Your NYU Langone doctor may recommend a pacemaker to manage bradycardia. A pacemaker monitors your heart’s rhythm. If it detects an irregularity, it sends electrical impulses to the heart to improve pacing and induce a normal rhythm.
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Some pacemakers connect to the heart with leads, which are two or three wires that are surgically connected to the heart. A leadless pacemaker is implanted inside the heart and requires no wires.
A pacemaker with leads is a small device implanted under the skin of the chest. The size of two half-dollars pressed together, this pacemaker contains a small computer and battery, which are connected to one or two flexible, insulated wires called leads. The leads extend from the device into the heart, where the tips have sensors called electrodes that monitor heart rhythm and deliver information to the pacemaker.
To place this pacemaker, your doctor makes an incision in a large vein near your shoulder. He or she then threads the electrodes through the vein and places them into your heart. A second incision is made in the skin of the chest. The pacemaker box is placed under the skin and connected to the electrodes.
A pacemaker with leads is recommended for people whose hearts need pacing in either just the right ventricle or both the right atrium and right ventricle.
Leadless pacemakers have no wires and are placed directly inside the heart. To place these pacemakers, your doctor makes a small incision in the groin. He or she guides a catheter, which is a long, thin, hollow tube, to the heart. The catheter serves as a pathway for the device, which is the size of a large vitamin. The leadless pacemaker is secured against the wall of the right ventricle.
The Micra™ is a single-chamber pacemaker and is used in people who only need pacing in the right ventricle. The Micra™ AV is the first leadless dual-chamber pacemaker that is available to people who have atrioventricular (AV) block, which occurs when electrical signals cannot pass from the atria to the ventricles.
Both pacemaker procedures take about an hour, and can be performed as an outpatient procedure or with a limited hospital stay. You can most likely return to your usual activities the day after pacemaker implantation, but your doctor may restrict some activities for two weeks. Restrictions include avoiding lifting anything heavier than 10 pounds and not engaging in exercises—such as swimming, golf, or tennis—that strain the affected side.
Two to four weeks after the procedure, your doctor examines the implantation site and checks to see how well the pacemaker is working by uploading information stored in the device’s generator to a computer. This includes information about the pacemaker’s battery life, the condition of the lead or leads, and any arrhythmias experienced since the pacemaker was implanted.
NYU Langone doctors provide you with a home transmitter that records information on the device and transmits it remotely, either over a telephone line, cellular network, or the internet. Our team, which is made up of experts in monitoring cardiac devices, contacts you if it receives alerts indicating that the device needs reprogramming or replacing. The battery typically lasts 7 to 13 years.
Once a year, you visit the Heart Rhythm Center for a check-up and reprogramming of the device, if necessary. Our experts also determine if another therapy, such as medication, is needed to manage a heart rhythm disorder.
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