Welcome back to In The Loop with Nadja Wlasiuk. Today, we’re diving into something I see nearly every day in practice, pacemakers, the small life-changing devices that keep the heart beating in rhythm when its natural electrical system can’t keep up. Whether it’s from age-related conduction disease, sinus node dysfunction, or for atrial fibrillation, pacemakers can restore energy, prevent fainting, and quite literally give people their lives back.
We’ll explore what a pacemaker actually does, how it knows when to step in, and the differences between single chamber, dual chamber, cardiac resynchronization, or CRT, and even leadless pacemakers, pacemakers so small that they look like a vitamin.
To help us unpack all of that, I am joined by Lauren Parr, a biomedical engineer and clinical specialist in cardiac rhythm management. She’s IBHRE certified as a cardiac device specialist and a graduate of the University of Missouri, Columbia. With years of experience in the electrophysiology lab supporting device implants, troubleshooting leads, and and educating both clinicians and patients. Lauren brings an engineer’s precision and a clinician’s heart to this conversation, and together we’ll translate pacemaker language into plain English.
So whether you’re a nurse, a provider, or someone curious about how these devices keep the rhythm of life steady, this episode is for you.
All right, let’s get in the loop on pacemakers.
Pacemaker Origin Story:
Pacemaker technology was born in two places at once.In 1958, Dr. C. Walton Lillehei, a cardiac surgeon at the University of Minnesota, teamed up with Earl Bakken, an electrical engineer and co-founder of a small medical device company in Minneapolis, to design the world’s first battery-powered external pacemaker. Before then, pacemakers had to be plugged in to an outlet.
That same year in Sweden, Dr. Åke Senning and engineer Rune Elmqvist implanted the first fully internal pacemaker, marking the transition from external to implantable devices.
Together, these breakthroughs laid the foundation for the modern pacemaker that is smaller, smarter, and life-sustaining.
Helpful Patient-Friendly Resources on Pacemakers
• American Heart Association — What a pacemaker is, why it’s used, and a plain-language overview of single-, dual-, and biventricular (CRT) pacemakers.🔗 heart.org/pacemaker
• UCSF Health — Clear, patient-focused explanation of pacemaker types, how implantation is performed, and what recovery and daily life look like.🔗 ucsfhealth.org/treatments/pacemaker
• Cleveland Clinic — Breaks down single-, dual-, biventricular/CRT, and leadless pacemakers in easy-to-understand language, with diagrams and FAQs about surgery and safety.🔗 clevelandclinic.org/permanent-pacemaker
• Stanford Health Care — Outlines different pacemaker options and what to expect before, during, and after implantation.🔗 stanfordhealthcare.org/pacemaker/types
• National Heart, Lung & Blood Institute (NHLBI) — Offers visuals and simple explanations of how pacemakers work, including leadless systems.🔗 nhlbi.nih.gov/pacemakers
• NYU Langone Health — Provides context on pacemakers alongside other cardiac implantable devices, highlighting how each supports rhythm management.🔗 nyulangone.org/cardiac-device-management
Standard Post Op Wound Care Recommendations
(for your individual situation please follow the guidance of your healthcare team)
You may shower.
Do NOT submerge site in water until fully healed. No swimming, baths, or hot tubs.
Try to avoid letting the shower stream hit the incision directly.
Pat site dry with paper towel or clean towel. Do not scrub or aggressively dry the incision.
Steristrips typically fall of within 2 weeks. If they do not after 2 weeks post procedure it may be okay to just remove them.
Avoid touching site. Hands have bacteria. Bacteria can cause infection.
If you notice any drainage from your device site please call your clinic immediately.
If you notice chills, fever, or you feel unwell, notify your clinic immediately.
Lauren and Nadja next to the largest leadless pacemaker
Standard Post Op Activity Recommendations
(for your individual situation please follow the guidance of your healthcare team)
Remember that it takes 6 weeks for the leads to fully heal in place.
Avoid sharp jerking motions with the implant arm. Avoid reaching the implant arm high above the head and far behind the back.
Avoid lifting, pushing, or pulling anything greater than 5lbs for the first 2-4 weeks.
For the life of the device/leads avoid repeated overhead motion in the gym or with activity that could impinge the lead with the clavicle to help maintain lead integrity.
Nadja and her demos
🩺 Pacemaker Quick-Check Guide for Non-EP Providers
A practical checklist for when you encounter a patient with an implanted pacemaker.
1. Identify and Confirm the Device
* Ask the patient if they have a pacemaker (some may not know if it’s also a defibrillator).
* Look for a scar or bulge—typically left upper chest, sometimes right or abdominal in pediatrics.
* Ask for or locate the patient’s device card — this lists the manufacturer, implant date, and model.
* Document the manufacturer and last follow-up date (you’ll need this for MRI or procedure planning).
2. Review the Patient’s Clinical Context
* Why do they have it? (e.g., AV block, sick sinus syndrome, post–AV node ablation, heart failure with CRT).
* Dependent or not? Ask if they were told they’re “pacemaker dependent.”
* Any recent symptoms? Dizziness, syncope, palpitations, fatigue, chest pain, or shortness of breath.
3. Vital Signs and Monitoring
* Obtain a rhythm strip or telemetry reading.
* Paced rhythm? Look for pacing spikes.
* Native rhythm? That’s okay—pacemakers don’t pace 100% of the time.
* Do not panic if “asystole” alarms but the patient is talking—tele monitors can misread small paced complexes or small native QRS.
* Always assess the patient first, not just the monitor.
4. Diagnostic and Imaging Considerations
* MRI:
* Most modern pacemakers are MRI-conditional (safe under specific settings).
* Check device card or chart; if unsure, contact the implanting center or device representative.
* Do not order MRI until compatibility is confirmed.
* X-ray or CT: Safe. Chest X-ray can show lead position and number of leads.
* Electrocautery/Surgery:
* For procedures below the umbilicus, generally safe without special measures.
* Above the umbilicus or on the ipsilateral shoulder: a magnet may be required or have EP/device support available.
* Avoid monopolar cautery near the generator pocket when possible.
5. Common Post-Implant Considerations
* Incision: Watch for erythema, swelling, drainage (possible infection).
* Pain or arm immobility: Encourage gentle movement to prevent frozen shoulder after healing.
* Pocket revisions or generator changes happen roughly every 7–10 years (battery end-of-life).
* Pacemaker-dependent patients may need temporary pacing if generator fails or must be replaced.
6. Remote Monitoring & Follow-Up
* Most patients are enrolled in remote monitoring every ~3 months.
* Remote transmissions are diagnostic, not emergency alerts.They flag issues like lead impedance/threshold/sensing, battery status, or arrhythmia detection for review.
* If the patient reports alerts or “beeping,” contact the device clinic or the manufacturer—not 911 unless symptomatic.
7. When to Call the Device Clinic or EP Team
* After other causes for symptoms of dizziness, syncope, chest pain, palpitations, or fatigue have been ruled out.
* Recent procedure or trauma near the device site.
* Concern for infection (pocket redness, pain, drainage).
* Loss of capture or erratic telemetry.
* Unknown manufacturer or model (need interrogation).
Produced by Nadja Wlasiuk, DNP, APRN, FNP-BC
