A pacemaker is a battery-operated device (generally small in size) that is placed in the chest or abdomen of the patient and helps control abnormal heart rhythms or arrhythmias. Arrhythmia is a condition of the heart where the heart is either beating too slow, too fast, or with an irregular rhythm.

A pacemaker senses when the heart is beating irregularly, and sends low-energy electrical pulses to the heart to restore the normal rate.

Pacemakers generally have 2 parts:

• The pulse generator containing the battery
• The leads or wires that carry the electrical signals to the heart

A pacemaker is implanted beneath the skin under local anesthesia. The implantation procedure takes about 1 hour and the patient is awake during the procedure. A small incision is made, usually on the left side of the chest below the collarbone, and the pacemaker is placed under the skin. The pacemaker generator can also be placed in the abdomen, but this is done in very rare cases. The leads are then inserted into a vein and positioned using the fluoroscopy machine. After this, the leads are tested and programmed. Most people get back to their normal lifestyle within a short period of time.

Pacemakers are used by people who have heart problems that cause their heart to beat too slow or too fast. Having a pacemaker can be lifesaving for many heart patients

People who need a pacemaker:

• Those whose heart beats are too fast (tachycardia), or too slow (bradycardia) and cannot be controlled by medication
• Those with a heart failure, where a defect in the heart’s electrical signals cause the heart to stop beating
• Those having a particular type of heart block, where a delay in the electrical conduction makes the heart beat too slowly

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 Types of Pacemakers

 The classification of pacemaker needed for the heart will majorly depend on the condition of the heart and the symptoms. Once the consultants have evaluated the diagnosis, the next step is to decide which pacemaker shall be used and the same is conveyed to the patient.

1. Single-chamber pacemaker

The single-chamber pacemaker is equipped with a lead which connects the pulse generator to one of the heart chambers. This is the commonest used pacemaker used to control the pacing of the heartbeat by connecting the lead to the lower heart chamber or the right ventricle.

2. Dual-chamber pacemaker

The dual-chamber pacemaker is equipped with two leads which connect to the right-side chambers of the heart or the right atrium and the right ventricle. The pace contractions are regulated to both the chambers to help the heart pace work in a rhythmic pattern. The flow of the blood is also regulated from the right atrium into the right ventricle.

3. Biventricular pacemaker

The biventricular pacemaker or the cardiac resynchronization therapy (CRT) device is equipped with three leads that connect to the right atrium and both the left and the right ventricles. The patients diagnosed with arrhythmias are usually advised this pacemaker.

The biventricular pacemaker coordinates the contractions of both the ventricles to help them pump in unison. This results in more blood to be pumped from the heart and reverses the symptoms of heart failure. This is called the cardiac resynchronization therapy technique.

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