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Pacemaker Primer:
What You Need to Know
Implantable devices keep your heart beating smoothly

Diabetics end up needing pacemakers fairly often, so they’re Did you know that diabetics require pacemakers at a far higher rate than the general public? This fact that means you may want to know more about them than you already do. You’ve probably heard that pacemakers are used to correct a problem with the heart. Two million have been implanted since their invention in1960. But what exactly does a pacemaker do?

Healthy hearts beat around the clock, speeding up and slowing down to match exertion. Each beat consists of a highly designed and choreographed sequence of electrical pulses, contractions, expansions, and valve movements. Like the conductor of an orchestra, the pulsing triggers the parts of the heart to work in concert, pumping a maximum amount of blood through the heart. If the electrical sparks are slow, misguided, or blocked, the heart may beat too lazily, too quickly, or at an unsteady rate. This is called arrhythmia, and can lead to many dangerous and life-threatening conditions. Enter: the pacemaker.

A pacemaker monitors how the heart is beating, and if it senses an arrhythmia, it sends a specially chosen set of electrical signals to the heart to correct the problem.

What are the symptoms of arrhythmia?

• A slow or unsteady heartbeat
• Heart palpitations (feeling your heart is beating too heavily or has missed a beat)
• Pauses between heartbeats

If the arrhythmia is more serious, symptoms may include:

• Anxiety
• Weakness, dizziness or light-headedness
• Fainting or nearly fainting
• Difficulty catching your breath
• Angina (chest pain)

What causes arrhythmia?

Arrhythmia occurs when disease disrupts the finely tuned electrical system of the heart. Untreated or uncontrolled high blood pressure and coronary artery disease (CAD) are the most common causes of heart damage in the US, and because diabetics suffer from high blood pressure and CAD in such great numbers, many diabetics also suffer from arrhythmia.

How do pacemakers work?

A pacemaker consists of a small battery, a computerized generator to create the electrical signals, and wires to connect the generator to one or more of the four chambers of the heart. The wires monitor, as well as delivering electrical impulses to, one or more chambers of the heart. The job of the pacemaker is to determine how the heart is beating at any given moment, determine how much activity is being performed, and select and deliver to the heart the precise set of signals to ensure that it beats properly.

How are pacemakers implanted and programmed?

Often a pacemaker can be implanted while the patient is awake, but anesthetized. First, wires are threaded into the proper chamber or chambers of the heart through a vein in the shoulder. Then, the small metal box that contains the battery and computerized generator is placed under the skin through a small cut in the shoulder or abdomen. Finally, the wires are connected to the pacemaker.

With the pacemaker in place, the doctor uses special equipment to adjust the settings and get heart-rhythm readings without needing to touch the patient. Since the batteries last anywhere from five to fifteen years, most pacemakers last for a long time.

What about recovery and limitations after the surgery?

Usually the patient returns home the day after surgery.

This day is spent monitoring the heart and calibrating the pacemaker programming based on the pacemaker. Pain is usually minimal, and can often be managed with over-the-counter pain relievers.

Because the pacemaker is a sensitive electrical device, you should avoid prolonged time near any electrical device, especially those that create radio waves or strong electric fields. For example, store your cell phone in a pocket or purse that is not directly over or beside the pacemaker. The same goes with MP3 players. Modern pacemakers are “shielded” to protect them from casual contact with common devices, such as microwave ovens and computers and airport metal detectors. In general, just avoid very close contact, and keep any close contact short.

What is the best way to avoid heart damage that can cause arrhythmia?

As with all diabetic complications, the best advice seems boring because all diabetics have heard it seemingly thousands of times. That is only because it works. Exercise regularly, eat a healthy diet that is high in vegetables and complex carbohydrates and low in saturated fats and sodium (see DASH story, p. 26), and follow your doctor’s directions to maintain as low an average blood glucose as possible.

If you have high blood pressure, check it regularly. Blood pressure cuffs that talk are available and most insurance will purchase them with a prescription. Take your prescribed blood pressure medicine every day without fail. Just because you feel good is not a reason to stop any prescribed medication, especially blood pressure medicine.

If you have elevated cholesterol levels or triglycerides, take a statin (a prescription medicine to lower cholesterol) every day if prescribed by your doctor, eliminate foods high in saturated fat and trans fats, and exercise. If you think you cannot exercise because of blindness or vision loss, that is not the case. Blind people can be as active as anyone else. Simply not being able to see is no reason not to exercise. Blind people have climbed mountains, run marathons, biked across the US, and completed triathlons. They also routinely exercise at fitness clubs, take vigorous walks, either outdoors or on treadmills, climb the stairs at work, and lift weights. Of course, check with your doctor before starting any new exercise routine, but if the only reason you are not exercising is because of blindness or lack of vision, there is no reason you cannot start today.

Tom LeyAbout the Author
Tom Ley has had Type 1 diabetes since he was seven and has been blind since he was 17. He is a manager and senior software support analyst for UPS and has a strong background in the field of accessible technology for the blind. He is the technology writer for the Voice of the Diabetic.