Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

A pacemaker for heart failure helps the lower chambers of your heart (the ventricles) pump blood at the same time. This can help your heart work better and make you feel better.

Consider the following when making your decision:

• A pacemaker sends electrical pulses to your heart to help it work better. You can't feel the pulses.
• A pacemaker for heart failure can help you feel better so you can do your daily activities. It also may help keep you out of the hospital and help you live longer.
• A pacemaker may be a good choice if you have moderate or severe heart failure. These types of heart failure can make you so tired and short of breath that you can't do your daily activities.
• If you get a pacemaker, you still need to take medicines for heart failure. You'll also need to follow a healthy lifestyle to help treat heart failure. This may include watching how much fluid you drink, eating healthy foods that are low in salt, and not smoking.
• There can be problems from having a pacemaker placed in your chest. The wires (called leads) that connect the pacemaker to your heart can move from the spot where they were placed. You could get an infection where the pacemaker was placed. Or the pacemaker or leads might not work.

Medical Information

How can heart failure affect heart rhythm?

When you have heart failure, the lower chambers of your heart (the ventricles) aren't able to pump as much blood as your body needs. Sometimes the ventricles also don't pump at the right time, so the heart has an abnormal rhythm.

A pacemaker for heart failure is a device that sends electrical pulses to make the ventricles pump at the same time. This can improve your symptoms of heart failure.

Using a pacemaker to make the ventricles pump at the same time is called cardiac resynchronization therapy, or CRT.

A pacemaker for heart failure is different than pacemakers used to treat other heart rhythm problems. This topic is only about pacemakers for heart failure. For information on other pacemakers, see the topics Atrial Fibrillation and Bradycardia.

A pacemaker for heart failure is called a biventricular (say "by-ven-TRICK-yuh-ler") pacemaker, because it sends signals to both ventricles. The pacemaker connects to three thin wires, called leads. The leads go into different chambers of your heart. If there is a problem with your heartbeat, the pacemaker sends a painless signal through the leads to fix the problem. The pacemaker also can speed up your heart if it is beating too slowly.

In some cases, you may get a pacemaker for heart failure that is combined with a device to shock your heartbeat back to a normal rhythm if it is dangerously fast. The device is called an implantable cardioverter-defibrillator, or ICD. It can prevent sudden death. For more information, see:

Should I get an implantable cardioverter-defibrillator (ICD) for heart failure?

How is the pacemaker placed?

Your doctor will put the pacemaker in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.

Your doctor makes a small cut (incision) in your upper chest. In some cases, the pacemaker can be placed lower in the chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered. The doctor puts the leads in a vein and threads them to the heart. In some cases, another incision is made to place the lead that goes near the left ventricle. Then your doctor connects the leads to the pacemaker. Your doctor programs the pacemaker and then puts it in your chest and closes the incision.

It can take up to 2 hours to place the pacemaker. It may take 2 to 3 hours if the doctor needs to make an incision to place the lead near the left ventricle.

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery. But sometimes the procedure is done as an outpatient procedure, which means you don't need to stay overnight in the hospital.

You may be able to see a little bump under the skin where the pacemaker is placed.

Who can have a pacemaker for heart failure?

Experts say that a pacemaker may help if all of the following are true:¹

• You have class III or class IV heart failure. This means that you have trouble doing everyday activities or you can't do them at all. Activity makes you very tired and short of breath, or you have pain or other problems.
• You are taking medicines for heart failure, but you still have symptoms like being very tired and short of breath.
• You have an ejection fraction of 35% or less. Ejection fraction is a measure of how much blood your left ventricle pumps. A normal ejection fraction is 55% or more.
• Tests show that your heart's ventricles are not beating at the right time. These tests may include an electrocardiogram (EKG, ECG) test, an echocardiogram, or an electrophysiology study.

What are the benefits of having a pacemaker for heart failure?

A pacemaker can help you feel better so you can be more active. It also can help keep you out of the hospital and help you live longer.

• A large study found that 19 out of 100 people who were treated with a pacemaker for heart failure had to go into the hospital during the study because of heart failure. But 27 out of 100 people treated with medicine alone had to go into the hospital for heart failure.²
• In the same study, 13 out of 100 people who got a pacemaker for heart failure died during the study, compared with 16 out of 100 who got only medicine.²

A pacemaker also can help your heart pump better by changing the shape of your heart. In heart failure, the left ventricle often gets too big as it tries to make up for not pumping well. Using a pacemaker may reverse this.

What are the risks of having a pacemaker for heart failure?

There are several risks to getting a pacemaker. But risks vary for each person. The chance of most problems is very low.³

• A lead could move out of place. This happens about 6 to 9 times out of 100. So 91 to 94 out of 100 times, the lead stays in place.
• The pacemaker or leads might not work. This happens about 7 times out of 100. So 93 times out of 100, the pacemaker and leads do work.
• The lead that is being placed near the left ventricle could tear the heart. This happens just over 2 times out of 100. So about 98 times out of 100, no tear happens.
• A lung could collapse (pneumothorax) from a buildup of air in the space between the lung and the chest wall. This happens about 2 times out of 100. So about 98 times out of 100, this lung problem doesn't happen.
• You could get an infection in your chest where the pacemaker is placed. The chance of this is less than 1 in 100. So there is no infection more than 99 times out of 100.
• The skin around the pacemaker could break down. This happens about 2 times out of 100, usually because of an infection. This means that it doesn't happen 98 times out of 100.
• The pacemaker might not be able to be implanted for several reasons, such as when a vein near the left ventricle is too small, too wide, or too hard to reach to allow a lead to be placed. Sometimes the chest or heart may be too big to place a lead. The chance that a doctor can't place the pacemaker is about 10 out of 100. That means the pacemaker can be placed 90 times out of 100.

In some cases, the above problems might mean that you would need surgery to take out the pacemaker or leads.

The pacemaker runs on a battery that usually lasts 8 to 10 years. You will need minor surgery to replace the battery.

What follow-up will you need after getting a pacemaker?

You will need regular checkups with your doctor to make sure that the pacemaker is working and to adjust the pacing, if needed. Sometimes medicine needs to be changed. You also may need regular tests, such as an echocardiogram.

It's important to keep taking your medicines for heart failure. You'll also need to follow a healthy lifestyle to help treat heart failure. This may include watching how much fluid you drink, eating healthy foods that are low in salt, and not smoking.

You have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines, battery-powered cordless power tools, and CB or ham radios. But most everyday appliances are safe. For more information, see:

Heart problems: Living with a pacemaker or ICD.

For more information, see the topic Heart Failure.

Your Information

Your choices are:

• Get a pacemaker for heart failure.
• Don't get a pacemaker for heart failure.

The decision whether to get a pacemaker for heart failure takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having a pacemaker for heart failure. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to get or not get a pacemaker for heart failure.

Check the box below that represents your overall impression about your decision.

Return to the topic Heart Failure.

Related Information

• Heart Failure