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5 Things to Know About Pacemakers

What it is, who needs one and how the device helps keep millions of older adults healthy

spinner image digital illustration of a chest with a pacemaker and heart rate
Photo Collage: AARP (Source: Shutterstock; Getty Images)

Donna Lulay, a retired educator, had open-heart surgery in 2007 to replace her aortic valve due to a genetic heart valve defect, and in 2023 needed surgery to replace the valve again. The procedures were a success despite one not so uncommon complication: After the second surgery, her heartbeat was slower than it should be, putting her at risk for serious health complications.

Lulay, now 66, was told she needed a pacemaker to help regulate it.

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“I was so upset,” says Lulay, an avid hiker, skier, walker and all-around active individual who also happens to be my first cousin. “Getting a pacemaker when it was unexpected was a shock.” But now, almost a year later, Lulay is back to exercising and traveling, and says she feels “more confident” not having to worry about her heart functioning properly.

Here are five things to know about pacemakers and how they work.

1. Roughly 3 million Americans are living with a pacemaker.

Lulay is one of nearly 3 million people in the U.S. who has a pacemaker, a small battery-powered device that prevents the heart from beating too slowly. Terminator actor Arnold Schwarzenegger, 76, is another  

Most people with pacemakers — more than 70 percent — are 65 or older, according to Yale Medicine.

2. People with abnormal rhythms may need a pacemaker.

There are several types of cardiac devices that can be implanted, or placed under the skin just below the collarbone with wires leading to the heart. A pacemaker is one of them.

It’s needed when the heart doesn’t beat normally — it may be too slow or the electrical signals that control the heartbeat are disrupted.

The device consists of a generator with a battery that provides the electrical impulse for the heart to beat, sensors (electrodes) and wires (leads) that deliver the electrical impulse to the heart muscle. The pacemaker monitors the heart’s rhythm and if it detects certain abnormalities, it will generate an electric impulse so the heart can beat with a normal rhythm.

For many patients, a pacemaker works only when needed — if the heartbeat gets too slow, it will jump in and correct it. However, some people are considered “pacemaker dependent” and rely on the device to constantly regulate the heartbeat. 

You may need a pacemaker if you have an abnormal heart rhythm that is considered serious and is not expected to go away on its own or with other treatment. You may also need one if a less serious rhythm issue causes symptoms such as lightheadedness or fainting, or prevents you from doing your day-to-day activities.

Common reasons that pacemakers are placed include:

  • Sinus node dysfunction: The sinus node is specialized heart tissue in the right atrium that initiates the electrical impulse for your heart to beat.
  • High-grade block: when a section of the heart’s conduction system does not transmit the electrical signal, for example at the atrioventricular (AV) node that sits between the upper and lower heart chambers.
  • Fainting due to abnormal heart rhythms.
  • Damage to the heart’s conduction system after procedures such as open-heart surgery or having an aortic valve replaced using a catheter.

There are several tests that your doctor can perform to determine if a pacemaker is right for you.

Understanding the heart’s electrical system

The heartbeat is an electric signal that is generated in specialized tissue, called the sinus node, in the heart’s upper right chamber, known as the right atria. This signal causes both the left and right atria to contract.

The signal then travels to another area of specialized tissue in the heart called the atrioventricular (AV) node that lies near the border of the upper and lower chambers, finally reaching the two lower chambers (left and right ventricles) and resulting in contraction of the ventricles.  

Normal heart rates are between 60 and 100 beats per minute. 

3. Getting a pacemaker can be a quick process.

The procedure takes approximately one to two hours to complete, and you will be given medicine to make you comfortable but not put you to sleep. A small incision (about 2 inches) will be made on the chest, just below the collarbone, usually on the left side.  The generator is then inserted under the skin.  

The leads have one end inserted into the generator and the other end guided through a blood vessel to a chamber of the heart. Patients generally stay one night in the hospital after getting a pacemaker placed.

Though uncommon, there are some risks to the procedure. These include perforation (a small hole or tear) of a blood vessel or cardiac chamber, a collapsed lung and infection at the site of implantation.

After the procedure, you’ll be somewhat limited in what you can do — especially when it comes to lifting and moving your arm, even driving. But these restrictions typically last only a few weeks.


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4. Your heartbeat will be regularly monitored.  

You will be set up for home monitoring once you get a pacemaker. The monitoring system may be an app on your smartphone or tablet, or a unit that fits on your bedside table. Information from your pacemaker is encrypted and then sent automatically to your doctor’s office and downloaded into your medical chart. The monitoring also shows how often your body has needed to rely on the pacemaker and any abnormal heart rhythms that have occurred. 

Regular monitoring and in-person doctor’s appointments decrease the likelihood of complications. Infections can happen, even long after implantation. If the infection cannot be cured with antibiotics, you may need to have the pacemaker removed and a new one put in.

Another potential complication is that your tricuspid heart valve — which helps blood flow between the two right chambers — could become leaky. This happens when the leads interfere with the function of the valve. It can be managed with medical treatment as well as changing the placement of the lead.

The battery life of a pacemaker is between five and seven years. Replacing the battery can be done with either an outpatient or inpatient visit. 

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5. Pacemakers don’t mix well with some devices. 

With a pacemaker, Lulay says she worries less about her heart and doesn’t feel like the device inhibits her lifestyle. She’s back to traveling and just returned from a trip to Australia and New Zealand.

However, there are some things to be aware of if you have a pacemaker, particularly other machines and devices that can disrupt its function. Jens Cosedis Nielsen, a professor of medicine at Aarhus University in Denmark and a chairperson for the 2021 European Society of Cardiology Guidelines, says patients should stay away from equipment with magnetic forces (like an MRI machine) and direct exposure to electrical currents (like electrotherapy).

And cellphones? People with pacemakers “can use a cellphone as everybody else,” Cosedis Nielsen says. “There is no problem to use your best ear, even if this is the one closest to the pacemaker.”

Here’s a look at what will — and won’t — interfere with a pacemaker:

Note: If you have a pacemaker, you’ll want to carry your pacemaker ID card with you. This has information on what kind of pacemaker you have and the manufacturer, and can help alert health care providers and others to any special accommodations.

The following can interfere with a pacemaker:

  • MRI: An MRI has a powerful magnet and patients with some models of pacemakers should not enter the MRI area in a facility. They make newer pacemakers that are “MRI conditional” and are better designed to withstand an MRI scan, so long as the pacemaker is programmed to MRI settings beforehand and then checked and reprogrammed back to original settings after.
  • Medical procedures: Some procedures that may present a problem include radiation therapy and extracorporeal shock-wave lithotripsy, which uses hydraulic shocks to dissolve kidney stones. Transcutaneous electrical nerve stimulation (TENS) for treatment of acute and chronic pain has a lower risk for any pacemaker problems. If a medical procedure will affect your pacemaker, the device can be turned off (unless you are dependent on your pacemaker) and then back on, or checked immediately after the procedure and reprogrammed if needed. 
  • Metal detectors and airport screening: Metal detectors won’t damage your pacemaker, especially as you pass through in a matter of seconds, but they may detect the metal in your device. Let the TSA agent know you have a pacemaker (keep your card handy). You may need to undergo a separate security procedure, such as screening with a hand wand.
  • Magnets: Strong magnets especially can inhibit pacemakers, so be sure to keep at least six inches away. The same goes for headphones that have magnetic material. Avoid magnetic pillows and mattress pads.
  • Electric fences: Avoid or limit exposure to electric fences and electric pet containment systems.

The following are felt to pose little or no risk to a pacemaker:

  • Consumer appliances and electronics
  • Microwave ovens
  • Home computer components
  • Yard equipment, such as hedge trimmers
  • Security badge scanners
  • CT scans

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