Cardiology
Inserting a Pacemaker Treatment
Inserting a Pacemaker
A pacemaker is a small device with two parts wires and a generator, the pacemaker is placed under the skin in the patient’s chest for helping them control their heartbeat. The patients may require a pacemaker for various reasons mostly due to one of a group of conditions named as arrhythmias, in which the heart's rhythm gets abnormal.
What is Pacemaker?
A pacemaker is a small device with two parts wires (leads, or electrodes) and a generator, the pacemaker is placed under the skin in the patient’s chest for helping them control their heartbeat. The patients may require a pacemaker for various reasons mostly due to one of a group of conditions named as arrhythmias, in which the heart's rhythm gets abnormal. Normal aging of the heart may disrupt the people’s heart rate, making the heart beat too slowly. Heart muscle damage resulting from a heart attack is another common cause a disruption of an individual’s heartbeat. Some medicines can affect the people heart rate as well. For some, genetic conditions can result in an abnormal heart rate. A pacemaker may fix regardless of the underlying cause of an abnormal heart rate. A pacemaker can usually be implanted in the patient’s chest with the help of minor surgery. The patients may be required to take certain precautions in their daily life after the pacemaker has been installed.
Types of Pacemaker
Single chamber pacemaker
Single chamber pacemaker generally carries electrical impulses from the pulse generator to the right ventricle of the heart.
Dual chamber pacemaker
A dual chamber pacemaker carries electrical impulses from the pulse generator to both the right atrium and the right ventricle of the heart. The electrical impulses help in controlling the timing of contractions between the two chambers of the heart.
Biventricular pacemaker
A biventricular pacemaker is a treatment given to those people with heart failure whose heart’s electrical systems have been damaged. A biventricular pacemaker is different from the regular pacemaker; a biventricular pacemaker stimulates both of the lower chambers of the heart (the left and right ventricles) for making the heart beat more efficiently.
Need for the Inserting a Pacemaker
The patients may require a pacemaker if the patient’s heart is pumping too slowly or quickly. In either of the case, the patient’s body doesn’t get enough blood. This can cause:
- Fatigue
- Lightheadedness or fainting
- Shortness of breath
- Damaging the vital organs
- Eventual death
A pacemaker regulates the patient’s body’s electrical system, which controls their heart rhythm. With each heartbeat, an electrical impulse travels from the top of the patient’s heart to the bottom, thus signaling the patient’s heart’s muscles to contract. A pacemaker can also record and track the heartbeat. A record is helpful to the doctors in understanding the patient’s arrhythmia. Not every pacemaker is permanent. Temporary pacemakers are also present which can control certain types of problems. The patients may require a temporary pacemaker after heart surgery or heart attack. The patients may also require a temporary pacemaker if a medication overdose temporarily slows down the heart. The cardiologist or doctor will test the patients to see if they are a good candidate for a pacemaker.
How is the Pacemaker inserted?
Implanting a pacemaker usually requires at least two hours. The patients will receive a sedative for relaxing the patients and a local anesthetic will provide to numb the cut area. The patients will be awake during the surgery. The surgeon will make a small cut near the shoulder. The surgeon will guide a small wire through the incision made near the shoulder into a major vein near the collarbone. Then the surgeon will lead the wire through the vein to the patient’s heart. An X-ray machine will be helpful in guiding the surgeon through the process. The surgeon will attach an electrode to the patient’s heart’s right ventricle (it is the lower chamber of the human heart) with the help of a wire. The other end of the wire is being attached to a pulse generator. The pulse generator contains the electrical circuits and the battery. Usually, the surgeon will implant the generator under the patient’s skin near their collarbone. If the patients are getting a biventricular pacemaker, the surgeon will attach a second lead to the patient’s heart’s right atrium (it is the upper chamber of the heart), and a third lead to the left ventricle of the heart. At the end of the surgery, the surgeon will close the patient’s cut with the help of stitches.
Preparing for the insertion of the Pacemaker
Before receiving a pacemaker, the patients will undergo several tests. These tests will ensure whether a pacemaker is a correct option for the patients or not.
- An echocardiogram uses sound waves for measuring the thickness and the size of the heart muscle.
- For an electrocardiogram, a doctor or a nurse will place sensors on the patient’s skin for measuring their heart’s electrical signals.
- For Holter monitoring, the patients will wear a device that will track the patient’s heart rhythm for 24 hours.
- A stress test monitors the heart rate while the patients are exercising.
If a pacemaker is right for the patients, they need to plan for the operation. The doctor will give them complete instructions on how to prepare for the surgery.
- The patients must not eat or drink anything after midnight the night before their operation.
- The patients must follow the doctor’s instructions about which medicines to stop taking.
- The patients must shower and shampoo well. The doctor may want the patients to use a special soap. The use of the soap reduces the chances of developing a potentially serious infection.
What are the Complications associated with the insertion of the Pacemaker?
Every medical procedure has certain risks. Most of the risks associated with a pacemaker are due to the surgical installation. They may include the following:
- An allergic reaction to anesthesia
- Bleeding
- Bruising
- Damaged blood vessels or nerves
- An infection at the area of the cut
- A collapsed lung (rare)
- A punctured heart (rare)
Most of the complications are temporary. Life-altering complications are very rare.
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