About to take the plunge!

I am 78 years old and have been slowly recuperating from congestive heart failure in 2004. My cardiologist says I am now a candidate for a pacemaker - since my heart condition has improved considerably, but the rate fluctuates to as low 30 bpm at times. The procedure is scheduled for 5/16. Anyone have any suggestions or words of encouragement? Don

7 Comments

Getting A Pacemaker

by SMITTY - 2008-05-08 08:05:29

Hello Don,

Welcome to the world of pacemakers and to the Pacemaker Club.

The following is an edited version of an article on getting a pacemaker. Also, I want to point out that possibly not all of it is applicable to you.

I recall how little I knew about pacemaker surgery and pacemakers when I was getting mine almost eight years ago, so I’m including anything that I think may help you understand. One other thing, this article deals mainly with a dual lead pacemaker. Since you have congestive heart failure, you probably have a low ejection fraction and it is possible that your doctor will implant a biventricular pacemaker. Both types of PM work the same but the bi-vent unit has three leads and also sends an impulse to the back side of the ventricle to cause it contract more completely. This increases the amount of blood pumped with each heart beat. I also have a low EF but my dual lead unit does everything I need. Your doctor will make the decision on which unit, dual lead or three lead, you need.

Having a pacemaker implanted is a fairly simple surgical procedure, but it does require a lifelong commitment. Keep in mind that pacemakers have been around for more than 30 years. With proper care, a pacemaker can help keep you feeling good for many years to come.
A pacemaker helps keep your heart from beating too slowly, but it doesn't stop your heart from beating on its own. The pacemaker "listens" to your heart. When the heart's own electrical system sends a signal and the heart beats, the pacemaker waits and does nothing. When the heart's system misses a signal, the pacemaker sends a signal to replace it.

The pacemaker will have a range in which it will help the heart. Mine is 70 to 110, which means that if my heart rate drops below 70 the pacemaker will come on line and try to maintain that minimum heart beat. It will remain “on line” helping as needed until my heart reaches 110 at which time it takes itself out of the picture. Since the PM is checking the heart each time to see if the heart will beat without help, if the heart is having PVC or skip beats, the pacemaker the PM may misinterpret one of them as the heart going to beat without help and the PM will not help. This can lead to a heart rate less than the low setting on th PM, which is what is happening to me right now. Because of PVC and skip beats that my PM thinks are going to be normal heart beats, my heart rate frequently drops to the low 40s. My experience has been that the heart can fake out the PM which results in a low heart rate at times.

Getting a pacemaker is a relatively minor procedure. A local anesthetic is given by injection to numb the area where the pacemaker will be inserted. This keeps you from feeling pain during the procedure. An incision is made in your skin below your collarbone to create a small "pocket.” The lead(s) for the pacemaker are threaded through the incision into a vein in your upper chest.

The pacemaker is attached to the leads. Then, the generator is placed in the pocket under your skin. The pacemaker's settings are programmed to help your heart beat at a rate that's right for you. The incision is then closed and covered with a sterile dressing.

After your pacemaker is implanted, you'll probably stay in the hospital for a day or two to be sure that there are no problems. When you go home, you will be given instruction on how to take care of the incision site as it heals. Your doctor may also schedule some follow-up visits. Your doctor will also tell you when you can go back to your normal activity.

Pacemaker batteries last about 5 to 10 years before they need to be replaced. Because the battery is sealed inside the generator, replacing a battery requires replacing the entire generator. This procedure is usually simpler and shorter than the initial implantation.

It isn't difficult to live with a pacemaker. You can usually do almost everything you did before you got your pacemaker, and since you will probably feel better, you may do even more. Modern pacemakers are well protected from outside signals, so there are very few things that can interfere with your pacemaker. Modern appliances are usually safe to around

I was younger than you when I got my PM in at age 71 in ‘00. If I had any restrictions imposed on my activities, I no longer remember them. In fact, within a few months after getting my PM, I completely forgot the thing. About the only time I am now aware of its presence is when I get a checkup every three months.

Good luck,

Smitty

Words of encouragement

by Blueaustralia - 2008-05-08 08:05:41

Yeah, keep in touch with us all. Hope everthing goes well and I know we will all be thinking of you and encouraging you to get well as soon as possible. Sincere wishes Billie

Go for it

by ElectricFrank - 2008-05-08 11:05:07

I'm also 78 and have had a pacer for 3 1/2 years. Properly adjusted they can make all the difference in how you feel. Just keep in mind that the pacer can't fix the damage done by the CGF, but it can get your heart rate back up to one that takes advantage of what you have left.
The most important thing is too get the pacer programmed to fit your body. They will likely leave it set to the factory programmed settings after implant. This is OK, but don't let them put you off for several months before doing a checkup. I insisted on one in about 2 weeks and had several close together until we got it right.
Be sure to get off on the right foot and let them know you want copies of the printouts of your settings. This tends to keep them honest as they know that the settings are part of your record.
Finally, a hint for comfort after the implant. It helps to put a pillow in front of you to support the arm on the side of the pacermaker. That way you can sleep on the opposite side and not have the weight of the upper arm put pressure on the incision area. I got a good nights sleep the first night after implant this way.

frank

To get the best result

by Terry - 2008-05-08 11:05:07

If you need ventricular pacing support, ask your EP about His bundle pacing for a natural ventricular contraction that won't give you the risks that Dr. Sweeney describes in his paper on the MOST Trial and also the DAVID Study. It can be done now.

Best wishes,
Terry

Thanks for encouragement!

by dsschaal - 2008-05-09 03:05:40

Thanks to all of you who have left comments so far. I really appreciate your good advice and encouragement. I will get back in touch after the implant and let you know how it all went. Will also pass on to my cardiologist the good advice from Smitty and Electric Frank. Don

Hang in

by Pete K - 2008-05-09 10:05:20

Hey Don, join da gang. I just got pacemaker about 5 weeks ago. First couple of weeks was a bit painful around the surgery area and shoulder. As has been said, iceing it helps a lot. Just hang back and give yourself some time to cope with it for the first 2 or 3 weeks. Not that you can't get up and do things, but you may not feel like doing much for most of that time and should take it easy while it's healing . Mine felt like the skin over the pacer was never going to stretch to accomadate it, but it soon does. By the third or fourth week, you're likely to find more energy than you've had in quite awhile. Makes it a bit harder by then to remember to keep that arm down, LOL.
Pete

don

by jessie - 2008-05-09 12:05:36

welcome to the pacemaker club! it is not so bad. they will put it in and you can have some sedation so you hardly will remember. after they kept me a day and then i went home with many instructions mostly not to raise my arm above my shoulder at all for 6 weeks . if you live alone you may need reminders of this like signs . tylenol should help the discomfort and ice. i slept supported ny nice soft pillows and was fine. also you can't vacuum or lift anything over 5 pounds as i remember. so good luck to you and we are here before and after for support. jess

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