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 in the Electrophysiology, Arrhythmia and Pacemaker Program at Rush surgically implant these small devices in the chest or abdomen. As specialists, these doctors focus on caring for patients with arrhythmias throughout their lives.
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:
- Shortness of breath (dyspnea)
To determine if you have 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 what pacemaker is 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 delivers pulses to a heart’s 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. The main two are as follows:
- Demand pacemaker: Monitors your heart rhythm; only send 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 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 patients 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 percent success rate, above the industry average of 80 to 90 percent.
Why choose Rush for pacemaker surgery and care
- Expertise you can trust: At Rush, you'll find electrophysiologists who specialize in caring for heartbeat irregularities and provide second opinions. They often collaborate closely with other specialists at Rush —cardiologists, cardiac surgeons, sleep specialists and dietitians — to provide advanced care.
- The latest diagnostic and treatment options: This includes new devices, such as leadless pacemakers; His bundle pacing; anti-arrhythmic drugs; and more advanced treatments including catheter based ablation procedures (a minimally invasive catheter based procedure to decrease the burden of disease), pacemakers and surgical hybrid procedures.
- Arrhythmia care for kids: Our dedicated Pediatric Electrophysiology Program at Rush Children's Hospital offers specialists who conduct extensive research, including clinical trials. This allows our team to deliver new therapies and treatment options with compassionate care to our young patients.
- Ongoing care for atrial fibrillation: People who have atrial fibrillation, the most common type of arrhythmia, can receive comprehensive, coordinated care and access to latest treatments as well as clinical trials through the Rush Atrial Fibrillation Clinic.