Who needs a pacemaker?

Doctors recommend pacemakers for a number of reasons. The most common reasons are bradycardia and heart block.
Bradycardia is a slower than normal heartbeat. Heart block is a problem with the heart's electrical system. The disorder occurs when an electrical signal is slowed or disrupted as it moves through the heart.
Heart block can happen as a result of aging, damage to the heart from a heart attack, or other conditions that interfere with the heart's electrical activity. Certain nerve and muscle disorders also can cause heart block, including muscular dystrophy.
Your doctor also may recommend a pacemaker if:
  • Aging or Cardiac, Other Heart and Vascular Diseases damages your sinus node's ability to set the correct pace for your heartbeat. Such damage can cause slower than normal heartbeats or long pauses between heartbeats (as discussed above). The damage also can cause your heart to alternate between slow and fast rhythms. This condition is called sick sinus syndrome.
  • You've had a medical procedure to treat an arrhythmia called atrial fibrillation. A pacemaker can help regulate your heartbeat after the procedure.
  • You need to take certain heart medicines, such as beta blockers. These medicines may slow your heartbeat too much.
  • You faint or have other symptoms of a slow heartbeat. For example, this may happen if the main artery in your neck that supplies your brain with blood is sensitive to pressure. Just quickly turning your neck can cause your heart to beat slower than normal. If that happens, not enough blood may flow to your brain, causing you to feel faint or collapse.
  • You have heart muscle problems that cause electrical signals to travel too slowly through your heart muscle. (Your pacemaker may provide cardiac resynchronization therapy for this problem.)
  • You have long QT syndrome, which puts you at risk for dangerous arrhythmias.
    Children, adolescents, and people who have certain types of congenital Cardiac, Other Heart and Vascular Diseases may get pacemakers. Pacemakers also are sometimes implanted after heart transplants.
    This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.
Imran K. Niazi, MD
Clinical Cardiac Electrophysiology

Pacemakers are artificial electrically powered devices, about the size of a silver dollar, implanted under the skin of the chest. They regulate heart rhythm and prevent the heartbeat from stopping.

They are used in people with a slow heartbeat, or in people who have fainting spells due to the heart stopping momentarily. The average pacemaker last five to seven years, and then it needs to be replaced. Replacement is an outpatient procedure.

A pacemaker may be inserted in order to provide stimulation for a faster heart rate when the heart is beating too slowly, and when other treatment methods, such as medication, have not improved the heart rate.

Problems with the heart rhythm may cause difficulties because the heart is unable to pump an adequate amount of blood to the body. If the heart rate is too slow, the blood is pumped too slowly. If the heart rate is too fast or too irregular, the heart chambers are unable to fill up with enough blood to pump out with each beat. When the body does not receive enough blood, symptoms such as fatigue, dizziness, fainting, and/or chest pain may occur.

Some examples of heart rate and rhythm problems for which a pacemaker might be inserted include:
  • bradycardia -- occurs when the heart beats too slowly
  • tachy-brady syndrome -- alternating fast and slow heartbeats
  • heart block -- occurs when the electrical signal is delayed or blocked after leaving the SA node; there are several types of heart blocks
There may be other reasons for your physician to recommend a pacemaker insertion.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.