Pacemakers — electronic devices used to prevent the heart from beating too slowly — have come a long way since battery-operated, portable pacemakers were invented in the 1950s. The very first pacemakers were pushed around on carts; subsequent models were worn around patients’ necks. Today, advances in miniaturized technology have led to some pacemakers small enough to be implanted directly in the heart.

“There are increasingly more types of pacemakers as we move forward in technology, and the implants have become very routine,” says Dr. David Slotwiner, an electrophysiologist and chief of cardiology at NewYork-Presbyterian Queens. “Fortunately, the risk of any serious complication is very low.”

While some people still believe that having a pacemaker restricts your life, today’s pacemakers allow patients to go back to their normal activities, including exercise and travel. “There’s really nothing that somebody with a modern pacemaker cannot do,” Dr. Slotwiner says.

Health Matters spoke with Dr. Slotwiner about who can benefit from a pacemaker, what to expect from the implant procedure, and what to know about living with the device.

Why do some people need a pacemaker?

A pacemaker is designed to prevent the heart from beating too slowly. For example, the heart may not be able to generate each electrical impulse, it may temporarily stop, or the nerve that carries the electricity from the top of the heart to the bottom chambers may wear out. These are often degenerative conditions that occur as a person ages and can cause dizziness, fainting, and shortness of breath with exertion.

What types of pacemakers are available?

A traditional pacemaker is implanted in the chest with one or two flexible wires, called leads, that are guided through a blood vessel into the heart. Single-chamber pacemakers are attached to one chamber of the heart. A dual-chamber pacemaker is attached to a top chamber, or atrium, and a bottom chamber, or ventricle. Some patients can benefit from a newer type of device called a biventricular pacemaker, which controls the pacing of three chambers. 

Over the last decade, a new category has emerged called leadless pacemakers, which are implanted directly in the heart and don’t require any wires. There are also single-chamber and dual-chamber leadless pacemakers, as well as an emerging type of three-chamber leadless pacemaker. Patients should talk to their physician about which device is right for them.

What should patients expect when a pacemaker is implanted, and what are the risks?

The procedure to implant a pacemaker is minimally invasive and most patients will go home the same day. While the chance of a serious complication is very low, there are always some associated risks, including infection, bleeding around the heart, or air leaking around the lung. These complications are all treatable and rare.

For traditional leaded pacemakers, the biggest risk is of the leads dislodging in the first few weeks after they are implanted. For the first six weeks after surgery, we tell patients to avoid lifting anything heavier than 10 pounds with the arm on the side of the implant, and we ask that they not lift their hand above their head. After six weeks, the tissue grows around the leads and the risk of dislodgement becomes very low.

What should people know about living with a pacemaker? Are there any restrictions to exercise or travel?

Once the recovery period has passed, I encourage patients to go back to their normal lives. There are certain repetitive arm exercises that might place the leads at slightly higher risk of fracturing over time. However, the benefits of being active far outweigh the very small risk that activity could eventually damage the leads.

I often get questions about the risks of having a pacemaker around microwaves, airport or store security devices, cell phones, and MRI machines.

• Many people believe there are still risks to having a pacemaker around microwaves, but that is no longer the case with modern devices.
• It’s best not to stay next to an airport security or store security device for a prolonged period, but it is not dangerous to walk through them.
• Cell phones are generally fine, but patients should be aware that some larger cell phones contain a strong magnet that may cause the pacemaker to pace at a certain speed if it is in close proximity. This response is not dangerous, but it’s best to avoid having a strong magnet within six inches of your pacemaker.
• If you need an MRI, talk to your implanting physician first. Most implants from the past 10 years can go through an MRI, but they typically have to be reprogrammed for the scan.

How long do pacemaker batteries last?

The batteries last about 10 years on average, and some last up to 15 years. Once the battery on your pacemaker runs low, it is generally a simple outpatient procedure to replace the pacemaker’s battery-powered generator.

How do doctors make sure the device is working properly?

Pacemakers store an enormous amount of data about the function of the device, and about the patient’s heart and heart rhythm. Each of our patients receives a remote monitor that they leave next to their bed at home and, in the middle of each night while they’re sleeping, the monitor is able to wirelessly connect to their pacemaker and send that data to our team for review. Some newer pacemakers can even be monitored via a smartphone — either through a special app on the patient’s phone or through a dedicated smartphone provided by the manufacturer.

Remote monitoring requires working in partnership with our patients to make sure we’re receiving the data regularly, but this system allows us to detect problems long before patients have symptoms, so they can continue living active lives.

What is the difference between a pacemaker and an implantable cardioverter defibrillator (ICD)?

ICDs are a different category of device. Like pacemakers, defibrillators are electronic devices that monitor the heart rhythm, but their primary purpose is to monitor for a cardiac arrest and give a sudden powerful shock to reset the heartbeat. They are generally for patients with significant heart muscle damage that leaves them at risk of a heart attack.

Are there any treatment alternatives to receiving a pacemaker?

Before recommending a pacemaker, we always first make sure there are no reversible causes for why a patient’s heart is beating too slowly. Some medications can cause this, thyroid disorders may cause this, and some infections can cause this – such as Lyme disease. If there is a reversible underlying reason for the slow rhythm, we always try to treat this first.