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You may have noticed there are times when your heart beats much slower than you expect. If you take your pulse it will be less than 60 beats a minute. There may be a number of possible reasons for this, but a common problem is when the heart rhythm itself is abnormal. Normally patients with heart rhythm disorders associated with slow palpitations complain of tiredness, a lack of energy, shortness of breath and dizziness. Some patients may have collapsed or had a blackout. Your GP may have told you that you have heart block or require a pacemaker.
Patients who suffer from slow heart rhythms tend to have them all the time, although there may be specific circumstances when you have noticed your heart rhythm slowing down excessively. The only way to make a diagnosis is with an electrical recording of your heart, an ECG.
An electrocardiogram (ECG) is a test that records the rhythm and electrical activity of your heart. It takes about five minutes and is painless. Small stickers (electrodes) are stuck to your arms, legs and chest, and connected via wires to an ECG machine. Every time your heart beats, it produces tiny electrical signals. An ECG machine traces these signals onto paper.
Once your consultant has taken a detailed history, and performed a thorough examination a number of investigations will be required. Basic blood tests including thyroid function tests will be performed. A trace of your heart rhythm at the time of your consultation will be taken. A scan of your heart, an echocardiogram, will be performed to assess the heart function. If you already have an ECG trace of your problem it is important that you bring this to the consultation as this could direct your consultant as to the most appropriate treatment.
In many patients with slow heart rhythms a diagnosis can be made at the time of the consultation, if not then some form of monitoring will be suggested. However, it may have been difficult to capture an episode, so your consultant may ask you to wear a small, portable electrocardiogram monitor to record your heart rate either continuously over 24 or 48 hours, or from when you switch it on at the start of an episode. In patients who experience blackouts a small implantable monitor that lasts for 2 years could be used.
For patients with slow heart rhythms, a pacemaker may be suggested. There are several types of pacemakers, and the most appropriate type will be chosen for you. Only the latest pacemakers are used from a number of different manufacturers to give you the best device for you.
The pacemaker is a small metal box weighing 20–50g approximately the size of a £2 coin and sends regular electrical pulses that help keep your heart beating regularly. It is attached to one or more wires, known as pacing leads, that run to your heart.
Having a pacemaker implanted is a relatively straightforward process. It is usually carried out under local anaesthetic, which means you will be awake during the procedure.
The generator is typically placed under the skin near the collarbone. The generator is attached to a wire that is guided through a blood vessel to the heart. The procedure takes around 30–60 minutes and most people are well enough to leave hospital either on the day or the day after surgery. You should be able to get back to normal physical activities very soon after surgery. As a precaution, it is normally recommended that you avoid strenuous activities for around three to four weeks after having your pacemaker fitted, this is so that the wires that have been placed in the heart have time to stick to the heart. After this, you should be able to do most activities and sports.
Your consultant will see you approximately one month following the implantation and check the function of the pacemaker, in addition some of the settings may need to be changed to adapt the pacemaker to each individual patient. Following this the pacemaker needs to be checked at regular intervals to check that all is well both with the pacemaker and the patient. The battery typically lasts 8 years but this varies by how much it is used.
If a pacemaker is recommended for you then you should expect it to prevent blackouts or collapses, or it may be given to improve your energy levels, these benefits should occur almost immediately.