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.