The heart has a natural pacemaker, a special group of cells which generate electrical impulses and conduct them to the heart muscle to ensure an adequate and regular blood supply to the body. At rest normal heart rate is 50 – 90 beat per minute. Any defect in impulse generation and conduction can cause disturbance in heart rate and rhythm. If the heart rate become too slow insufficient blood supply may cause dizziness, shortness of breath on exertion, fainting or loss of consciousness which can cause serious injury. Artificial pacemaker is needed to resume optimal heart rate. If the cause is reversible and correctable temporary pacemaker pacing wire inserted into the heart through the vein and connected to external artificial pacemaker may be sufficient. But if the cause is irreversible and uncorrectable permanent pacemaker implant is needed.

Permanent pacemaker is an electrical device battery operated sealed in a metal box size about 10-15 ml. Implantation includes insertion of pacemaker lead(s), for receiving and sending electrical signal between the pacemaker generator and the heart, into the heart chamber(s) through the vein usually beneath the collar bone. The lead(s) is(are) placed where the sensing and pacing parameters are acceptable. The lead(s) is(are) then connected to the pacemaker generator which is placed in the pocket under the skin usually on the chest below collar bone. The pacemaker will pace, by electrical stimulation, the heart at the programmed rate only when the patient’s heart rate sensed by the pacemaker is slower than the programmed rate.

After implant the patient will be asked not to move the ipsilateral arm vigorously for a few weeks. Depending on the patient’s condition driving may be allowed after the first pacemaker check, about 2 weeks after implant. Most of the houses hold electrical devices e.g. microwave oven, TV, home audio system, computer, home telephone and mobile phone can be used safely. The patient should avoid working with high power motoring devices e.g. chain saw, arc welder, not enter into the area with high electromagnetic field e.g. restricted area of the radio/TV stations, restricted area of the electric generator plant. Placing magnet direct on the pacemaker generator can switch the pacemaker function to a special mode and usually be done only by pacemaker specialist.

The patient will receive pacemaker identification card which should be carried with the patient especially when traveling or seeking medical service elsewhere. The patient needs regular follow up for pacemaker check 2-3 times within the first 6 months then every 6-12 months afterwards. The pacemaker check includes wound check, pacemaker generator function and battery status, and pacemaker leads. Most of the pacemakers today can store data about the patient’s heart rate and rhythm which is useful information for the physician to adjust treatment or pacemaker program.

Depending on usage, mainly affected by pacing output and pacing frequency, battery life is usually 5-10 years. If the ERI (Elective Replacement Indicator) is found during pacemaker follow up the pacemaker generator needs replacement. If the pacemaker leads are still in good condition, which is usually the case in most replacement procedures, the procedure includes only the generator change which is easier and takes much shorter time than new implant.