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    PACEMAKERS
    Making sure the beat goes on

    Once, pacemakers were considered a novelty and medical miracle. Today, they're regulating the heartbeats of some 500,000 Americans.

    As the population ages, many more pacemakers will be implanted during the next 10 years. And thanks to advances in technology, pacemakers increasingly are responsive to the varying needs of your body.

    Keeping pace

    Under normal circumstances, your heart's natural pacemaker the sinus node runs like clockwork. It keeps your heart beating at an appropriate level for your daily activities. The sinus node is located in the upper right chamber (right atrium) of the heart. Special cells in the sinus node produce regular electrical impulses that normally travel to the lower chambers (ventricles) of your heart. With each impulse, your heart muscle contracts and blood is pumped throughout your body.

    However, if those regular impulses are slowed or disrupted, or there are abnormal electrical events in other parts of the heart, you may experience sudden faintness, dizzy spells or other symptoms.

    A disrupted or a slowed impulse may be related to aging of the heart muscle or scarring that can occur following a heart attack. In addition, some drugs used to treat heart disease or episodes of rapid heartbeat can impair the heart's normal rhythm.

    To get your body's all-important pump back to normal working order, your heart may need the help of a pacemaker.

    Inside the box

    A pacemaker is a small electronic device that stimulates your heart to beat. Essentially, it consists of two parts:

    *

    The pulse generator This small metal "can" houses a battery and electrical circuitry (a computer) that regulates the rate of electrical pulses sent to your heart. Usually, it's implanted in your chest, just below your collarbone.
    *

    Insulated leads These flexible wires deliver the electrical pulses to the heart. The wires, which are attached to the pulse generator, usually are threaded through a large vein into the heart.

    With advances made possible by the computer age, today's pacemakers are considerably smaller and lighter than their predecessors. Typically, the smaller models weigh less than an ounce and are not much bigger than three silver dollars sandwiched together. Battery life varies, but is generally about 6 years. The pacemaker must be replaced when the batteries wear out.

    Pacing for different needs

    In years past, pacemakers were set to pace the heart at one rate no matter what you were doing. Today, most are "rate-adaptive" they can be programmed to adjust your heartbeat rate to your activity level, mimicking your heart's natural beat.

    A pacemaker modifies that rate by tracking your sinus node activity or by responding to sensors that monitor body motion and depth or rate of breathing.

    Different pacing needs can be met depending on where the leads are directed and how the pulse generator is programmed. For example:

    *

    Atrioventricular sequential (atrial synchronous) pacing With this type of pacing, the leads are placed so they can sense heart activity and pace, as needed, first in an upper chamber of your heart and then in a lower chamber.

    Certain adjustments to atrial synchronous pacing can be helpful for people who experience a sudden drop in heart rate and blood pressure and are prone to fainting. To counter the sudden drop, the pacemaker is set to respond by briefly speeding up the heartbeat.
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    Dual-site atrial pacing With this configuration, which is still being investigated, leads are directed to stimulate both the right and left atria. This may reduce episodes of atrial fibrillation, an irregular heart rhythm where the upper chambers quiver continuously.
    *

    Biventricular pacing This type of pacing is still being studied and may be of particular benefit to people with heart failure. Biventricular pacing involves stimulating both the right and left ventricles of the heart. It's thought that by doing so, the heart's pumping action becomes more efficient.

    In addition to these types of pacing, pacemaker functions are now included in all implantable defibrillators devices used to shock a heart back into normal rhythm in case of sudden cardiac arrest.

    Based on a person's needs, implantable defibrillators can be programmed in several ways to "capture" a racing heart rhythm. One way is by briefly accelerating the heart rate even more, then bringing the rate back down within a normal range.

    Setting the pace

    Surgery to implant a pacemaker is a straightforward procedure, usually requiring no more than an overnight hospital stay. In most instances, local anesthesia is used and other medications are given intravenously to help you relax.

    Before you leave the hospital, your pacemaker is programmed to fit your particular pacing needs. A return visit is scheduled in several months to make more refined adjustments to the pacemaker settings.

    In addition, you'll have a follow-up care plan. This involves periodically having your pacemaker checked via telephone using a special phone transmitter. The transmitter is connected to wristbands on each arm. Then you place your telephone on the transmitter and hold a special magnet over your pacemaker. A technician on the other end of the line checks your heart rate and rhythm, pacemaker battery life, and if your pacemaker is working properly.

    What to expect

    Today's pacemakers are fully capable of mimicking your heart's normal rhythm. They're also tuned in to what your body needs from moment to moment. As a result, you can expect to go on with your normal activities, whether that's a round of golf or just trying to keep up with your grandchildren.


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