ExplainerDoctors belatedly reveal PM's heart conduction problems

Netanyahu underwent surgery to have pacemaker fitted. Here’s why, and what it will do

Premier has small battery-powered cardiac pacing device implanted to prevent heart from beating too slowly; PM’s trips to Turkey, Cyprus are postponed

Renee Ghert-Zand

Renee Ghert-Zand is a reporter and feature writer for The Times of Israel.

Prime Minister Benjamin Netanyahu attends a memorial ceremony for Revisionist Zionist leader Ze'ev Jabotinsky at Mount Herzl in Jerusalem on July 18, 2023. (Noam Revkin Fenton/Flash90)
Prime Minister Benjamin Netanyahu attends a memorial ceremony for Revisionist Zionist leader Ze'ev Jabotinsky at Mount Herzl in Jerusalem on July 18, 2023. (Noam Revkin Fenton/Flash90)

Physicians at Sheba Medical Center implanted a pacemaker in Prime Minister Benjamin Netanyahu early Sunday morning. He was admitted to the hospital on Saturday night after an alert relayed by the internal cardiac monitor he was fitted with a week ago indicated a transient heart block, or a problem with the heart’s electrical conduction system.

A pacemaker, also called a cardiac pacing device, is a small, battery-powered device that prevents the heart from beating too slowly. A pacemaker is surgically placed under the skin near the collarbone.

Pacemakers are prescribed when the electrical conduction system of a person’s heart causes slow or irregular heartbeats, or if a person has heart failure.

Problems with the heart’s conduction system usually result from heart muscle damage, genetics, or the effects of certain medications.

Upon the premier’s initial discharge from Sheba last week, both the hospital and the hospital stated that all the tests performed on Netanyahu were fine and that the subcutaneous implantation of the implantable loop recorder (ILR) was merely a “normal” precaution.

However, in a video statement released by Sheba this morning, it was revealed that the prime minister has a history of heart conduction problems. The hospital also stated that Netanyahu had fainted last weekend, which was information the Prime Minister’s Office had not revealed.

Police gather outside the emergency entrance to the Sheba Medical Centre in Ramat Gan after Prime Minister Benjamin Netanyahu was hospitalized (AHMAD GHARABLI / AFP)

Despite protocols requiring prime ministers to release an annual health report, Netanyahu has not published one since 2016.

It has not been possible to legally force him to share this health information, as the protocols have not been enshrined in law.

“The prime minister came to Sheba Medical Center last week because he had a fainting episode… And since he had a conduction disorder that we’ve know about many years, we decided to perform an electrophysiological study, which is a kind of catheterization that assesses the conduction system,” Prof. Roy Beinart, director of the Davidai Center for Rhythm Disturbances and Pacing at Sheba Medical Center, said Sunday.

Beinart said the catheterization had gone well and all the results were fine, and the decision was made to implant the loop recorder as a way to constantly monitor the premier’s heart health.

He continued, “Data we received last night from the monitor suggested transient atrioventricular block, and this was an indication for urgent pacemaker implantation.”

There are several types of pacemakers, but the Sheba doctors did not indicate which one Netanyahu received.

Screen capture from video of Professors Roy Beinart, right, and Eyal Nof at Sheba Medical Center, July 23, 2023. (Channel 12 screenshot; used in accordance with Clause 27a of the Copyright Law)

In general, a pacemaker has three parts: a pulse generator, one or more leads, and an electrode on each lead.

A pulse generator is a small metal case that contains electronic circuitry with a small computer and a battery that regulate the impulses sent to the heart.

A lead is an insulated wire that is connected to the pulse generator on one end, with the other end placed inside one of the heart’s chambers via a large vein in the chest.

The electrode on the end of the lead touches the heart wall and delivers electrical impulses to the heart. It also senses the heart’s electrical activity and relays this information back to the pulse generator. The lead may be positioned in the atrium (upper chamber) or ventricle (lower chamber) or both, depending on the medical condition.

A pacemaker works only when it needs to signal the heart to beat, when it senses that the heartbeat is too slow or irregular.

Prime Minister Benjamin Netanyahu gives a video message, explaining that he is going into the hospital to have a pacemaker fitted, early on July 23, 2023. (Screenshot)

The surgical insertion of the device usually takes one to two hours and is done under sedation, but not general anesthesia, meaning that the patient is usually groggy but awake during the procedure.

The procedure is done either in a hospital or in an outpatient setting, and recovery takes several days. Following that, a person with a pacemaker is advised to carry a pacemaker registration card and to avoid magnetic fields.

Although a 2019 German study stated that it is possible to fly just two days after an uncomplicated pacemaker insertion, the NHS in the UK recommends waiting at least six weeks, or until after the first post-operative follow-up appointment.

It was reported Sunday morning that Netanyahu’s trips to Cyprus and Turkey in the coming days have been postponed.

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