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Pacemaker Surgery
The implantation of a pacemaker into the chest of a person by a surgeon is known as a pacemaker surgery. Pacemaker surgery is indicated in people having an irregular heartbeat, that is, a heartbeat that is too fast or too slow.
A cardiac pacing device or pacemaker is a small electrical device that mimics the action of the natural electrical system of the heart and helps in correcting irregular heartbeat or arrhythmias. Pacemakers can be implanted temporarily or permanently, and they carry impulses to the four different chambers of the heart, namely right atrium, left atrium, right ventricle, and left ventricle.
Causes:
Purpose: Pacemaker surgery is required in the following conditions:
- Heartbeat that pauses
- Heartbeat is too fast (tachycardia)
- Heartbeat is too slow (bradycardia)
- Heartbeat is irregular (arrhythmia)
- Heart failure (a condition in which the heart fails to pump sufficient blood to the body)
Symptoms: Certain symptoms may indicate heart disorders that may require a pacemaker. The symptoms include:
- Dizziness
- Fainting
- Light-headedness
- Tiredness
- Heart palpitations (when the heart adds an extra beat or skips a beat)
- Chest pain or tightness
- Shortness of breath
-
Electrocardiogram (EKG or ECG): This test measures the electrical activity of the heart and helps in showing if the heart is beating too fast, or too slow, or not beating at all.
-
Echocardiogram: Sounds waves are used in this test to obtain images of the heart.
-
Holter monitoring: A Holter monitor is a small device that needs to be worn for one or two days to keep track of the rhythm of the heart.
-
Stress test: An electrocardiogram is taken before and immediately after doing some form of exercise, such as walking on a treadmill or riding a stationary cycle. This helps in checking for any heart problems.
The pacemaker surgery can be performed in the following different ways:
1. Transvenous method:
- This is the most commonly used method for pacemaker surgery.
- The procedure is usually done under local anesthesia (the surgical area is numbed).
- One or more wires are inserted by the surgeon into a major vein near or under the collarbone.
- These wires are then guided to the heart using x-ray images.
- The end of each wire is secured at an appropriate position in the heart, and the other end of each wire is attached to the pulse generator, which is normally implanted by the surgeon under the skin beneath the collarbone.
- In the case of a leadless pacemaker, the parts of the pacemaker are contained in a single capsule. A catheter (thin tube) is inserted in a vein in the groin region, and the pacemaker is guided through the catheter to position it properly in the heart.
- The procedure takes approximately one hour to complete.
2. Epicardial method:
- This procedure is done under general anesthesia (the patient is put to sleep during the procedure).
- In this procedure, the electrodes are attached to the surface of the heart, rather than inside the heart.
- The catheter and wireless pacemaker are guided using an x-ray through a vein in the thigh to the heart.
- This procedure is normally completed in less than one hour.
The complications of pacemaker surgery are:
-
Infection
-
Bruising, bleeding, or swelling
-
Thromboembolism (blood clot formation)
-
Pneumothorax (collapse of lungs)
-
Blood vessels damage or nerve damage
-
Hemothorax (collection of blood in the space between the chest wall and lungs)
-
Shifting of the leads or pacemaker device causing the perforation of the heart
-
You will most likely stay in the hospital for one day after the procedure.
-
The pacemaker is programmed to fit the patient’s heart rhythm needs.
-
Avoid heavy lifting and vigorous exercises for one month after the surgery.
-
The doctor may prescribe pain killers to ease your pain and discomfort after the procedure.
-
Avoid putting pressure on the site of pacemaker implantation.
-
Keep your mobile phone at least six inches away from the pacemaker.
-
In case of future medical treatments, inform your doctor that you have a pacemaker. This is because certain medical procedures can interfere with the pacemaker.
-
Stay at least two feet away from power-generating equipment like motor-generator systems, high-voltage transformers, or welding equipment.
-
Carry an ID stating that you have a pacemaker when passing through a metal detector in places like the airport and malls.
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Pacemaker Surgery
The implantation of a pacemaker into the chest of a person by a surgeon is known as a pacemaker surgery. Pacemaker surgery is indicated in people having an irregular heartbeat, that is, a heartbeat that is too fast or too slow.
A cardiac pacing device or pacemaker is a small electrical device that mimics the action of the natural electrical system of the heart and helps in correcting irregular heartbeat or arrhythmias. Pacemakers can be implanted temporarily or permanently, and they carry impulses to the four different chambers of the heart, namely right atrium, left atrium, right ventricle, and left ventricle.
Causes:
There are several causes that may lead to various heart conditions. These heart disorders may require treatment by a pacemaker surgery. The various cause includes:
- Increase in age
- History of heart surgery
- Heart disease
- History of heart attack
- Congenital heart disorders (present at birth)
- Some like calcium channel blockers or beta-blockers may slow down the heart rate
- Health disorders such as:
- Hypothyroidism: When the thyroid gland produces less thyroid hormone, the condition is known as hypothyroidism.
- Pericarditis: The inflammation of the tissue surrounding the heart is called pericarditis
- Myocarditis: An inflammation of the heart muscle is known as myocarditis.
- Cardiomyopathy: Certain changes to the heart muscle may affect the ability of the heart to pump blood, and is known as cardiomyopathy.
- Systemic sclerosis: It is a condition leading to the scarring and inflammation of the skin and internal organs.
- Sarcoidosis: Sarcoidosis is a condition that causes swellings called granulomas in the various body organs.
Types: The different types of pacemakers that can be implanted depending on the condition of the heart and the symptoms of the patient include:
- Single-chamber pacemaker: It has one electrode that connects the pulse generator to only one chamber of the heart, usually the right atrium or right ventricle.
- Dual-chamber pacemaker: This type of pacemaker has two leads that are connected to the right atrium, as well as the right ventricle of the heart.
- Biventricular pacemaker: It has three electrodes that are connected to the right atrium, right ventricle, and left ventricle of the heart, and is used for patients with arrhythmias that are caused by advanced heart failure.
Parts: A pacemaker is made up of two parts:
- Pulse generator: This is a small metal container consisting of a battery and electrical circuits which control the rate of electrical pulses that are sent to the heart.
- Electrodes or leads: One to three insulated, flexible wires are placed in one or more chambers of the heart to adjust the heart rate by delivering electrical pulses. Some pacemakers are implanted into the heart muscle directly and are known as leadless pacemakers (pacemakers without leads).
Symptoms
Purpose: Pacemaker surgery is required in the following conditions:
- Heartbeat that pauses
- Heartbeat is too fast (tachycardia)
- Heartbeat is too slow (bradycardia)
- Heartbeat is irregular (arrhythmia)
- Heart failure (a condition in which the heart fails to pump sufficient blood to the body)
Symptoms: Certain symptoms may indicate heart disorders that may require a pacemaker. The symptoms include:
- Dizziness
- Fainting
- Light-headedness
- Tiredness
- Heart palpitations (when the heart adds an extra beat or skips a beat)
- Chest pain or tightness
- Shortness of breath
Diagnosis
-
Electrocardiogram (EKG or ECG): This test measures the electrical activity of the heart and helps in showing if the heart is beating too fast, or too slow, or not beating at all.
-
Echocardiogram: Sounds waves are used in this test to obtain images of the heart.
-
Holter monitoring: A Holter monitor is a small device that needs to be worn for one or two days to keep track of the rhythm of the heart.
-
Stress test: An electrocardiogram is taken before and immediately after doing some form of exercise, such as walking on a treadmill or riding a stationary cycle. This helps in checking for any heart problems.
Treatment
The pacemaker surgery can be performed in the following different ways:
1. Transvenous method:
- This is the most commonly used method for pacemaker surgery.
- The procedure is usually done under local anesthesia (the surgical area is numbed).
- One or more wires are inserted by the surgeon into a major vein near or under the collarbone.
- These wires are then guided to the heart using x-ray images.
- The end of each wire is secured at an appropriate position in the heart, and the other end of each wire is attached to the pulse generator, which is normally implanted by the surgeon under the skin beneath the collarbone.
- In the case of a leadless pacemaker, the parts of the pacemaker are contained in a single capsule. A catheter (thin tube) is inserted in a vein in the groin region, and the pacemaker is guided through the catheter to position it properly in the heart.
- The procedure takes approximately one hour to complete.
2. Epicardial method:
- This procedure is done under general anesthesia (the patient is put to sleep during the procedure).
- In this procedure, the electrodes are attached to the surface of the heart, rather than inside the heart.
- The catheter and wireless pacemaker are guided using an x-ray through a vein in the thigh to the heart.
- This procedure is normally completed in less than one hour.
Risks
The complications of pacemaker surgery are:
-
Infection
-
Bruising, bleeding, or swelling
-
Thromboembolism (blood clot formation)
-
Pneumothorax (collapse of lungs)
-
Blood vessels damage or nerve damage
-
Hemothorax (collection of blood in the space between the chest wall and lungs)
-
Shifting of the leads or pacemaker device causing the perforation of the heart
After Procedure
-
You will most likely stay in the hospital for one day after the procedure.
-
The pacemaker is programmed to fit the patient’s heart rhythm needs.
-
Avoid heavy lifting and vigorous exercises for one month after the surgery.
-
The doctor may prescribe pain killers to ease your pain and discomfort after the procedure.
-
Avoid putting pressure on the site of pacemaker implantation.
-
Keep your mobile phone at least six inches away from the pacemaker.
-
In case of future medical treatments, inform your doctor that you have a pacemaker. This is because certain medical procedures can interfere with the pacemaker.
-
Stay at least two feet away from power-generating equipment like motor-generator systems, high-voltage transformers, or welding equipment.
-
Carry an ID stating that you have a pacemaker when passing through a metal detector in places like the airport and malls.
FAQ Section
A pacemaker is a small electrical device which is fitted in the chest or abdomen and is used to treat some abnormal heart rhythms that can cause your heart to either beat too slowly or miss beats. Some pacemakers can also help the chambers of the heart to beat in time. Each time the heart beats, the heart muscle contracts in preparation for pumping blood around the body, and these contractions are triggered by electrical pulses that are generated by a group of specialized cells known as the sinoatrial node (SA node) which is often referred to as a natural pacemaker because it generates a series of electrical pulses at regular intervals. A pacemaker or implantable cardioverter defibrillator (ICD) is implanted when something disrupts this process and causes an abnormal heartbeat, arrhythmia.
Pacemaker surgery is a procedure performed to implant pacemaker in the chest or abdomen. It does not require open heart surgery, and most people go home within twenty-four hours. Before the surgery, medication may be given to make the patient sleepy and comfortable, and generally, the procedure is performed under local anesthesia.
You may feel some amount of pain or discomfort during the first forty-eight hours after having a pacemaker fitted, and you'll be given pain-relieving medication. There may also be some bruising where the pacemaker was inserted, and the bruising usually passes within a few days. You should tell the staff if your symptoms are persistent.
Single chamber pacemaker is a type of pacemaker that usually carries electrical impulses from the pulse generator to the right ventricle of the heart.
Dual chamber pacemaker is a pacemaker that carries electrical impulses from the pulse generator to both the right ventricle and the right atrium of the heart. These impulses help regulate the timing of contractions between the two chambers.
A biventricular pacemaker is a treatment option for people with heart failure whose hearts electrical systems have been degraded. Unlike a regular pacemaker, a biventricular pacemaker stimulates both of the lower chambers of the heart to make the heart beat more efficiently. A biventricular pacemaker paces both ventricles so that all or most of the ventricular muscle pumps together, allowing your heart to pump blood more effectively. It's also referred to as cardiac resynchronization therapy (CRT) as it resets the ventricles pumping mechanism.
Issues from having surgery to implant your pacemaker are rare but could include:
- Infection where the pacemaker was implanted
- Allergic reaction to the dye or anesthesia
- Swelling, bruising or bleeding at the generator site
- Damage to your nerves or blood vessels near the pacemaker
- Collapsed lung
Most people are able to go home on the same day they have the implant. Occasionally, some people stay a day or two in the hospital, but before going home, you'll be given a pacemaker registration card, which has the details of the make and model of your pacemaker, so you should always carry the card with you in case of an emergency. You may also wear a bracelet or necklace engraved with important information on the type of pacemaker you have, a personal identification number and a 24-hour emergency phone number.
You may be able to feel the pacemaker and it may feel uncomfortable when you lie in certain positions, but like most people, you'll soon get used to it. And also modern pacemakers are now so small that they're almost completely hidden by the chest tissue and rarely draw any notice.
Do’s
- Patients with a pacemaker should always carry their Patient Identification Card at all times
- The identification card carries important information like the type of pacemaker, and in an emergency, this card will give the doctor critical data that could save the patient’s life
- Follow the doctor’s instructions for returning to normal activities
- When traveling, the person with a pacemaker should always inform the security staff about the device in advance as it may trigger an alarm
- When walking through security gates, the person with a pacemaker should never allow the security personnel to place the scanner over the pacemaker. The Patient Identity Card comes handy in such situations.
- When going for any other treatment, the patient should always inform the treating doctor about the pacemaker.
Don’ts
- People having a pacemaker should not venture into rough contact sports like boxing and rugby.
- People with a pacemaker that is not MRI compatible should avoid proximity with magnetic devices such as MRI scanners.
- The electromagnetic signals of cellular phones can interfere with the proper functioning of the device, hence people with the device should avoid carrying it in the pocket over the pacemaker.
- After getting a pacemaker, patients should avoid getting heat therapy
- The strenuous repetitive upper-body workout may affect the pacemaker or the leads, hence it is better to avoid them
- The doctors advise the patient not to play with or move the pacemaker under the skin
- The patient with a pacemaker should avoid lifting, stretching and sudden jerky movements for some weeks after the implant
You should be back to your usual self, or even better, very quickly after the procedure.
You should avoid exhausting activities for around four to six weeks after having your pacemaker fitted; after this, you should be able to do most activities and sports.
Don't get your wound wet until your stitches have been taken out, and after that, you should avoid wearing anything that rubs against the area of your wound, such as bands.
You'll usually have your pacemaker checked after four to six weeks at the hospital where it was fitted. If these checks are satisfactory, you'll have your pacemaker checked every three to twelve months.
Signs that your pacemaker isn't operating as it should or you have developed an infection or blood clot include:
- breathlessness
- dizziness
- fainting
- prolonged weakness
- a swollen arm near the pacemaker
- chest pains
- prolonged hiccups
- a high temperature of 38C or above
- Swelling, pain, and redness at the site of the pacemaker.