Cardiac Pacemaker Implantation

Cardiac pacemakers are sometimes used in patients with dilated cardiomyopathy to help maintain a stable heart rhythm. These small electronic devices, about the size of a stopwatch, monitor the electrical activity of the heart and synchronize the contractions within the heart. When necessary, the pacemaker will send an electrical impulse, which cannot be felt, to stimulate the heart to contract.

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The most commonly used pacemaker for cardiomyopathy is a dual chamber pacemaker, which attaches to the heart in two different places using tiny wires known as leads. This allows doctors to alter the sequence of contraction within the heart muscle. The placement of the leads on the heart and the setting of the time delay between the activation of the two leads are crucial to the success of this treatment.

Cardiac resynchronization therapy (CRT) uses a specialized pacemaker designed to coordinate how the heart beats. In addition to overall weakening of the heart muscle and poor contraction, many patients with dilated cardiomyopathy also have an abnormal pattern of contraction, with half of the heart pumping while the other half does not. CRT "re-times" the heart so that both sides pump synchronously. This has been shown to improve symptoms of heart failure and improve survival in appropriate patients.

Pacemakers are implanted in a hospital room equipped with special X-ray equipment. In adults, local anesthesia and sedation are used to minimize any discomfort felt during the procedure. The procedure begins with cleaning the chest with antibacterial soap and starting an intravenous line in the arm. The pacemaker leads are then inserted into a vein under the collarbone and guided into the heart; X-rays are used to help guide the placement of the pacemaker leads. After the leads are in place, the pacemaker is slipped into a small, surgically created pocket under the skin in the upper part of the chest. The pacemaker will then be fine-tuned to your specific heart rhythm over the next 24 hours. Upon dismissal, you'll receive a card that identifies you as having a pacemaker.

Ask your doctor about any restrictions on your activity before you leave the hospital. In most cases, physical activity can gradually be resumed, but your doctor will probably tell you to limit driving and participation in contact sports. The pacemaker must be monitored regularly, which can often be done by telephone using a special transmitter. Usually, weekly monitoring is recommended for the first four weeks, then once every three months after that.

General guidelines for people with pacemakers:

• Memorize the name of your device's manufacturer.
• Check with your healthcare provider before starting an exercise program.
• Do not drive until your healthcare provider says you may.
• Stay at least 8 feet away from arc welders.
• Avoid powerful magnets and heavy industrial equipment.
• Do not stand in entryways equipped with retail surveillance/shoplifting devices; walking past at normal speed should not interfere with the pacemaker.
• Keep cellular phones at least 6 inches from the pacemaker and use on the opposite side from the implant.
• Do not lean over a running engine; standing next to it is safe.
• Do not have magnetic resonance imaging (MRI).
• Before you receive any healthcare, be sure to tell the provider that you have a pacemaker.
• Tell healthcare provider about your pacemaker before a lithotripsy (procedure used to remove a kidney stone) or any procedures that involves using heat or electricity to burn tissue (cautery, diathermy, or radiation therapy).
• Whenever you have surgery, the surgeon must contact your cardiologist before the surgery because your pacemaker may need to be reprogrammed before the procedure.