Pacemaker Insertion

Introduction

A pacemaker is a small electronic device, designed to maintain the regularity of the heartbeat. It consists of a long-lasting battery and an electronic circuit placed in a sealed metal case. The pacemaker is fitted under the skin and generates an electrical impulse. These impulses are sent to the heart muscle with the help of one or two leads causing the heart muscles to contract, thus producing a heartbeat.

The heart beats are produced regularly by an impulse generator called as S.A. node in the wall of the heart. The rate of impulse generation depends on the needs of the body. It is connected to the heart muscles by means of a conducting system. The muscles contract on receiving the impulse producing the heartbeat. But if this beat becomes irregular or too slow or too fast patient can feel light headed, breathless or sometimes there are blackouts or other severe complications. This condition is known as arrhythmia.

Causes of various arrhythmias are:

1. Heart diseases

2. Congenital heart disease

3. Damage to the conducting system of heart.

Functions of pacemaker:

It does one of the following things

1. To control the pumping rate of ventricles

2. To restore the co-ordination between the atria and ventricles

3. To increase the heart rate in accordance with the physical demands

Pacemaker does not work when the heart rhythm is normal. It paces only when the heart rate is too slow. It is programmed not to activate during sleep when the heartbeats are normally slow.

There are several different types of pacemakers available but the doctor decides which type will suit the patient best.

Procedure of insertion:

1. Pacemaker insertion is done in operating room. Patient generally requires to get admitted in the hospital on previous day.

2. A light sedative is given to the patient to allay anxiety and local anesthesia is given to numb the area of insertion.

3. The leads of the pacemaker are inserted in a vein below the collarbone and passed along the vein into the heart. The leads are fixed to the inner aspect of the heart wall. Testing of the leads is done before connecting it them to the pacemaker.

4. The pacemaker is then implanted beneath the skin below right or left shoulder.

5. Then programming of the pacemaker is done according to the individual needs.

6. Procedure is generally over in about 1 hour but it may take longer.

After the insertion:

Prior to any treatment or investigative procedure, the doctor should be informed that a pacemaker is fitted in the body.

Patient is sent home in about 6 to 24 hours. Some discomfort is common after the procedure which can be relieved by simple analgesics. The pacemaker site should be kept dry for a week. An information booklet is given to the patient and any queries of the patient are solved. Regular follow ups in a pacemaker clinic ensures the proper working of the device. Lifting heavy weights and lifting arm above the shoulder should be avoided. In about 4 to 6 weeks, patient can return to normal activity.

The battery of the pacemaker lasts for a period between 5 to 10 years. At each visit to the pacemaker clinic, the battery is checked. If needed, the battery can be changed by a simple procedure under local anesthesia.

Contact your doctor or pacemaker clinic immediately if one of this happens:

1. Previous symptoms start to recur.

2. Twitching in the chest

3. If heart rate feels to be increased.

4. Pain, redness, swelling or discharge from the site.

The following equipment or devices can interfere with the electronic system of the pacemaker:

1. MRI, lithotripsy or radiotherapy equipment

2. Magnetic chairs, mattresses and chairs

3. Diathermy equipment used by physiotherapists

4. Electric arc welding machines

5. Mobile phones

6. High power radar or electric hubs

7. Car ignition systems

Prior to any treatment or investigative procedure, the doctor should be informed that a pacemaker is fitted in the body. A card of pacemaker can also be carried with the patient.