Who Needs a Pacemaker?

Doctors recommend pacemakers to patients for a number of reasons. The most common reason is when a patient's heart is beating too slow or there are long pauses between heartbeats.

A pacemaker may be helpful if:

• Aging or heart disease damages your sinus node's ability to set the correct pace for your heartbeat. Such damage can make your heart beat too slow, or it can cause long pauses between heartbeats. The damage also can cause your heart rhythm to alternate between slow and fast.
• You need to take certain heart medicines (such as beta blockers), but these medicines slow down your heartbeat too much.
• The electrical signals between your heart's upper and lower chambers are partially or completely blocked or slowed down (this is called heart block). Aging, damage to the heart from a heart attack, or other heart conditions can prevent electrical signals from reaching all the heart's chambers.
• You often faint due to a slow heartbeat. For example, this may happen if the main artery in your neck that supplies your brain with blood is sensitive to pressure. In you have this condition, just quickly turning your neck can cause your heart to beat slower than normal. When that happens, not enough blood may flow to your brain, causing you to faint.
• You have had a medical procedure to treat an arrhythmia called atrial fibrillation. A pacemaker can help regulate your heartbeat after the procedure.
• You have heart muscle problems that cause electrical signals to travel through your heart muscle too slow. (Your pacemaker will provide cardiac resynchronization therapy for this problem.)

To decide whether a pacemaker will benefit you, your doctor will consider any symptoms you have of an irregular heartbeat, such as dizziness, unexplained fainting, or shortness of breath. He or she also will consider whether you have a history of heart disease, what medicines you're currently taking, and the results of heart tests.

A pacemaker won't be recommended unless your heart tests show that you have irregular heartbeats.

Tests That Help Determine Whether You Need a Pacemaker

A number of tests are used to detect an arrhythmia. Your doctor may recommend some or all of these tests.

EKG (Electrocardiogram)

This simple and painless test detects and records the electrical activity of the heart. An EKG shows how fast the heart is beating and the heart's rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through each part of the heart.

Holter Monitor

A Holter monitor, also called an ambulatory EKG, records the electrical signals of your heart for a full 24- or 48-hour period. You wear small patches called electrodes on your chest that are connected by wires to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.

During the 24 or 48 hours, you do your usual daily activities and keep a notebook, noting any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.

The purpose of a Holter monitor is to record heart signals during typical daily activities and while sleeping, and to find heart problems that may occur for only a few minutes out of the day.

Echocardiogram

This test uses sound waves to create a moving picture of your heart. An echocardiogram shows the size and shape of your heart and how well your heart is pumping blood. The test can identify areas of heart muscle that aren't contracting normally or getting enough blood flow.

Electrophysiology Study

For an electrophysiology study, your doctor threads a small, flexible wire from a blood vessel in your arm or leg to your heart. The wire electrically stimulates your heart to see how your heart's electrical system responds. The electrical stimulation helps to find where the heart 's electrical system is damaged.

Stress Test

Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise to make your heart work harder and beat faster while heart tests, such as an EKG or echocardiogram, are performed.