Pacemaker
A pacemaker is a small device, about the size of a pocket watch,
that's placed under the skin near the heart to help control heartbeat.
People may need a pacemaker for a variety of reasons — mostly due
to one of a group of conditions called arrhythmias, in which the heart's
rhythm is abnormal. Normal aging of the heart may disrupt the heart
rate, making it beat too slowly. Heart muscle damage resulting from a
heart attack is another common cause of disruptions of the heartbeat.
Some medications can affect heart rate as well. For some, genetic
conditions cause an abnormal heart rate. Regardless of the underlying
cause of an abnormal heart rate, a pacemaker may fix it. A
pacemaker can often be implanted in the chest with a minor surgery.
Client may need to take some precautions in his daily life after
pacemaker is installed. Pacemakers consist of two components: an
electronic pulse generator and pacemaker electrodes, which are
located on leads or wires. The generator contains the circuitry and
batteries that generate the rate (measured in beats per minute) and
the strength (measured in milliamperes [mA]) of the electrical stimulus
delivered to the heart Leads can be threaded through a major vein
into the right ventricle (endocardial leads), or they can be lightly
sutured onto the outside of the heart and brought through the chest
wall during open heart surgery (epicardial wires). The epicardial wires
are always temporary and are removed by a gentle tug within a few
days after surgery. The complete code consists of five letters, but only
the first three are commonly used. The first letter of the code identifies
the chamber or chambers being paced—that is, the chamber
containing a pacing electrode. The letter characters for this code are A
(atrium), V (ventricle), or D (dual, meaning both A and V). The second
letter describes the chamber or chambers being sensed by the
pacemaker generator. Information from the electrode within the
chamber is sent to the generator for interpretation and action by the
generator. The possible letter characters are A (atrium), V (ventricle),
D (dual), and O (indicating that the sensing function is turned off).
Complications of Pacemaker Use
Complications associated with pacemakers relate to their presence
within the body, and improper functioning. The following complications may
arise from a pacemaker:
 Local infection at the entry site of the leads for temporary pacing, or at
the subcutaneous site for permanent generator placement
 Bleeding and hematoma at the lead entry sites for temporary pacing, or
at the subcutaneous site for permanent generator placement
 Hemothorax from puncture of the subclavian vein or internal mammary
artery
 Ventricular ectopy and tachycardia from irritation of the ventricular wall
by the endocardial electrode
 Movement or dislocation of the lead placed transvenously (perforation
of the myocardium)
 Phrenic nerve, diaphragmatic (hiccuping may be a sign of this), or
skeletal muscle stimulation if the lead is dislocated or if the delivered
energy (mA) is set high
 Rarely, cardiac tamponade from bleeding resulting from removal of
epicardial wires used for temporary pacing
At the completion of the home care instruction, the patient or
caregiver will be able to:
Monitor pacemaker function.
 Describe the importance of reporting to physician or pacemaker
clinic periodically as prescribed, so that the pacemaker’s rate
and function can be monitored. This is especially important
during the first month after implantation.
 Adhere to monitoring schedule as instructed after implantation.
 Check pulse daily. Report immediately any sudden slowing or
increasing of the pulse rate. This may indicate pacemaker
malfunction.
 Resume more frequent monitoring when battery depletion is
anticipated. (The time for reimplantation depends on the type of
battery in use.)
 Promote safety and avoid infection.
 Wear loose-fitting clothing around the area of the pacemaker.
 State
the
reason
for
the
slight
bulge
over
the
pacemaker
implant.
 Notify physician if the pacemaker area becomes red or painful.
 Avoid trauma to the area of the pacemaker generator.
 Study the manufacturer’s instructions and become familiar with
the pacemaker.
 Recognize that physical activity does not usually have to be
curtailed, with the exception of contact sports.
 Carry
and
medical
model
identification
number
of
indicating
pacemaker,
physician’s
name,
manufacturer’s
pacemaker rate, and hospital where pacemaker was inserted.
type
name,
Electromagnetic interference: Describe the importance of the
following:
 Avoid large magnetic fields such as those surrounding
magnetic resonance imaging, large motors, arc welding,
electrical substations. Magnetic fields can deactivate the
pacemaker.
 Some electrical and small motor devices, as well as
cellular phones, may interfere with pacemaker function if
placed very close to the generator. Avoid leaning directly
over devices, or ensure that contact is brief; place cellular
phone on opposite side of generator.
 Household items, such as microwave ovens, should not
cause any concern.
 When going through security gates (eg, at airports,
government buildings) show identification
card
and
request hand search.
 Hospitalization may be necessary periodically to change
battery or replace pacemaker unit.