Most pacemakers are recommended when an individual experiences symptoms (such as fatigue, weakness, lightheadedness, shortness of breath or fainting) related to an inappropriately slow heart rate. When the heart beats too slowly, it does not pump enough blood to meet your body’s needs. Most commonly, the slow heart beat results from diseases in the heart’s own pacemaker (SA node) or in the heart’s conduction (‘wiring’) system. A mechanical pacemaker is designed to help the heart regulate and mimic a natural heartbeat.

In a mechanical pacemaker, there is a pulse generator that contains batteries and electronic circuitry that produce an electrical pulse or pulses to the heart muscle. This device is surgically implanted subcutaneously near the armpit. The pacemaker is connected to the heart by tiny wires called pacing leads. These pacing leads send an electrical pulse from the pacemaker to the heart.

Present day pacemakers are the size of a pocket watch. Most pacemakers operate only when needed—these are called “demand” pacemakers. Demand pacemakers contain sensing electronics which monitor for natural heart rhythm. Stimulation pulses are only provided to the heart if a natural rhythm is not detected.

Pacemakers are designed to provide up to ten years of service to a patient. However, the device is operated by batteries which will eventually run low. An indication is given to the patient with sufficient time (usually six months) to schedule a replacement procedure.

It is important to periodically check the pacemaker to make sure that it is functioning properly and that its settings remain appropriate for your medical needs. Therefore your doctor will schedule you for periodic follow-up checks. A typical follow-up visit to your doctor usually includes a brief physical examination, an electrocardiogram and a detailed evaluation of how well your pacemaker is performing. Examining and adjusting your pacemaker is quick and painless. Your doctor has special equipment that communicates with the pacemaker, allowing adjustment of its function without any additional surgery. In addition, some doctors use telephone monitoring (transtelephonic monitoring) to obtain information about your pacemaker.