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Pacemaker Implantation

Home >> Top Procedures >> Pacemaker Implantation

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A pacemaker refers to a small device that consists of two parts. There is a generator and wires that are placed under the skin of one’s chest for controlling the heartbeat. Doctors suggest a pacemaker for various reasons – majorly due to conditions such as arrhythmias where the heart rhythm is abnormal.

Our hearts start to beat slowly with normal aging. Then in cases where there is a heart attack, heart muscles tend to get damaged and this further disrupts the heartbeat. Some medicines can also cause abnormal heart rate and sometimes, it could be genetics too. A pacemaker helps in fixing it, regardless of the condition that caused it.

Their major role is to control your heartbeat. They can be temporarily implanted for treating a slow heartbeat after an attack, overdose of medication or surgery. They are also implanted permanently to slow down the heartbeat or to treat heart failure. An implanted electronic pacemaker emulates the actions of your natural pacemaker. It includes two parts –

  • Pulse generator – This comes with a battery and an electrical circuitry that controls the rate of the electrical pulses being sent to your heart.
  • Leads, also known as electrodes – These flexible leads are insulated wires which are placed in the chambers of your heart and their job is to deliver electrical pulses that adjust your heart rate.

They monitor your heartbeat, slow it down or pace it up by sending electrical signals to your heart. They also come with sensors that detect breathing rate or body motion that further sends signals to your heart to function properly and meet the need for a balanced level of oxygen and blood.

Types of pacemakers

There are three types of pacemakers that re mentioned below:

Single chamber pacemaker

This refers to a pacemaker that carries electrical impulses from pulse generator and takes it to the right ventricle of your heart.

Dual chamber pacemaker

This one carries electrical impulses from pulse generator to both the right atrium and right ventricle of your heart. The role of the impulses is to monitor the timing of contractions between the two chambers.

Biventricular pacemaker

This is recommended to people who have had a heart failure and their heart’s electrical systems demand repairing. Unlike a normal pacemaker, this one stimulates both the lowers chambers, thereby making the heartbeat more efficiently. It resets the pumping mechanism of the ventricles and therefore is also referred to as cardiac resynchronization therapy.

Causes

  • Who needs a pacemaker implantation? Here are some of the causes for one to get it implanted -
  • The sinus node is responsible for controlling accurate pace of your heartbeat. However, with age or heart disease, its ability gets damaged. This often leads to slower than normal heartbeats which in turn also cause your heartbeat to switch between slow and fast rhythms. This condition is often referred to as the Sinus Syndrome.
  • There is a medical procedure for treating Arrhythmia known as atrial fibrillation. A pacemaker can help in regulation of your heartbeat post the procedure.
  • You have been recommended medicines such as beta blockers. The problem with these medicines is that tend to slow down your heart more than required.
  • In cases when you faint often or have other symptoms of a slower heartbeat. This happens in many cases where the main artery in your neck, responsible for supplying blood to the brain becomes sensitive to pressure.
  • You are suffering from muscle problems that are leading to slow travel of electrical signals through your heart muscle.
  • Pacemakers are also suggested to people who have congenital heart diseases or who have gone through heart transplants.

Symptoms

  • Abnormally fast heartbeat. This is also known as Tachycardia.
  • Abnormally slow heartbeat. This is also known as Bradycardia.
  • A heart block where the heart is beating irregularly due to the unstable electrical signals being transmitted.

Diagnosis

Many tests are carried out to recommend if the implantation of pacemaker is needed.

Electrocardiogram (EKG)

This one is a painless and simple test that is done to detect and record the electrical activity of your heart. It shows how fast he heart is beating and how steady or irregular is the rhythm. This also records the timing and strength of the signals as they transmit through the heart.

Holter and event monitors

It records your heart’s electrical activity for 24 or48 hours. One has to wear it while carrying on with his/her regular activities. It allows one to monitor the heart for a longer time than a standard EKG. For many of the event monitors, one has to push the start button whenever he/she feels the symptoms. Other event monitors automatically start the event monitors when they sense some abnormal heart rhythm.

Echocardiography

This involves usage of sound waves to create a moving picture of your heart. It shows the shape and size of your heart and concludes how well is your heart chamber and valve working. It also points to the areas where there is poor blood flow, muscles that aren’t contracting normally, or injury to the muscle caused by poor blood flow.

Electrophysiology study

This involves passing a thin and flexible wire through your vein in your upper thigh or arm to your heart. It records your heart’s electrical signals.

Stress test

This involves exercising to make your heart work and beat faster while other heart tests like echo or EKG are done. If some people find it difficult to exercise, medicines are given, to increase heart rate.

Treatment 

It is implanted in two ways –

Endocardial approach – It is the most common technique used –

It is performed in a electrophysiology or pacemaker lab.
A local anaesthesia is given to numb the area. This is followed by an incision in the chest where the pacemaker and leads are inserted.
The lead is inserted through an incision to the vein and then guided through heart with the help of a fluoroscopy machine.
The lead tip attaches itself to the heart muscle while the other end of the lead is placed in a pocket that is created under the skin in the upper part of the chest.

 

Epicardial approach

This is carried out by any surgeon in a surgical suite and initiated with a general anaesthesia that puts you to sleep.
Surgeon attaches the lead tip to the heart muscle and the other part pf the lead is placed in the pocket thereby creating a pocket under the skin of the abdomen.
Recovery from this is longer than other approach but minimally invasive techniques allow shorter hospital stays and quicker recoveries.

 

What to keep or avoid post pacemaker implantation

  • Electric blankets, microwave ovens and heating pads can be used as they do not interfere with the function of your pacemaker
  • It is suggested to keep the cell phone on the other side of where the pacemaker was implanted.
  • It is recommended to avoid strong electromagnetic fields such as high intensity radio waves which is fund near power plants or electrical generators. You can also stay away from arc resistance welders
  • It is suggested not to undergo tests that demand magnetic resonance imaging.

 

Usually a complete pacemaker check is required post six weeks after the implantation. Adjustments are made after discussions with your doctor and how the recovery happens. The treatment for a pacemaker is usually invasive but still requires care. That is why it is essential to opt for a reliable and trusted medical facility such as Max Healthcare that utilizes the skills of experienced doctors and state-of-art equipment for a effortless procedure. 

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