Cardiac pacemaker implantation

Cardiac pacemakers are not the first choice for patients with hypertrophic cardiomyopathy, but they can be used in those who are not candidates for--or don't want to pursue--other treatment options. 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 you cannot feel, to stimulate a contraction in a manner that lessens the symptoms of HCM.

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Dual chamber pacemakers, which have two leads that attach to the heart, are used to help relieve the symptoms of HOCM. This type of pacemaker allows doctors to modify the sequence of contraction within the heart muscle to help the left ventricle empty before obstruction occurs. 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 alternative.

Pacemakers don't work for everyone. Recent trials of patients with HOCM indicate that only 20 percent to 30 percent of patients experience a sustained improvement in their symptoms. Though nearly all patients say they feel better soon after the pacemaker is implanted, many patients report improvements in their symptoms even with the pacemaker turned off, indicating a significant placebo effect.

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 your collarbone and then into your heart; X-rays are used to help guide the placement of the 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. Over the next 24 hours, the pacemaker will be fine-tuned to your heart rhythm. Upon dismissal, you'll receive a card that identifies you as having a pacemaker.

Ask your doctor about restrictions on activity before you leave the hospital. In most cases, physical activity can gradually be resumed, but the doctor will likely tell you to limit driving and participation in contact sports. The pacemaker must be monitored regularly, which can 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 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 opposite side of 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 involve 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.