Question: When is a pacemaker recommended, and what are the risks associated with it?
Dr. Hibberd's Answer:
Pacemakers are used to support the electrical signal from your heart muscle when the proper signal fails, which can cause the heart fail to skip beats or to even stop. This is often caused by sick sinus syndromes common as we age, and not usually related to coronary artery disease. Sometimes, pacemakers are needed to protect us from the very low heart rates seen in damaged hearts or in those who have had interventional cardiac surgery when their natural conduction pathways have been altered and need backup support to stop the heart from beating too slowly.
A heart that beats under 40 usually is strained to produce an effective blood pressure. However, this is not set in stone, and I have seen some athletes with heart rates of 36 to 38 who have effective blood pressure rates, and they are able to vary their heart rates when needed. Troubles occur when lower rates don't increase when needed.
Pacemaker checks are usually done by phone with an adapter, and are easily performed intermittently by your doctor. The batteries last from five to 10 years before needing replacement. They are incorporated into the pacemaker itself which is buried in the front of your chest wall.
Pacemakers are the safety net for those of us with high-grade heart blocks, conditions when the loss of heart beat is anticipated, or for those of us with conducting-system disease that needs backup pacemaker support. The choices are usually between a pacemaker or risking circulatory collapse, stroke, or death.
Pacemakers are useful only when the electrical pathways in our heart muscle are diseased or damaged. They will not help us if we have coronary artery disease that prevents oxygen and nutrients from getting to vital cardiac muscle or if our muscles have been damaged so badly that the pumping ability of the heart muscle has been lost. In other words, pacemakers will not keep you alive for longer than your heart muscle's pumping function stays intact.
There is no question of risk here ... a pacemaker may conserve your brain and save your life. If you do not need one, you will not be offered one.
Without a needed pacemaker, you are often at risk of sudden death and/or stroke without warning. But if I am 90 years of age and have a condition that is expected to occur rarely, I may choose not to have a pacemaker for my own reasons and may prefer to take the risk of not having a pacemaker. This is an example of a situation you will need to discuss with your doctors. Remember, correct advice for one is not necessarily the correct advice for all.
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