Pacemaker Surgery

Pacemakers help control heartbeat irregularities called arrhythmias by sending electrical pulses to your heart. These pulses help your heart beat at a normal rate.

Pacemakers also can track and record electrical activity in your heart as well as your heart's rhythm. This information can be sent wirelessly to your doctors, so they can monitor your well-being.

Electrophysiologists at Rush surgically implant these small devices in the chest or abdomen. As specialists, these doctors focus on providing lifelong care for people with arrhythmias.

As clinicians who are also researchers, our physicians continue to explore new treatment options and offer the latest advances in technology for their patients, such as leadless — or wireless — pacemakers (e.g., Micra) and His bundle pacing (a new technique that uses a patient's own electrical system to create a more uniform heartbeat).

Do I Need a Pacemaker?

Hearts sometimes beat too fast (tachycardia), too slow (bradycardia) or just out of sync. This occurs when your heart's internal electrical system sends faulty signals to your heart. And it can happen in children as well as in adults.

Doctors may recommend pacemakers in the following situations:

Aging or heart disease has affected your heart rhythm
You have atrial fibrillation and have difficulty managing the arrhythmia
You have long QT syndrome, which causes sudden, dangerous arrhythmia because of exercise or stress
Medications have slowed down your heart rhythm
Your heart muscles are weak, you have congenital heart disease or you have had a heart transplant

The following symptoms may indicate a heartbeat irregularity:

Fatigue
Fainting
Dizziness
Shortness of breath (dyspnea)

To determine if you have an arrhythmia or a heart problem, your doctor will perform tests that may include the following:

Electrocardiography (EKG)
Heart monitors
Stress testing

How Pacemakers Work

The typical pacemaker includes a battery, pulse generator and one to three wires with sensors (or electrodes) that connect the generator to parts of the heart. Recently, advances have been made to develop wireless pacemakers.

In general, here's what pacemakers can do:

Use low-pulse energy to adjust faulty electrical signaling
Speed up or control heart rhythm
Help heart ventricles contract normally and coordinate activity between the chambers of your heart
Record your heart's electrical activity and heart rhythm, information your doctor will use to meet your health needs

Types of Pacemakers

There are different types of pacemakers. Your doctor will choose the pacemaker that's right for your condition and needs.

Permanent or temporary pacemakers.
Single chamber pacemakers, which have one wire that carries pulses to the right ventricle of the heart.
Dual chamber pacemakers, which have one wire that carries pulses to the right atrium and another wire that delivers pulses to the right ventricle.
Biventricular pacemakers, which have three wires and deliver pulses to the atrium and both ventricles.
His bundle pacemakers, which replace the standard ventricular lead with a lead that stimulates the patient's own electrical system.
Leadless pacemakers, which are wireless and significantly smaller than standard pacemakers. This innovative technology, offered at Rush, has been associated with fewer complications than traditional pacemakers.

Pacemakers also have different types of programming. These are the main two types:

Demand pacemaker: Monitors your heart rhythm; only sends electrical pulses if your heart beats too slowly or skips a beat
Rate-responsive pacemaker: Slows down or speeds up your heart rate depending on your activity level, which is based on factors like breathing and blood temperature

His Bundle Pacing

His bundle pacing is an innovative approach in which permanent pacemaker leads are placed at the Bundle of His (or His bundle) instead of in the right ventricle (the traditional approach).

One of the potential drawbacks to placing leads in the right ventricle is that it causes the right ventricle to contract before the left ventricle, known as dyssynchrony. As a result, long-term right ventricular pacing has been associated with atrial fibrillation, cardiomyopathy (weakening of the heart muscle), hospitalization from heart failure and even an increased risk of death.

The His bundle is a part of the normal electrical conduction (wiring) system of the heart. It helps relay the electrical impulses produced in the atria (top chambers) to the ventricles (bottom chambers). Directly stimulating the His bundle helps the right and left ventricles to be more synchronized and squeeze at the same time. This can help you avoid the potential adverse effects of right ventricular pacing.

Electrophysiologists at Rush are among the most experienced in the nation in the use of His bundle pacing; we are one of the highest-volume His bundle centers in the region and have an outstanding 95% success rate, above the industry average of 80 to 90%.