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Pacemaker

A pacemaker is a small electronic device that helps the heart beat more regularly. It does this with a small electric stimulation that helps control the heartbeat. Doctor places the pacemaker under the skin on the chest, just under the collarbone. It will be hooked up to the heart with tiny wires.

electrical system of the heart

Generally a pacemaker is required to keep the heart beating properly. This will help the body to get the blood and oxygen as it needs. Some patients just need a pacemaker for a short time like immediately after a heart attack. They may use an outside pacemaker which will be outside the skin, the battery unit for this type can be worn on a belt strap. This is sometimes called as temporary pacemaker.

Conduction Abnormalities:

Pacemakers are commonly used to treat arrhythmias. Arrhythmias are the problems with the rhythm of the heartbeat.

The conduction abnormalities are classified into 3 types:

  1. Bradycardia (Too slow heartbeat)
  2. Tachycardia (Too fast heartbeat)
  3. Dys-synchrony (Unequal contraction)
heart conduction abnormalities

Symptoms to Have a Pacemaker:

These are few symptoms which we observe for patients who suffer with Arrhythmia (Irregular Heartbeat)

  • Dizziness
  • Congestive heart failure
  • Mental confusion
  • Palpitations
  • Shortness of breath
  • Exercise intolerance
  • Fatigue
  • Light headedness

Diagnosis Before Pacemaker:

Before going for a pacemaker, doctor may prescribe with few investigations like listed below

  • Echocardiogram (Commonly called as ECHO)
  • Electrocardiogram (Commonly called as ECG or EKG)
  • Holter monitoring
  • Stress test (Commonly called as TMT test)

Types of Pacemakers:

The type of pacemaker mainly depends on the symptoms and the specific heart condition. After diagnosis, doctor will discuss this with patient and family.

These are mainly classified into 3 types:

  1. Single-chamber pacemaker
  2. Dual-chamber pacemaker
  3. Biventricular pacemaker

Single-chamber Pacemaker:

Single-chamber pacemaker is the basic type of pacemaker. As name indicates this pacemaker will have one lead that connects the pulse generator to any one chamber of the heart.

Single-chamber pacemaker will be used for maximum of patients to control the heartbeat pacing by connecting the lead to the right ventricle (lower heart chamber of the heart). Depending on the symptoms and the type of pacing needed, the lead will be connected to the right atrium (upper heart chamber of the heart) to stimulate the pacing in that chamber.

Dual-chamber Pacemaker:

As name indicates this pacemaker will have two leads, this device connects to both the chambers on the right side of the heart, the right atrium (upper chamber of the heart) and the right ventricle (bottom chamber of the heart). Surgeon will program the dual-chamber pacemaker to regulate the pace of contractions of both the chambers.

This type of pacemaker helps the two chambers work together, contracting and relaxing in the proper rhythm. The contractions allow blood to flow properly from the right atrium into the right ventricle.

Depending on the pacing needs of your heart, a dual-chamber device may be an appropriate option for you.

Biventricular Pacemaker:

This is the third type of pacemaker and is also called as Cardiac Resynchronization Therapy (CRT). This pacemaker will have three leads connected to the right atrium and both the ventricles. Biventricular pacemaker is mainly used to treat the people who suffer with arrhythmias caused by the advanced heart failure.

For many people with heart failure, the left and right ventricles do not pump the blood at the same time. Doctor will program the biventricular pacemaker to coordinate the contractions of the ventricles, so that both the ventricles pump together.

Coordinating the ventricles’ contractions helps the heart to pump blood more efficiently and can relieve the heart failure symptoms. The treatment is known as Cardiac Resynchronization Therapy (CRT) as it resynchronizes the ventricles’ pumping action.

Pacemaker Illustration:

Pacemaker will mainly help in maintaining the regularity of the heart beat, this is related to the electrical signals of the heart. Hence the pacemaker device is designed with electrical leads, a battery and electronic circuit which manages the task.

Pacemaker is metal medical device. This metal device will contain the electronic circuit, battery and the leads connecting to the circuit.

pacemaker illustration

Pacemaker is of 1-2 inch size, leads used to connect look like tiny wires. This device generally occupies the chest room of the patient’s body, hence it is manufactured very compact.

Battery associated in the pacemaker will generate the electrical signal. Leads associated to the device and patient’s heart will carry the signals. Circuit in the device will generate the electrical signals based on the patient’s heartbeat.

Pacemaker Process:

Pacemaker’s main task is to send an electrical signal to the heart during weak pulses of the heart beat.

Battery in the pacemaker device will send the electric signals to the heart to help it pump the right way. The pacemaker is connected to the heart by one or more wires which are also called as leads. Tiny electric charges that even can’t feel move through the wire to the heart. Pacemakers will work only when needed. They go on when the heartbeat is too slow, too fast or irregular.

pacemaker implantation

For example,

If the heartbeat is very slow then one electrical signal is generated using the electric circuitry and battery. This signal will increase the heartbeat instantly to maintain the regular heartbeat.

If the heartbeat is very high then a different electrical signal is generated using the same battery and circuit. This signal will reduce the pace of heartbeat instantly and helps in maintaining regular heartbeat.

Patient may also some have the situation where the heartbeat is irregular (increase and decrease). Pacemaker will pass on the electrical signals to maintain the regular heart beat even in irregular heartbeats.

Implantation Surgery Procedure:

Pacemaker implantation generally takes 1 to 2 hours. Patient will under anesthesia locally to numb the incision site.

Surgeon will make a small incision near the shoulder. They will guide a small wire through the incision into a major vein near the collarbone. Surgeon will lead the wire through the vein to the heart. Surgeon will be guided on monitor with the help of an X-ray machine through the process.

Using the wire, surgeon will attach an electrode to the heart’s right ventricle. The ventricle is the lower chamber of the heart. The other end of the wire (lead) attaches to a pulse generator or called as signal generator. This contains the battery and electrical circuitry. Basically surgeon will implant the generator inside the skin near the collarbone.

In case of a biventricular pacemaker, surgeon will attach the second lead to the heart’s right atrium. The atrium is the upper chamber of the heart.

Finally after the procedure will close the incision with stitches.

Complications With a Pacemaker:

All medical procedure / surgeries are associated with their own risks and complications. Pacemaker implantation also associated with set of complications, which are listed below:

  • Allergic reaction to the anesthesia
  • Bleeding
  • Damaged nerves
  • Damaged blood vessels
  • Infection at the site of the incision or the foreign body which is implanted
  • Collapsed lung (rare complication)
  • Punctured heart (rare complication)

Precautions After Pacemaker Implantation:

Unlike other medical procedures, a special care will be prescribed for patients who undergo pacemaker implantation.

Immediately after the procedure the patient should avoid heavy exercise and heavy lifting. Patient may also need to take over-the-counter medications for any discomfort. Consult doctors regarding the safe pain relievers.

Patient should avoid the following:

  • Placing mobile phone or a music player like MP3 player near the pacemaker
  • Staying long time near few electronic & magnetic devices
  • Long exposure to metal detectors
  • High-voltage transformers

Advantages and Disadvantages of Pacemaker:

Pacemaker has certain advantages and disadvantages associated to the implantation procedure, here are few listed below

S. No

Advantages

Disadvantages

1

Imitate the natural heart pacing.

Generally every heart generates its own pacing signals to maintain the heartbeat if it is abnormal. If natural heart pacing system fails and leading to shortness of breath and fainting then doctor will suggest for a artificial pacemaker implantation. This helps to maintain the heartbeat.

Surgical procedure risks.

Implantation of a pacemaker is done by a minor surgical procedure, the risks include infection at the surgery location. Patients may be allergic to the anesthesia and experience swelling and bruising. More extreme risks include a collapsed lung or damage to blood vessels or nerves near the pacemaker implantation.

2

Improve heart efficiency.

Biventricular pacemaker is the best device to improve the efficient of the heart. As it not only regulates the pace of the heart, but also helps improving the heart pumping efficiency in the patients who have had lower heart damage resulting from heart failure.

Lifestyle changes.

Once after the pacemaker implantation, the device will be placed inside the body. Hence patient need to very careful with the electromagnetic devices, metal detectors etc.

Frequently Asked Questions:

After pacemaker, can I perform the daily activities as regular?

Once the pacemaker has been implanted, people with pacemakers should be able to do the same activities everyone else in their age group is doing.

Patients with a pacemaker may still be able do the following:

  • Exercise moderately, upon advice from the doctor
  • Drive or travel
  • Return to work
  • Work in the yard or house
  • Participate in sports and other recreational activities
  • Take showers and baths
  • Continue sexual relationships
  • When involved in a physical, recreational, or sporting activity, a person with a pacemaker should avoid receiving a blow to the skin over the pacemaker. A blow to the chest near the pacemaker can affect its functioning. See your doctor if a blow to chest is received near the pacemaker.

Always consult with the doctor when feeling ill after an activity, or if there are questions about beginning a new activity.

How do I know whether the pacemaker is working properly?

Always keep a track and check the pacemaker device regularly to ensure that it is working properly.

The best method for checking the accuracy of the pacemaker device includes the following:

  • Patients should check their pulse regularly, any abnormality in the pulse rate can be escalated to the doctor immediately.
  • Check the “pacing lead” (the lead which sends information from the heart to the pacemaker) with an electrocardiogram (ECG) at the hospital.
  • Consult the doctor regularly for checkup

What is the pulse and how do we check that?

checking pulse rate

Basically, Pulse rate is a measurement of the heart rate or simply we can say it as the number of times the heart beats in a minute. As the heart pumps the blood through the arteries, the arteries expand and contract with the flow of the blood.

Pulse measurement will also indicate the following:

  • Heart rhythm
  • Strength of the pulse

The normal pulse rate for healthy adult ranges from 60 to 100 beats in a minute. The pulse rate will fluctuate when doing exercise, suffering with illness, or with any injury.

Checking the pulse is very easy and any individual can do. Generally as the heart pumps blood through the arteries, individual can feel the beats by firmly pressing on the arteries, which are located close near to the skin at certain points of the body. Generally the pulse can be checked at the side of the lower neck, on the inside of the elbow, or at the wrist.

Process to check the pulse:
  • Press firmly on the arteries with the first and second fingertips until you feel a pulse.
  • Start counting the pulse when the clock’s second hand is on the 12
  • Count the pulse for 60 seconds

How frequently we should replace pacemaker?

Generally pacemakers will last from 8 to 10 years, accordingly replacement of pacemaker can be done. Doctor can decide and confirm on the pacemaker replacement. If the pacemaker device doesn’t work properly, then doctor may opt for replacement immediately.

What is pacemaker ID card?

Patients who were implanted with pacemaker will be issued with a unique identity card with the type and details of the pacemaker device on the card. This is very much required for the patient. As the device is made up of metal, this will be detected in all metal detectors.

Patients may be issued with a temporary identity card during discharge from hospital, but over a period of time will be issued with original identity card from the pacemaker manufacturer.

Can we feel the pacemaker device?

In initial stages, patient may feel the pacemaker device which is implanted in the chest room. But eventually over a period of time, it will be accustomed.

Can we use mobile phones after pacemaker implantation?

Patients can use mobile phones after pacemaker implantation. Anyways patients were instructed to hold their mobile phone six inches away from the pacemaker. Also, patients should avoid placing the mobile phones in the pocket near the pacemaker.

Settings of pacemaker need to be adjusted periodically?

Some pacemakers may need adjustment if the patient’s medical condition or the lifestyle changes. Doctor will instruct the patients about the follow-up consultations, where doctor keep a track on the performance of the device.

Can we reuse the leads during replacement?

Leads are the actual wires which will carry the electrical charges to the heart. Leads can we re-used while replacing the pacemaker device provided the original leads are functioning properly, in many cases they can be left in place and reattached to the new pacemaker device.

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