Last Updated: May 6, 2015
It's only about the size of a matchbook, but the life-altering
effects of a pacemaker can't be overstated. Whether a patient's
heart rate is erratic because of a heart
attack, illness or disease, a pacemaker implanted into the
chest can greatly increase quality of life.
After feeling lightheaded and dizzy at work in May of 2005, Gene
C., 67, of Juneau, Alaska discovered how urgently he needed a
pacemaker. After his family doctor consulted with a cardiologist at
Madigan Army Medical Center in Tacoma, Washington, Gene found
himself on an unplanned trip to Seattle.
"They said they wanted me down there immediately. My doctor
arranged for the ambulance to pick me up, then for the medivac to
Seattle, and I was at Madigan Army Hospital within four hours,"
Gene explains. "I wasn't really sure what was going on, but he said
this was a problem that had to be addressed."
After surgery, the only problem Gene had was with the pacing on
the pacemaker. He has an extremely low resting heart rate, in the
thirty to forty beats per minute range, and the pacemaker was
initially set at around fifty beats per minute.
"Needless to say I didn't get any sleep that night," he says,
"so they changed it down to forty."
Today, Gene no longer has problems with dizziness, and has
resumed his active lifestyle. "I walk and I climb up and down hills
with about 6-to-9 degree inclines, I shovel snow, and I can walk at
a fast pace," he says.
More than 600,000 people each year receive a pacemaker-a
battery-operated device implanted under the skin to regulate the
body's heart rate. More than 3 million people around the world
currently have a pacemaker, allowing them to resume normal
day-to-day functions with limited inconvenience.
The most common reason for pacemakers for seniors is
arrhythmia-an abnormal heart rhythm, caused by a disruption to the
heart's electrical system. Arrhythmia may be caused by a heart
attack or other injury to the heart, medication, or a genetic
How the Heart Functions
A human heart is comprised of four chambers: the right and left
atria are the upper chambers; the right and left ventricles are the
lower chambers. They must work together to keep the heart beating,
normally from fifty to one hundred beats per minute in adults. A
slow or rapid heart rate means not enough blood is being pumped to
all the internal organs. This can lead to shortness of breath,
fatigue, loss of consciousness, or confusion.
The sinus node (often called the body's natural pacemaker) in
the right atrium generates the initial electrical impulse, which
tells the right and left atria to contract and squeeze blood into
the ventricles. That electrical impulse then tells the ventricles
to contract, pumping blood to the rest of the body. But, with
arrhythmia, that electrical impulse is impeded.
A pacemaker consists of the pulse generator (a small metal
container with a battery and electrical circuits), and flexible,
insulated wires called leads, which deliver the electrical impulses
to the heart.
"Leads are basically a pair of coiled wires wrapped in silicone
or polyurethane that either have a screw in the end or a grappling
hook kind of thing that grabs onto the heart," explains Dr. Adam H.
Zivin, an electrophysiologist with the Swedish Heart and Vascular
Institute in Seattle. "One end is placed into the heart, the other
end is in the pacemaker. The procedure is relatively low risk," he
Implantation is done in a hospital. Patients are given local
anesthesia and mildly sedated using a drug such as
Valium®, and then the doctor makes an incision
underneath the collar bone, about 1-1/2 inches long. Using X-ray
imaging, the doctor guides the leads into the right ventricle and
right atrium (this is called a "dual chamber"
pacemaker**), then connects the other end to the
pacemaker. The pacemaker is inserted into a small pocket under the
skin and the incision sewn up.
The newer "rate responsive" pacemakers monitor factors such as
blood temperature and breathing rate, and adjust the pulse rate to
the body's needs, such as during exercise. Depending on the model,
pacemakers for seniors could be as tiny as a quarter and weigh less
than one ounce.
Caring for a Pacemaker
Zivin explains that the first pacemakers, used in the 1960s,
were about the size of a hockey puck and required much more
extensive surgery and post-operative care. Today's pacemakers
generally require an overnight stay, plus a few easy-to-follow
- Keep the arm closest to the pacemaker below shoulder level for
a couple of weeks, to keep from putting stress on the leads or the
incision site. (Pacemakers are usually implanted on the left side,
but not always.)
- Keep the incision site dry for the first few days, and watch
for infection (red skin or leaking fluid).
- Have the doctor check the incision site after one week.
- Follow-up with the doctor again from one to three months after
- Continue follow-ups with the doctor from every six months to
At those follow-up appointments, the doctor will fine tune the
pacing of the patient's pacemaker, and check the battery. Batteries
generally last five to ten years, depending on the type of
pacemaker. "The battery voltage declines slowly and predictably, so
it's important that they get follow-up," Zivin says. "So they'll
drop a little bit and they'll plateau, and drop a little bit and
plateau, so we know it needs to be replaced soon. And when we say
'soon,' we mean about six months."
Surgery to replace a pacemaker involves the same kind of
sedation as the original implantation. The doctor will open the
skin pocket, remove the old generator, and implant a new one.
"Assuming that the leads are okay, that's all you need to do, and
it only takes forty-five minutes," Zivin says. It is highly
unlikely that a lead will come unhooked, and usually only within
the first month while scar tissue is forming around it, which is
why it's so important to follow the doctor's orders those first few
Some pacemakers can be checked periodically via telephone, with
transmitters attached to wristbands on each arms, or a special
device placed over the pacemaker. Zivin says this is most useful
when a patient lives far from the hospital (as in Gene C.'s case)
and can't see the doctor as often as recommended.
In the past, people with pacemakers were told to stay several
feet away from microwave ovens, but that's no longer the case.
Everyday items such as radios, electric blankets and shavers, and
televisions pose no risk to pacemakers. However, patients should
always tell their doctors they have a pacemaker. Magnetic Resonance
Imaging (MRI), radiation for cancer treatment, and shock waves used
to break up kidney stones or gallstones can interfere with
pacemaker function, as can electrocautery procedures to control
It's also best to talk on cell phones on the opposite side of
the body from the incision site, to keep the pacemaker from
possibly misinterpreting a cell phone signal as a heartbeat.
After implantation, patients will be given an ID card stating
that they have a pacemaker, what precautions to take, and the name
of the company that produced the pacemaker. Patients should carry
it in their wallet at all times, and show it to airport security
personnel, who will likely hand-screen passengers with pacemakers
because they set off metal detectors. But, Zivin says it won't harm
the pacemaker: "They're very well shielded from electro-magnetic
Should a patient get close to a very large magnet, it could
change the pacemaker's frequency slightly, but it shouldn't cause a
problem for the patient. "It's an issue if you work in a power
plant or around large generators, or work on cars and use a timing
light, but it's pretty uncommon," says Zivin.
Pacemakers can be implanted into just about anyone of any age,
even infants. "There is no upper age limit, really. I put one in a
lady who fainted on her 100th birthday," says Zivin. "I have
patients in their twenties who have pacemakers and mountain climb.
I have one woman who's done the Ironman [Triathlon]."
While not every senior citizen is climbing mountains or
competing in triathlons, pacemakers for seniors can help give those
who need it the chance to enjoy a healthy, active lifestyle.
ICDs vs. Pacemakers: What's the Difference?
Some patients with fast and chaotic heart rhythms or who have
cardiac arrest need an implantable cardioverter defibrillator
(ICD), rather than a pacemaker. An ICD is larger than a pacemaker,
but implanted in generally the same area near the shoulder and
under the collarbone. The ICD delivers a small electrical shock to
the heart if the pulse exceeds a certain rate, resetting the heart
back to a normal rhythm.