Pacemakers and Medications

Bradycardias are often treated with implantable pacemakers to speed up the heart beat. Anticoagulants may be prescribed. Commonly known as blood thinners, anticoagulants minimize the potential for blood clots to form that may cause strokes. A pacemaker is a device that gives your heart an electrical stimulus when your heart's natural pacemaker (called the sinus node) or the conduction pathways do not work as they should. When the pacemaker senses that the heart is beating too slowly, it sends an electrical impulse to make the heart beat. The implanted pacemaker does not compete with your natural pacemaker, but rather replaces it when needed. The electrical impulses are usually not felt. A pacemaker may be used alone or with medications.

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A pacemaker has several parts. The microprocessor, or logic circuit, is the "brains" of the device. A battery provides power, and the leads send the electrical impulse from the pacemaker to the electrode, which senses each beat of the heart and delivers the electrical impulse when needed. Rate-adaptive pacemakers can also sense increased activity----walking, running, or other types of exercise. These pacemakers monitor your heart rate and increase the rate to the right level for the activity. Sometimes a temporary pacemaker is inserted before a permanent pacemaker is implanted. It may be used for a short time, ranging from hours to days. It remains outside your body, and you have to stay in bed while the temporary pacemaker is in place. It will be removed after the permanent pacemaker is in place.

The type of permanent pacemaker used depends on your heart rhythm. The types include the following:

• Single-chamber pacemakers have one lead, which is placed in an upper or lower chamber of the heart.
• Dual-chamber pacemakers have two leads. One is placed on an upper chamber on one side of the heart, the other in a lower chamber.
• Biventricular pacemakers have leads in both lower chambers and usually also in an upper chamber of the heart. The biventricular pacemaker is used in patients with congestive heart failure due to fluid retention from a weakened heart muscle. This special type of pacemaker synchronizes the contraction of the right and left ventricles to improve the pumping action of the heart, increasing the patient's exercise ability.

There are risks associated with pacemaker implantation, including some serious risks, so ask your doctor about them before the procedure.

This section has more on:

• The implantation procedure
• Living with a pacemaker