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Anatomy of a Pacemaker
 Some pacemakers, like the Microny K SR shown here,
are incredibly compact.Photo courtesy of St. Jude Medical, Inc.
The pacemaker is a small, metal (usually titanium) case surgically implanted in the shoulder area that contains electronic circuitry and a battery. The pacemaker's circuitry is like a tiny computer; it transforms the power from the battery into tiny, controlled electrical pulses. At the top of the metal container is a connector block, where the pacing lead attaches through a connector pin.
The lead body is very flexible, so the movement of the body does not disturb it. In an endocardial lead, the most common, the lead is inserted through a vein and guided into the right ventricle or right atrium. In an epicardial lead, most often used in children to accommodate their growing bodies, the lead is attached to the outside of the heart. A small fixation mechanism holds the lead to the heart tissue. At the very tip of the lead is at least one electrode, which delivers the electrical energy from the pacemaker into the heart tissue. The lead can also deliver information about the heart's rhythm back to the pacemaker.
At a check-up, the doctor at the clinic or hospital will use a programming device, sometimes called a programmer/recorder/monitor (PRM), to receive information about how the pacemaker or the heart itself is functioning. The programming device communicates with the pacemaker via radio waves from a wand held over the site where the pacemaker is implanted. The PRM sends instructions to the pacemaker about how often to deliver an electrical pulse.
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