What is a Pacemaker Implantation?
A pacemaker is a tiny electronic device implanted in the chest (just below the collarbone) to assist moderate sluggish electrical abnormalities with the heart. It's inserted under your skin by the surgeon to control arrhythmias or irregular heartbeats. It’s also used for the treatment of fainting spells, congestive heart failure and hypertrophic cardiomyopathy.
Pacemakers are used to treat two distinct forms of arrhythmias:
- Rapid pulse is known as tachycardia.
- Sluggish heartbeat is known as bradycardia.
Some people need a biventricular pacemaker, also known as bivent pacemaker. If you have serious heart disease, you may need a bivent.
Types of Pacemakers
Depending on the conditions, the doctor will suggest any one of the following types of pacemakers.
Single Chamber Pacemaker-
Normally, the single chamber pacemaker carries electrical impulses to the right ventricle.
Dual Chamber Pacemaker-
This type carries electrical impulses to your heart's right ventricle and right atrium, allowing you to regulate the timing of contractions in both chambers.
Biventricular Pacemaker-
Cardiac resynchronization therapy or biventricular pacing is used in people with heart failure and dysfunctional electrical systems. It activates the right and left ventricles to make the heartbeat more efficient.
What Does a Pacemaker do ?
Pacemakers are only activated when they are required. The pacemaker gives electrical signals to your heart to correct the heartbeat if it is too slow (bradycardia).
Sensors, in some newer pacemakers, detect body movements or breathing rate and notify the devices to boost heart rate during exercise as needed.
A pacemaker has two parts:
Pulse generator
A battery and the electrical circuitry that controls the rate of electrical pulses supplied to the heart are housed in this small metal container.
Leads (electrodes)
One to three flexible, insulated wires are implanted in one or more chambers of the heart, each delivering electrical pulses to regulate the heart rate. Some modern pacemakers do not require leads. Leadless pacemakers are devices that are inserted directly into the heart muscle.
Temporary Pacemaker Implantation (TPI) and Permanent Pacemaker Implantation (PPI)
Temporary Pacemaker
Temporary pacemaker is a procedure that helps the heartbeat get back to normal after it has been out of rhythm for a short period of time. It involves inserting wires directly into the heart through the chest or a large vein in the groin or neck, and are directly connected to the heart. A temporary pacemaker is used to treat a bradydysrhythmia, when the problem is temporary and permanent pacemaker is either not needed or not available.
Permanent pacemaker is a tiny device that is implanted beneath the skin of the chest to assist the heartbeat in a regular rhythm. It is made up of two components: a battery-powered pacemaker and leads that are connected to the heart. The pacemaker transmits electrical signals to maintain the heart pumping at a normal rate.
Why does a Person need a Pacemaker?
A person needs a pacemaker if the heart is pumping too quickly or slowly. In either of the case, the body doesn’t get enough amount of blood and it can lead to:
- Fatigue
- Lightheadedness
- Shortness of breath
- Damage to vital organs
- Arrhythmia
A pacemaker regulates your heart rhythm by controlling your body's electrical system. An electrical impulse travels from the top of your heart to the bottom, signalling the heart's muscles to contract with each heartbeat. Your pulse can be monitored and registered by a pacemaker. Your doctor will be able to better understand your arrhythmia if you keep a record.
Pacemakers aren't necessarily permanent. Temporary pacemakers can help with a number of issues. If you had a heart attack or heart surgery, you might need a temporary pacemaker.
Risks of the procedure
Some possible risk of pacemaker includes:
- Bleeding from catheter insertion site
- Damage to the vessel at the insertion site
- Infection of the incision or catheter site
- Pneumothorax
Patients with allergies or sensitivities to drugs or latex should tell their physicians.
Some patients can feel discomfort or pain from lying still on the procedure table for the duration of the procedure.
How to Prepare for Pacemaker Implantation?
Before your doctor decides whether you need a pacemaker, you’ll have to take various tests for finding out the cause of the irregular heartbeat. It includes:
Electrocardiogram (ECG)
In this test sensor pads with wires attached called electrodes are placed on the chest or limbs to measure the heart’s electrical impulses.
Holter monitoring
This is a portable ECG. It's particularly useful for determining the cause of irregular heartbeats that occur at inappropriate times. You wear the monitor for a day or two, and it collects details about your heart's electrical activity as you go about your everyday activities.
Electrocardiogram monitoring is available on certain personal devices, such as smartwatches. Consult your doctor and see if this is a realistic alternative.
Echocardiogram
This noninvasive test utilizes harmless sound waves to encourage your doctor to observe your heart's operation. A transducer, a tiny instrument, is mounted on your stomach. It sends the captured sound waves (echoes) from your heart to a computer that composes pictures of your beating heart on a monitor using the sound wave patterns.
Stress Test
Some heart attacks only arise when you exercise. An electrocardiogram is taken before and after walking on a treadmill or riding a stationary bike for a stress test. An echocardiogram or nuclear imaging can be performed in some cases.
Pacemaker Implantation Procedure
Before the Procedure
- If you are susceptible to or allergic to any drugs, iodine, silicone, tape, or anesthetic agents, tell your doctor.
- Prior to the treatment, you need to be on an empty stomach for a certain amount of time. Your doctor will advise you on how long you can be on an empty stomach.
- Drugs such as prescription and over-the-counter, as well as herbal or other supplements, should be reported to your doctor.
- If you have a history of bleeding problems or are taking some anticoagulant (blood-thinning) drugs, aspirin, or other blood-clotting medications, notify your doctor. You will need to avoid taking any of these drugs before the operation.
- Before the operation, your doctor can ask you for a blood test to see how long it takes your blood to clot.
- You may be given a sedative to help you relax before the operation. If you're given a sedative and there's a chance you'll be discharged. After the procedure, you will most likely spend at least one night in the hospital for observation and to ensure that the pacemaker is working properly.
During the Procedure
- You'll be asked to take off any jewellery or other items that can create hurdles during the procedure.
- Prior to the procedure, you will be asked to empty your bladder.
- Prior to the procedure, an intravenous (IV) line will be started in your hand or arm to administer medication and IV fluids if necessary.
- You'll be hooked up to an electrocardiogram (ECG or EKG) monitor, which tracks and monitors your heart's electrical activity during the procedure with thin, adhesive electrodes. During the operation, the vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be controlled.
- Before the treatment, you will be given a sedative drug via your IV to help you relax. You will, however, most likely remain awake throughout the operation.
- Antiseptic soap will be used to disinfect the pacemaker insertion site.
- This area will be covered with sterile towels and aboard.
- At the injection site, a local anaesthetic will be inserted into the skin.
- The surgeon will make a small incision at the injection site after the anaesthetic has taken effect.
- A sheath, also known as an introducer, is inserted into a blood vessel, usually under the collarbone. The pacer lead wire would be inserted into the blood vessel and advanced through the heart through the sheath, which is a plastic tube.
- It is important that you stay completely still during the procedure to ensure that the catheter does not move out of place and that the insertion site is not compromised.
- The ECG will be checked to ensure that the pacemaker is operating properly.
- Sutures, adhesive strips, or special glue can be used to seal the skin incision.
After the procedure
In the Hospital
- You can be taken to the recovery room for observation or returned to the hospital room after the operation. Your vital signs will be checked by a nurse.
- If you experience any chest pressure or tightness, or any other pain at the incision site, you can call your nurse right away.
- You can get out of bed with assistance after your bed rest period has ended. When you first get out of bed, the nurse will assist you and monitor your blood pressure while you are lying in bed. To prevent dizziness from bedrest time, walk slowly.
- It's possible that the injection site would be sore or painful. If you are facing severe pain then a painkiller will be given to you.
- While you are healing, your doctor will pay you a visit in your bed. The doctor will provide you with clear guidance and will answer any questions you might have.
- You will be taken to your hospital room or released home until your blood pressure, pulse, and breathing are steady and you are alert.
At Home
Within a few days, you should be able to resume your usual routine. If you need to take some time to return to your regular activities, your doctor will inform you. For a few weeks, you can stop lifting or pulling on something. Depending on your doctor's preferences, you might be advised to restrict the movement of the arm on the side where the pacemaker was inserted.
Precautions to take if you have a Pacemaker
- Electric blankets, heating pads, and microwave ovens can all be used without interfering with your pacemaker's operation.
- Strong electric or magnetic fields, such as those generated by industrial machinery, ham radios, high-intensity radio waves (found near large electrical generators, power plants, or radiofrequency transmission towers), and arc resistance welders, must be avoided.
- There are no studies that necessitate magnetic resonance imaging (MRI).
- More information about what types of equipment can interact with your pacemaker can be obtained from your doctor or nurse.
- Before going for any radiological procedures, you must inform your doctor about the pacemaker.
