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Pacemaker 101: What Are They and When Do I Need One
Pacemakers regulate heart rate on a beat-by-beat basis. Dr. Michael Link, electrophysiologist at UPMC Pinnacle Heart and Vascular Institute, discusses the ins and outs of pacemakers.
Featuring:
Michael Link, MD
Michael Link, MD is an electrophysiologist at UPMC Pinnacle Heart and Vascular Institute. He completed medical school at the University of Medicine and Dentistry of New Jersey, residency at the Hospital of the University of Pennsylvania and fellowships in cardiology and electrophysiology at Lankenau Medical Center. Dr. Link is board certified in internal medicine, cardiovascular disease and clinical cardiac electrophysiology. Transcription:
Bill Klaproth (Host): So, we’ve all heard of pacemakers but what is their exact function and how do you know if you need one? And we’re going to get an answer to the burning question. Can you still have a heart attack if you have a pacemaker? Those answers coming up with Dr. Michael Link, an Electrophysiologist at UPMC Pinnacle Heart and Vascular Institute. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. Link, let’s start here. What is a pacemaker?
Michael Link, MD (Guest): So, a pacemaker is a device which is implanted into the body which regulates the heartrate. It’s main function is to give you a minimum heartrate, no matter what. So, I like to explain that it gives a floor to how low your heartrate can go. It doesn’t do a whole lot for fast heartrates, but it guarantees that if your heartrate is too slow, the device kicks in, it adjusts that on a beat by beat basis.
Host: So, how would someone know if they need a pacemaker? What are the signs and symptoms.
Dr. Link: There are several symptoms that you may have. Unexplained fatigue, a tendency to what we call hit the wall with exercising where you just can’t get above a certain point no matter what and we’re not talking about elite training, saying just basic can’t go more than a couple miles an hour on a treadmill and the heart just doesn’t seem to kick in. Sometimes it’s for fainting. Sometimes it’s for just sudden weakness with extreme slow heart beating. It can come on gradually and it can come on suddenly. But they all have in common a very slow heartbeat that cannot be adjusted by the body.
Host: So, how do you diagnose this? How do you know if someone does need a pacemaker?
Dr. Link: It starts by checking a pulse and actually checking that your pulse is low. Now not everyone with a low pulse needs a pacemaker but that’s usually the clue that you may need one. And then it’s confirmed with a heartrate monitor. So, either a 12-lead EKG like you’d get in a hospital or a doctor’s office or an ambulatory monitor such as a Holter monitor or a newer one like a Zio Patch or a Loop Recorder and even sometimes we are seeing this with things like Fitbits and Apple Watches that people are wearing now as well.
Host: Really interesting. So, if someone does need a pacemaker, is getting a pacemaker major surgery?
Dr. Link: No, it’s not. And I think it’s important for people to know. I have witnessed people go through major open heart surgery and then it turns out they need a pacemaker and they are more concerned about the pacemaker than they were about the open heart surgery. And a pacemaker is very minor surgery. Believe it or not, it really is minor. It’s only a skin incision. It’s not open heart surgery at all. We just make a little pocket under the skin to fit the device and the wires are put down into the heart under x-ray guidance. So, there is no open heart surgery. It’s very minimal. We can even do them wide awake if necessary, just with local anesthesia.
Host: So, can somebody feel this? Do they notice it regulating the heart?
Dr. Link: People won’t feel the pacing, the actual act of the device pacing the heart. I get that question a lot. What they will tend to notice is just that their quality of life is better. I’ve seen people’s color be better like they go from being more pale to more of a pinkish color because they are getting better blood flow after getting a pacemaker. The times people feel it kick in can be under two circumstances. One, is if they have a function called rate responsiveness, so they’re exercising, and the device actually kicks in with rapid pacing. There are times people are aware, wow, my heart is a lot faster than it used to be. And there are some people that can tell when the ventricular pacing actually kicks in just because of the way that changes the feeling of the heart. I’ve gotten that before as well. But the actual feeling of the device delivering energy to the heart and pacing, one should never feel that.
Host: So, if a pacemaker regulates and controls the heart basically pacing it as you put it; can you still have a heart attack?
Dr. Link: So, yes and in fact, from my perspective, that’s a very – that question hits me oddly because a heart attack has nothing to do with the pacemaker. However, I get these kind of questions a lot from patients. And I think a lot of that is because of the sort of the misunderstanding of what a heart attack actually is. So, just very briefly, a heart attack is when an artery blocks off in your heart. So, basically think of it as shutting off the supply line of fuel to the heart muscle. If you shut your fuel line off to a car engine, it’s going to burn out very quickly and that’s the end of your engine. Well the same thing happens to the heart. If you suddenly block off blood flow, that part of the heart will actually die, and it turns into scar tissue. That’s a heart attack.
But what people are actually concerned about most of the time, is that they are going to suddenly drop dead. They say they suddenly “drop dead of a heart attack.” What that actually is, is ventricular fibrillation. That’s when the heart goes into electrical disarray and then just suddenly stops beating and that’s it. Yes, that can still happen with a pacemaker. Because it doesn’t affect that. Slightly different is a defibrillator which will fix that.
Host: So, then how often do you follow up or check on the pacemaker?
Dr. Link: Once a quarter. And most of the time now, that is done remotely so just through a device in your bedroom over the air waves and then you end up coming into the office once a year to have it checked in clinic.
Host: Okay and then for someone with a pacemaker, are there certain activities or things they should avoid because of it?
Dr. Link: Not really. Not in this day and age. But there are a couple of things that people should be careful of. When you go through airport security, they will set off metal detectors. So, it’s a good idea to tell TSA or whatever security agency you are going through that you have one. So, that you don’t set if off and then they can wand search you. But that one actually damages the pacemaker. About the only way I see patients damage pacemakers is with repetitive trauma such as putting a rifle stock up against it and firing hundreds of rounds. Unfortunately, we do see that occasionally so, it’s a good idea to shoot with the other shoulder.
Host: So, then if it is damaged or isn’t working properly; would the person know that? Would they feel it?
Dr. Link: Sometimes yes, sometimes no. So, if one has a pacemaker and is doing okay and then suddenly has a problem; that may be a sign the pacemaker is acting up. Or if you have excessive palpitations and you never had that before. Most of the time now, when there is an issue with the pacemaker; that remote alert that checks you once a quarter will actually send an alert. So, oftentimes, we know there’s a problem before the patient does.
Host: And Dr. Link, how long does a pacemaker last?
Dr. Link: The wires that we put in, we expect to be lifelong. They are not always. They fail probably about .1 to .2% of the time. The battery in the device can which actually goes in the chest. Depending on your usage and the company, can last anywhere from about five years to 15 years. I usually tell people that they last about seven to ten years on the average.
Host: And then last question Dr. Link. As far as physical activity goes; this shouldn’t hold anyone back from what they were doing before the pacemaker. If someone was a marathon runner, if you will; they should be able to go back to that. Is that right?
Dr. Link: Absolutely. The first month after you get one; it’s a good idea to not do extreme arm movements like real heavy lifting overhead or playing golf, tennis or bowling with that arm just to allow it to heal. Once a pacemaker is healed, you can pretty much do anything you want. In fact, it actually enhances people’s quality of life because often they could do it before and now, they can.
Host: Which has got to be a great feeling. Dr. Link, this has been fascinating. Thank you so much for your time. We appreciate it.
Dr. Link: Oh, you’re very welcome. Thanks for having me.
Host: That’s Dr. Michael Link, and for more information about cardiovascular services at UPMC Pinnacle please visit www.upmcpinnacle.com/heart. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So, we’ve all heard of pacemakers but what is their exact function and how do you know if you need one? And we’re going to get an answer to the burning question. Can you still have a heart attack if you have a pacemaker? Those answers coming up with Dr. Michael Link, an Electrophysiologist at UPMC Pinnacle Heart and Vascular Institute. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. Link, let’s start here. What is a pacemaker?
Michael Link, MD (Guest): So, a pacemaker is a device which is implanted into the body which regulates the heartrate. It’s main function is to give you a minimum heartrate, no matter what. So, I like to explain that it gives a floor to how low your heartrate can go. It doesn’t do a whole lot for fast heartrates, but it guarantees that if your heartrate is too slow, the device kicks in, it adjusts that on a beat by beat basis.
Host: So, how would someone know if they need a pacemaker? What are the signs and symptoms.
Dr. Link: There are several symptoms that you may have. Unexplained fatigue, a tendency to what we call hit the wall with exercising where you just can’t get above a certain point no matter what and we’re not talking about elite training, saying just basic can’t go more than a couple miles an hour on a treadmill and the heart just doesn’t seem to kick in. Sometimes it’s for fainting. Sometimes it’s for just sudden weakness with extreme slow heart beating. It can come on gradually and it can come on suddenly. But they all have in common a very slow heartbeat that cannot be adjusted by the body.
Host: So, how do you diagnose this? How do you know if someone does need a pacemaker?
Dr. Link: It starts by checking a pulse and actually checking that your pulse is low. Now not everyone with a low pulse needs a pacemaker but that’s usually the clue that you may need one. And then it’s confirmed with a heartrate monitor. So, either a 12-lead EKG like you’d get in a hospital or a doctor’s office or an ambulatory monitor such as a Holter monitor or a newer one like a Zio Patch or a Loop Recorder and even sometimes we are seeing this with things like Fitbits and Apple Watches that people are wearing now as well.
Host: Really interesting. So, if someone does need a pacemaker, is getting a pacemaker major surgery?
Dr. Link: No, it’s not. And I think it’s important for people to know. I have witnessed people go through major open heart surgery and then it turns out they need a pacemaker and they are more concerned about the pacemaker than they were about the open heart surgery. And a pacemaker is very minor surgery. Believe it or not, it really is minor. It’s only a skin incision. It’s not open heart surgery at all. We just make a little pocket under the skin to fit the device and the wires are put down into the heart under x-ray guidance. So, there is no open heart surgery. It’s very minimal. We can even do them wide awake if necessary, just with local anesthesia.
Host: So, can somebody feel this? Do they notice it regulating the heart?
Dr. Link: People won’t feel the pacing, the actual act of the device pacing the heart. I get that question a lot. What they will tend to notice is just that their quality of life is better. I’ve seen people’s color be better like they go from being more pale to more of a pinkish color because they are getting better blood flow after getting a pacemaker. The times people feel it kick in can be under two circumstances. One, is if they have a function called rate responsiveness, so they’re exercising, and the device actually kicks in with rapid pacing. There are times people are aware, wow, my heart is a lot faster than it used to be. And there are some people that can tell when the ventricular pacing actually kicks in just because of the way that changes the feeling of the heart. I’ve gotten that before as well. But the actual feeling of the device delivering energy to the heart and pacing, one should never feel that.
Host: So, if a pacemaker regulates and controls the heart basically pacing it as you put it; can you still have a heart attack?
Dr. Link: So, yes and in fact, from my perspective, that’s a very – that question hits me oddly because a heart attack has nothing to do with the pacemaker. However, I get these kind of questions a lot from patients. And I think a lot of that is because of the sort of the misunderstanding of what a heart attack actually is. So, just very briefly, a heart attack is when an artery blocks off in your heart. So, basically think of it as shutting off the supply line of fuel to the heart muscle. If you shut your fuel line off to a car engine, it’s going to burn out very quickly and that’s the end of your engine. Well the same thing happens to the heart. If you suddenly block off blood flow, that part of the heart will actually die, and it turns into scar tissue. That’s a heart attack.
But what people are actually concerned about most of the time, is that they are going to suddenly drop dead. They say they suddenly “drop dead of a heart attack.” What that actually is, is ventricular fibrillation. That’s when the heart goes into electrical disarray and then just suddenly stops beating and that’s it. Yes, that can still happen with a pacemaker. Because it doesn’t affect that. Slightly different is a defibrillator which will fix that.
Host: So, then how often do you follow up or check on the pacemaker?
Dr. Link: Once a quarter. And most of the time now, that is done remotely so just through a device in your bedroom over the air waves and then you end up coming into the office once a year to have it checked in clinic.
Host: Okay and then for someone with a pacemaker, are there certain activities or things they should avoid because of it?
Dr. Link: Not really. Not in this day and age. But there are a couple of things that people should be careful of. When you go through airport security, they will set off metal detectors. So, it’s a good idea to tell TSA or whatever security agency you are going through that you have one. So, that you don’t set if off and then they can wand search you. But that one actually damages the pacemaker. About the only way I see patients damage pacemakers is with repetitive trauma such as putting a rifle stock up against it and firing hundreds of rounds. Unfortunately, we do see that occasionally so, it’s a good idea to shoot with the other shoulder.
Host: So, then if it is damaged or isn’t working properly; would the person know that? Would they feel it?
Dr. Link: Sometimes yes, sometimes no. So, if one has a pacemaker and is doing okay and then suddenly has a problem; that may be a sign the pacemaker is acting up. Or if you have excessive palpitations and you never had that before. Most of the time now, when there is an issue with the pacemaker; that remote alert that checks you once a quarter will actually send an alert. So, oftentimes, we know there’s a problem before the patient does.
Host: And Dr. Link, how long does a pacemaker last?
Dr. Link: The wires that we put in, we expect to be lifelong. They are not always. They fail probably about .1 to .2% of the time. The battery in the device can which actually goes in the chest. Depending on your usage and the company, can last anywhere from about five years to 15 years. I usually tell people that they last about seven to ten years on the average.
Host: And then last question Dr. Link. As far as physical activity goes; this shouldn’t hold anyone back from what they were doing before the pacemaker. If someone was a marathon runner, if you will; they should be able to go back to that. Is that right?
Dr. Link: Absolutely. The first month after you get one; it’s a good idea to not do extreme arm movements like real heavy lifting overhead or playing golf, tennis or bowling with that arm just to allow it to heal. Once a pacemaker is healed, you can pretty much do anything you want. In fact, it actually enhances people’s quality of life because often they could do it before and now, they can.
Host: Which has got to be a great feeling. Dr. Link, this has been fascinating. Thank you so much for your time. We appreciate it.
Dr. Link: Oh, you’re very welcome. Thanks for having me.
Host: That’s Dr. Michael Link, and for more information about cardiovascular services at UPMC Pinnacle please visit www.upmcpinnacle.com/heart. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.