likely had an EKG, Holter or event monitor that made your doctor refer you to a surgeon for follow-up. An EKG detects the electrical activity of the heart. A Holter monitor essentially performs the same service, but for a 24- to 48-hour period. You would wear one much as a doctor would wear a beeper on a belt. A similar device, known as an event monitor, would have been worn until you experienced symptoms and pushed a button on the unit so it would record the “event.” The unit might have been worn for a month or two until symptoms occurred.
If questions continued, an echocardiogram, electrophysiology study or stress test might have followed.
Your pacemaker will work to help maintain a normal heartbeat. At one stage in my career, pacers were good for about a year, and the patient had to return to the hospital for a battery change. Now, however, pacemakers typically last more than five years.
You were likely given instructions on what you could and couldn’t do following surgery, such as avoiding vigorous activity and lifting for a few months. You also should have been told to avoid prolonged contact with cell phones (if you have an older-generation pacemaker), metal detectors, anti-theft systems and devices with strong magnetic fields that could disrupt your pacemaker’s electrical signaling. This is not to indicate you should not use a cell phone, but you should not place it in a pocket over your pacemaker, and you might talk on it using the ear that is farthest away from the incision site. All doctors you visit should be aware you have an implantable pacemaker. You will not be able to have an MRI performed, use a TENS unit, electrocautery to stop bleeding during surgery, or shock wave lithotripsy for kidney stones. However, you will ultimately be able to return to most activity except for full-contact sports.
Readers who would like related information can send for my Health Reports “An Informed Approach to Surgery” and “Coronary Artery Disease” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order made payable to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing, or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.
