Cardiac Devices

Overview

A cardiac device is a small medical implant, or sometimes a wearable unit, that helps your heart beat at a healthy rate and rhythm, or protects you if your heart goes into a dangerous rhythm. The most common types are a pacemaker (keeps a slow heart beating at a safe speed), an ICD or implantable cardioverter defibrillator (watches for dangerous fast rhythms and gives a small electrical shock to reset the heart), a CRT device (cardiac resynchronisation therapy — helps both sides of the heart beat together in some kinds of heart failure), and an implantable loop recorder (a tiny monitor that records your heart rhythm over months). The device is usually placed under the skin below the collarbone, with thin wires (called leads) running to the heart. Some newer devices need no wires at all.

Yes. Fitting a pacemaker or ICD is a routine, well-established procedure in hospitals around the world. Millions of people live full, active lives with a cardiac device.

Most people who get a device are older adults, because heart rhythm problems and heart failure become more common with age. But devices are also fitted in younger adults and sometimes in children, for example when a heart rhythm problem is there from birth or caused by a previous heart problem or inherited condition.

Symptoms

Common symptoms

• Feeling very tired or having little energy for everyday things
• Dizziness or light-headedness, especially when standing up
• Fainting or near-fainting (a blackout)
• Palpitations — a fluttering, racing or pounding feeling in the chest
• Shortness of breath, particularly with exercise or walking uphill
• A pulse that feels unusually slow or unusually fast
• Chest discomfort or tightness
• Swollen ankles or legs, or waking up breathless at night (signs of heart failure)

Symptoms in children

• Poor feeding and slow weight gain in babies
• Tiring quickly during play or being unable to keep up with other children
• Fainting or unexpected collapse, especially during sport or excitement
• A bluish tinge to the lips or skin in some heart conditions
• A very fast or very slow heartbeat noticed by a parent or school nurse

Symptoms in older adults

• Confusion, memory changes or repeated falls that can be caused by a slow heart rate
• Breathlessness doing very light tasks such as dressing or walking to the bathroom
• Blackouts that are sometimes mistaken for a simple trip or a faint
• Thin, fragile skin over the device site, which needs gentle care
• More than one health condition at once, so symptoms can be easy to miss

Causes

Main causes

• A slow heart rhythm (bradycardia) or a block in the heart's electrical pathways — treated with a pacemaker
• Dangerous fast rhythms from the lower chambers of the heart (ventricular arrhythmias), or a high risk of them — treated with an ICD
• Heart failure where the two sides of the heart no longer beat in step — treated with a CRT device
• Damage to the heart muscle after a heart attack, which can upset the heart's electrical system
• Inherited (genetic) heart conditions that cause rhythm problems in younger people
• Some medicines, infections or other illnesses that slow the heart's electrical signals

Risk factors

• Older age
• Coronary heart disease or a previous heart attack
• Heart failure or a weakened heart muscle
• High blood pressure and high cholesterol over many years
• Diabetes
• A family history of heart rhythm problems, fainting or sudden cardiac death
• Certain inherited conditions such as cardiomyopathies (heart muscle diseases)
• Smoking, heavy alcohol use and being physically inactive

When to see a doctor

See a doctor urgently if:

• Fainting, near-fainting or unexplained falls
• A racing or irregular heartbeat with dizziness or breathlessness
• Signs of infection at your device site — redness, swelling, heat, fluid or fever
• Your device gives a shock and you feel unwell afterwards
• Your device beeps or vibrates, or your remote monitor sends an alert
• New chest pain, or breathlessness that is getting worse quickly

Book a routine appointment if:

• Feeling more tired than usual, or more breathless with everyday activity
• Occasional palpitations without dizziness
• Questions about exercise, driving, travel, airport security or medical scans
• Before any surgery, dental work or procedure, so staff know about your device
• Any worries about your mood, sleep or anxiety since getting the device

Diagnosis

The heart problem that needs a device is found through a combination of your story, a physical examination and heart tests. Your doctor will ask about fainting, palpitations, breathlessness and your family history, and will check your pulse and blood pressure. Simple heart tracing tests often show the answer, and a heart scan shows how well the heart muscle is working. If the diagnosis is still unclear, you may be referred to a heart rhythm specialist (an electrophysiologist) for more detailed testing.

Tests that may be done

• ECG (electrocardiogram) — a painless recording of your heart's electrical signals taken in the clinic
• Ambulatory monitor (Holter) — a portable ECG you wear for a day or more to catch symptoms when they happen
• Event recorder or implantable loop recorder — a longer-term monitor for symptoms that happen only now and then
• Echocardiogram — an ultrasound scan showing heart size, valves and pumping strength
• Exercise or stress test — watching your heart while you walk on a treadmill or cycle
• Blood tests — to check for anaemia, thyroid problems and other causes of symptoms
• Chest X-ray — to look at heart size and, after surgery, the position of device leads
• Electrophysiology study — a test in hospital where the heart's electrical system is mapped in detail

What to expect at your appointment

Most tests are quick and painless, and you can usually go home the same day. Results are explained to you in person or by letter, and if a device is recommended you will have time to ask questions before deciding. You are always free to ask for a second opinion or to take a family member with you.

Treatment

Treatment depends on the type of heart rhythm problem you have and how much it affects your daily life. A cardiac device is only recommended when the benefit clearly outweighs the risks, and your doctor will discuss other options with you first. Fitting a device is usually a short procedure under local anaesthetic, with a small cut below the collarbone, though some devices are fitted under general anaesthetic. You will be given antibiotics around the time of the procedure and shown how to care for the wound. After that, your device is checked at regular clinic visits and often by remote monitoring from your home.

Self-care at home

• Keep the wound clean and dry as advised, and follow the dressing instructions you are given
• Avoid lifting heavy objects or raising the arm on the device side high for the first few weeks
• Carry your device ID card at all times and show it at appointments and airport security
• Keep your device clinic appointments and complete any remote monitoring downloads
• Tell every doctor, dentist and nurse that you have a cardiac device before any procedure or scan
• Keep mobile phones and strong magnets a short distance away from the device, as your clinic advises
• Note down any symptoms, shocks or alerts so you can describe them clearly at your review

Medical treatments

Devices work alongside, not instead of, good general heart care. Your medical team may adjust other treatments for your heart or blood pressure, review medicines that could slow the heart, and treat any underlying conditions such as thyroid problems. Pacemakers and ICDs are programmed and fine-tuned at the clinic to suit your needs, and the battery is replaced with a small procedure when it runs low. If you have an ICD, your team will explain what a shock feels like and what to do if it happens. Never stop or change any prescribed medicine without talking to your doctor first.

When is surgery considered?

Fitting a device is a minor operation, not open heart surgery. Most people have it under local anaesthetic with sedation, and are awake but relaxed. The device sits in a small pocket under the skin, and leads are passed through a vein to the heart — some newer devices are leadless and sit directly inside the heart. You may feel bruised and sore for a week or two. Rarely, a device may need to be repositioned or replaced if it becomes infected or a lead develops a fault.

Living with this condition

Most people get back to normal life quickly. You can usually shower within a few days once the wound is sealed, return to desk work within a week or so, and get back to heavier activity after about four to six weeks, depending on your doctor's advice. Driving rules vary by country and by device type, and by whether you have had a shock or a blackout — always follow the advice given to you by your own team. Airport security scanners may notice your device, so show your ID card. Most modern devices are safe for MRI scans, but staff must know about your device beforehand.

Lifestyle tips

• Stay as active as your heart team advises — regular gentle activity is good for your heart and mood
• Avoid heavy alcohol and do not smoke; ask for help if you want to stop
• Keep to a healthy weight and have your blood pressure and cholesterol checked regularly
• Tell your clinic about any new sport or hobby, especially scuba diving, contact sports or welding
• Wear a medical alert bracelet or necklace if you have an ICD, so emergency staff know
• Plan travel with your device clinic — they can give advice and arrange checks before you go

Diet and exercise

A heart-healthy eating pattern helps whatever your device: plenty of vegetables and fruit, whole grains, beans, nuts, fish, and less salt, sugary drinks and processed meat. Your team can refer you to a dietitian if you need help. Exercise is safe and encouraged for most people with a device. Start gently — walking is ideal — and build up over weeks. Ask your team about the right level of activity for you, and avoid very hard contact sports if you have an ICD.

Mental health and emotional wellbeing

It is very common to feel anxious after a device is fitted, and some people worry about shocks, become overly aware of their heartbeat, or feel their body has let them down. These feelings usually ease with time, support and information. Talking to your device clinic, a counsellor or a support group can really help. If low mood or anxiety is affecting your sleep, appetite or daily life, please speak to your doctor — effective help is available. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local crisis support service or your local emergency number straight away.

Prevention

Not every heart rhythm problem can be prevented — some are inherited or simply related to getting older. But the most common reasons people need a device are linked to heart disease, and looking after your heart lowers that risk. Keeping blood pressure and cholesterol in a healthy range, not smoking, staying active, eating well and keeping to a healthy weight all help. If you already have heart disease, sticking to your agreed treatment plan and attending reviews is the most important thing you can do.

Vaccines

Ask your doctor about recommended vaccinations, including flu and pneumonia vaccines, which are especially important for people with heart conditions.

Screening programmes

There is no routine screening for needing a device. If you have fainting, a very slow or fast pulse, a family history of sudden cardiac death, or a known heart muscle condition, ask your doctor whether a heart rhythm check is appropriate for you.

Complications

If left untreated

• Dangerous fast heart rhythms that can cause cardiac arrest
• Fainting and falls, which can lead to broken bones or head injury
• Worsening heart failure with breathlessness and fluid build-up
• Reduced ability to work, exercise or live independently
• Rarely, sudden cardiac death in people with high-risk conditions

Long-term outlook

The outlook for people with a cardiac device is generally good. Pacemakers reliably stop the symptoms of a slow heart, ICDs save lives in people at risk of dangerous rhythms, and CRT devices can improve breathing and energy for many people with heart failure. Devices need checks and battery changes over the years, and some people have a wound infection or a lead problem that needs treatment — but most people live long, active lives and quickly get used to the device being there.

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