Pacemakers are commonly used to treat several forms of arrhythmia. A pacemaker is a battery-powered device that is inserted under the skin (or sometimes under the muscle), usually near the collarbone; it is attached to the heart via one or more wires (leads) that extend from the pacemaker through the veins to the right side of the heart. The pacemaker monitors the heartbeat. If the heart rate is normal it stays off; however, if the beat is too slow, fast or erratic, the pacemaker sends a mild electrical signal to the heart that causes it to beat at a more beneficial pace. For patients who have had an AV node ablation, the pacemaker is required to keep the heart beating. A similar device called a biventricular pacemaker can be used to treat some arrhythmia issues caused by heart failure.
Pacemakers are normally implanted through a small incision under the collarbone; the leads are channeled through the large vein here into the heart, using an X-ray machine to help guide the electrophysiologist performing the procedure. Insertion may also occur during an open surgical procedure, often in combination with another heart surgery; in this case the leads are attached to the outside of the heart muscle.