menuclose
Treatment for Bradycardia
Patients who have been identified to have slow heart rates may undergo a variety of treatments. These may typically include either stopping or changing medications that may have been causing the slow heart rate or undergoing implantation of a permanent pacemaker.
Additionally, sleep apnoea treatment may help in reducing symptoms and in the case of electrolyte imbalances or hormonal deficiencies, these can be addressed with medication which in turn can relieve the bradycardia.
For patients with electrical abnormalities, typically the most appropriate treatment method is the implantation of a permanent pacemaker. A pacemaker will typically include a lead (or multiple leads) that are implanted within your heart and connected to a pacemaker unit (where the battery and electrical components are). A pacemaker can monitor the heart rate for natural activity and then “stimulate” the heart to contract or beat when it detects abnormal activity, essentially mimicking the natural electrical conduction of the heart.
How do permanent pacemakers work?
Below is a video explaining how permanent pacemakers work by identifying an abnormal heart rhythm and in turn stimulating the heart to return to its normal rhythm.
Video Source: Biotronik
Are there different types of permanent pacemakers?
There are three types of traditional pacemakers that are used in adults. These include:
- Single chamber pacemaker,
- Dual-chamber pacemaker, and
- Biventricular pacemaker.
However, the type of pacemaker will depend on the individual patients’ circumstances. Below is a detailed description of these three types of pacemakers along with two other types: leadless and cardiac resynchronisation therapy (CRT) pacemakers.
Single chamber pacemaker: Where a single lead is inserted into the right ventricle and is often used in the case of a patient with bradycardia and underlying atrial fibrillation (AF).
Dual-chamber pacemaker: have two leads implanted into the heart, one positioned in the right ventricle and the other in the right atrium.
Biventricular pacemakers: are used in those patients with heart failure who may also have electrical conduction disease. It has three leads implanted, one in the atrium, the right ventricle, and one that sits over the left ventricle. The aim of these pacemakers is to increase the pumping mechanism of the heart by synchronising the right and left ventricles to improve ventricular contraction, which in turn improve the pumping action of the heart.
Leadless Pacemakers: this type of pacemaker has no leads and the device is essentially “screwed” into the inner lining of the ventricle. The device is implanted through the femoral artery (in the groin) and a catheter delivers the leadless pacemaker to the heart, where it is screwed into the ventricle. Following this, the catheters are removed leaving the pacemaker positioned within the heart and working as normal. This pacemaker device functions the same as the above pacemakers with all of the same functions as one that is implanted on the chest with lead(s) attached.
Below is a video animation of a leadless pacemaker implant.
Please note this is one example of this device and there may be other products available in your region.
Cardiac Resynchronisation Therapy (CRT) Pacemakers
In patients who have a slow heart rate and require pacemaker implantation, some may receive a Cardiac Resynchronisation Therapy (CRT) pacemaker. These devices are specifically used for people who have also been diagnosed with heart failure. A CRT pacemaker aims to “re-synchronise” the left and right ventricles, to improve cardiac function. A third lead is implanted and works to “re-synchronise” both ventricles to work together and improve cardiac output.
Not all patients are suitable for these devices and the patients’ personal Cardiology team will be able to decide if this is the right pacemaker for the individual.
Living with a Pacemaker
Getting back to daily life
Your pacemaker is designed to monitor and treat your slow heart rate so you can lead a full and active life. Here, you’ll find some general tips about going back to usual activities after your procedure. Please be sure to talk to your doctor about what’s right for your specific situation.
Exercise and Sports
Being active demands more oxygenated blood flow to your body than doing things like watching TV. Usually, your heart responds to the need for more blood flow by increasing your heart rate. But sometimes, your heart rate doesn’t increase on its own and may need to rely on your pacemaker. Be sure to work with your doctor to decide what activity level is best for you.
Driving After Your Pacemaker Procedure
Driving with a pacemaker depends on your specific symptoms and the driving laws where you live. Generally, having a pacemaker does not mean you can’t drive. You might need to wait to drive at first while you recover from the procedure. Be sure to ask your doctor about any reasons why you shouldn’t drive.
Whether you’re a driver or passenger, you may want to find padding to cover your implant site to make the seatbelt more comfortable. You can find pads in many pharmacies.
Sexual Activity
You may be concerned about whether it’s safe to be sexually intimate after your pacemaker procedure. Sexual activity is safe for most people with a pacemaker. This is because the natural heart rate increase during sex is the same as the heart rate increase that happens when you exercise. Your doctor may give you a stress or exercise test at the hospital to see how your heart rate increases. This will help them program your pacemaker settings.
Most patients decide to avoid sexual activity for about a week after the procedure. While your incision is healing, you should avoid supporting your weight with your arms during sexual activity.
Travel
As you get back to the rhythm of life, it’s natural to begin travelling again. It’s safe to travel with your pacemaker as long as you talk to your doctor, carry your Medical Device ID Card, and understand the following precautions before taking off.
Airport security
Going through airport security can be confusing even for people without an implanted device. To help make the process easier, be sure to show your Medical Device ID Card at the first security station. This card identifies you as an implanted device patient. After showing your card, follow the security staff’s directions. Depending on the airport, the staff may do one of the following:
- Send you through the security full body scanner. The Advanced Imaging Technology (AIT) full body scanner will not harm your pacemaker or change the settings. However, your pacemaker’s metal parts may set off metal detector alarms.
- Use a hand-held security wand. If it’s held over your pacemaker for too long, the wand could temporarily affect your pacemaker. If they must use a wand, tell them that the search must be done quickly and not to hold the wand over your pacemaker.
- Do a hand-pat search. If you request a hand-pat search, you can ask them to do it in a private area.
Note: The full body scanner will show your pacemaker but it will not sound an alarm while you are inside. You may be asked to show your Medical Device ID Card or they may ask to do a hand-pat search.
Medical Device ID Card
Whether you’re running a quick errand or going away for an extended trip, it’s important to carry your Medical Device ID Card with you at all times. In an emergency, your card will let medical and security personnel know that you have an implanted device. In addition to your Medical Device ID Card, most pacemaker manufacturers will provide a security card for international travel. The card explains that your implanted device may trigger airport security alarms and is printed in many different languages.