In Episode 11 of the Healthy Matters Podcast, I enjoy an electrifying conversation with electrophysiologist Dr. Rehan Karim about pacemakers. He’s a cardiologist who specializes in the electrical systems of your heart. Why do some people need pacemakers? What exactly do they do?

“In simplistic terms, the only job of a pacemaker is to prevent the heart from going too slow,” explained Dr. Karim. “If someone’s heart rate is very slow, they are going to have symptoms like feeling dizzy or lightheaded. The pacemaker’s main task is to make sure that it’s providing a minimum heart rate.”

So it sets the pace. That’s where we get the term, “pacemaker.” In addition to feeling dizzy, Dr. Karim said that people can pass out and injure themselves if their heart decides to slow down and not beat – even for a few seconds.

“Sometimes when there’s an electrical problem, the heart rate doesn’t increase appropriately in scenarios when it should increase with exertion,” he said. “This can also make people feel very fatigued.”

Dr. Karim mentioned how in adults aged seventy-five or older, more than 2,500 out of one hundred thousand may end up needing pacemakers. “You can think of it this way: as time passes by, the electrical wiring tends to get worn out and may need some extra support.”

The same-day procedure for pacemaker placement is not extremely complicated, and usually takes about an hour.

“For comfort, patients are given a mild to moderate degree of sedative drugs to make sure they’re not having too much pain,” said Dr. Karim. “So, we give local anesthesia, and the incision may be about two to three finger breadths. Patients may feel a slight pushing and tugging kind of sensation on the skin. And you know how they say all roads lead to Rome? Well all veins go to the heart. So basically, you get access to a large vein under the collarbone, thread a couple of wires into the heart, and those wires have a little screw at the tip. The screw is then secured into the heart muscle.”

Dr. Karim wants patients to take away three important messages about pacemakers from this podcast:

  1. Pacemakers are there to treat your symptoms, not to “set” a specific number for your heart rate, for example.
  2. Pacemakers can make a big difference in someone’s life and people can lead as normal of a life as possible with them.
  3. There are a lot of resources available if you have any questions. He recommends the Heart Rhythm Society. They have a website for patients called which has a lot of information about heart rhythm disorders in general.

More about what to expect during and post-procedure, the future of pacemakers, and great questions and answers about microwaving oatmeal and airport security are discussed in Episode 11 of the Healthy Matters Podcast.