Medical Information
How can heart failure affect heart rhythm?
When
you have
heart failure, the lower
chambers of your heart 
(the ventricles) aren't able to pump as much blood as your
body needs. Sometimes the ventricles also don't pump at the right time, so the
heart has an abnormal rhythm.
A
pacemaker for heart failure is a device that sends electrical pulses to make the
ventricles pump at the same time. This can improve your symptoms of heart
failure.
Using a pacemaker to make the ventricles pump at the same
time is called cardiac resynchronization therapy, or CRT.
A
pacemaker for heart failure is different than pacemakers used to treat other
heart rhythm problems. This topic is only about pacemakers for heart failure.
For information on other pacemakers, see the topics
Atrial Fibrillation and
Bradycardia.
A pacemaker for heart
failure is called a biventricular (say "by-ven-TRICK-yuh-ler") pacemaker,
because it sends signals to both ventricles. The pacemaker connects to three
thin wires, called leads. The leads go into different chambers of your heart.
If there is a problem with your heartbeat, the pacemaker sends a painless
signal through the leads to fix the problem. The pacemaker also can speed up
your heart if it is beating too slowly.
In some cases, you may get
a pacemaker for heart failure that is combined with a device to shock your
heartbeat back to a normal rhythm if it is dangerously fast. The device is
called an implantable cardioverter-defibrillator, or ICD. It can prevent sudden
death. For more information, see:
Should I get an implantable cardioverter-defibrillator (ICD) for heart failure?
How is the pacemaker placed?
Your doctor will put
the pacemaker in your chest during minor surgery. You will not have open-chest
surgery. You probably will have
local anesthesia. This means that you will be awake
but feel no pain. You also will likely have medicine to make you feel relaxed
and sleepy.
Your doctor makes a small cut (incision) in your upper
chest. In some cases, the pacemaker can be placed lower in the chest. This
would allow you to wear clothing with a lower neckline and still keep the scar
covered. The doctor puts the leads in a vein and threads them to the heart. In
some cases, another incision is made to place the lead that goes near the left
ventricle. Then your doctor connects the leads to the pacemaker. Your doctor
programs the pacemaker and then puts it in your chest and closes the
incision.
It can take up to 2 hours to place the pacemaker. It may
take 2 to 3 hours if the doctor needs to make an incision to place the lead
near the left ventricle.
Most people spend the night in the
hospital, just to make sure that the device is working and that there are no
problems from the surgery. But sometimes the procedure is done as an
outpatient procedure, which means you don't need to
stay overnight in the hospital.
You may be able to see a little
bump under the skin where the pacemaker is placed.
Who can have a pacemaker for heart failure?
Experts say that a pacemaker may help if all of
the following are true:1
- You have
class III or class IV heart failure. This means that
you have trouble doing everyday activities or you can't do them at all.
Activity makes you very tired and short of breath, or you have pain or other
problems.
- You are taking medicines for heart failure, but you still
have symptoms like being very tired and short of breath.
- You have
an
ejection fraction of 35% or less. Ejection fraction is
a measure of how much blood your left ventricle pumps. A normal ejection
fraction is 55% or more.
- Tests show that your heart's ventricles are not beating at the
right time. These tests may include an
electrocardiogram (EKG, ECG) test, an
echocardiogram, or an
electrophysiology study.
What are the benefits of having a pacemaker for heart failure?
A pacemaker can help you feel better so you can be more
active. It also can help keep you out of the hospital and help you live
longer.
- A large study found that 19 out of 100 people
who were treated with a pacemaker for heart failure had to go into the hospital
during the study because of heart failure. But 27 out of 100 people treated
with medicine alone had to go into the hospital for heart failure.2
- In the same study, 13 out of 100 people who got
a pacemaker for heart failure died during the study, compared with 16 out of
100 who got only medicine.2
A pacemaker also can help your heart pump better by
changing the shape of your heart. In heart failure, the left ventricle often
gets too big as it tries to make up for not pumping well. Using a pacemaker may
reverse this.
What are the risks of having a pacemaker for heart failure?
There are several risks to getting a pacemaker. But
risks vary for each person. The chance of most problems is very low.3
- A lead could move out of place. This happens
about 6 to 9 times out of 100. So 91 to 94 out of 100 times, the lead stays in
place.
- The pacemaker or leads might not work. This happens about 7
times out of 100. So 93 times out of 100, the pacemaker and leads do
work.
- The lead that is being placed near the left ventricle could
tear the heart. This happens just over 2 times out of 100. So about 98 times
out of 100, no tear happens.
- A lung could collapse (pneumothorax) from a buildup of air in
the space between the lung and the chest wall. This happens about 2 times out
of 100. So about 98 times out of 100, this lung problem doesn't
happen.
- You could get an infection in your chest where the
pacemaker is placed. The chance of this is less than 1 in 100. So there is no
infection more than 99 times out of 100.
- The skin around the
pacemaker could break down. This happens about 2 times out of 100, usually
because of an infection. This means that it doesn't happen 98 times out of
100.
- The pacemaker might not be able to be implanted for several
reasons, such as when a vein near the left ventricle is too small, too wide, or
too hard to reach to allow a lead to be placed. Sometimes the chest or heart
may be too big to place a lead. The chance that a doctor can't place the
pacemaker is about 10 out of 100. That means the pacemaker can be placed 90
times out of 100.
In some cases, the above problems might mean that you
would need surgery to take out the pacemaker or leads.
The
pacemaker runs on a battery that usually lasts 8 to 10 years. You will need
minor surgery to replace the battery.
What follow-up will you need after getting a pacemaker?
You will need regular checkups with your doctor to make sure that the
pacemaker is working and to adjust the pacing, if needed. Sometimes medicine
needs to be changed. You also may need regular tests, such as an
echocardiogram.
It's important to keep taking your medicines for
heart failure. You'll also need to follow a healthy lifestyle to help treat
heart failure. This may include watching how much fluid you drink, eating
healthy foods that are low in salt, and not smoking.
You have to
be careful not to get too close to some devices with strong magnetic or
electrical fields. These include
MRI machines, battery-powered cordless power tools,
and CB or ham radios. But most everyday appliances are safe. For more
information, see:
Heart problems: Living with a pacemaker or ICD.
For more information, see the topic
Heart Failure.
Wise Health Decision
Use this worksheet to help you make your decision.
After completing it, you should have a better idea of how you feel about having
a pacemaker for heart failure. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
| I don't have the energy to do my hobbies and other
activities. | Yes | No | Unsure |
| My tests show that my heart is not pumping as well
as it could. | Yes | No | Unsure |
| I want to do everything I can to have a good
quality of life and stay out of the hospital. | Yes | No | Unsure |
| I am worried about the problems that could happen
when the pacemaker is placed. | Yes | No | Unsure |
| My medicine for heart failure is not working well
enough to control my symptoms. | Yes | No | Unsure |
| I have some symptoms but I am still able to do my
hobbies and other daily activities. | Yes | No | NA* |
| I want to wait to see if medicine and lifestyle
changes can help my heart failure. | Yes | No | Unsure |
*NA=Not applicable
Use
the following space to list any other important concerns you have about this
decision.
What is your overall impression?
Your answers in
the above worksheet are meant to give you a general idea of where you stand on
this decision. You may have one overriding reason to get or not get a pacemaker
for heart failure.
Check the box below that represents your
overall impression about your decision.
Leaning toward getting a pacemaker for heart failure | | Leaning toward NOT getting a pacemaker for heart failure |
Return to the topic
Heart Failure.
