Pacemaker – Everything You Need to Know

An electric medical device known as a pacemaker is typically the size of a matchbox. It is implanted beneath your skin by a surgeon to help manage arrhythmias, which are irregular heartbeats. Pacemakers can be used to treat several forms of heart failure. The electrical signal that begins your heartbeat often comes from the sinoatrial (SA) node. 

Your heart’s natural pacemaker is called the SA node. A heartbeat is produced by the synchronised movement of electrical signals produced by the SA node from the top to the bottom of the heart. In specific situations, there may be problems with this electrical transmission, which could lead to an irregular pulse or an excessively rapid heartbeat (tachycardia).

Some recent pacemakers only weigh 1 ounce (28 grams). Most pacemakers consist of two parts:

• The battery and instructions for controlling the heartbeat are included in the generator.

• The leads, which are actually wires, send electrical signals from the generator to the heart.

A pacemaker is surgically inserted. In most instances, this procedure takes an hour or so. To make you more relaxed, a sedative will be administered. Throughout the procedure, you will be awake.

There is a brief cut or incision created. The cut most frequently occurs below the collarbone on the left side of the chest (if you are a right-handed person). The pacemaker generator is then positioned here under the skin. 

Although less often, the abdomen is another possible location for the generator. In the right ventricle of the heart, a self-contained device known as a “leadless” pacemaker is placed. The doctor inserts the leads through the cut, into a vein, and then into the heart while using live X-rays to view the area. The generator is wired using the leads. Stitches are used to close the skin. Most patients return home one day after their treatment.

Types

Depending on the heart condition, a particular pacemaker with one to three wires (referred to as leads) may be utilised. Various pacemaker types include:

Leadless pacemaker: A compact pacemaker that is placed using a catheter. It is about the size of a huge pill. This device doesn’t require any wires because it is affixed to the inside wall of your heart.

Single-chamber pacemaker : A single cable is inserted to one chamber of your heart to power a single-chamber pacemaker.

Dual-chamber pacemaker : Two wires are linked to each of your heart’s two chambers via a dual-chamber pacemaker.

Biventricular pacemaker : Three wires are used by a biventricular pacemaker, two of which link to the lower chambers of your heart (known as the ventricles), and a third to the right upper chamber (known as the right atrium). It is also referred as cardiac resynchronisation therapy (CRT).

Why it’s done 

To regulate or quicken the heartbeat, a pacemaker is employed. To keep the heart beating normally, it stimulates it as necessary.

Usually, the electrical system of the heart regulates the heartbeat. The heart’s chambers are filled with electrical messages or impulses. When to beat, they instruct the heart.

If the heart muscle is injured, changes in heart signalling may occur. Changes in genes prior to birth or the use of specific medications can also result in issues with heart signalling.

Signs you need a pacemaker

Finding out if you have health issues that can be treated with a pacemaker begins with talking to your healthcare professional about your worries or symptoms. You should inform your healthcare practitioner about the following symptoms, among others:

• Chest pain is also referred as angina.
• Unexplained confusion.
• Tachycardia – This is an unusually fast heartbeat which is more than 100 beats per minute.
• Bradycardia – This is an unusually slow heartbeat which is fewer than 60 beats per minute.Lightheadedness, nausea , unexplained dizziness or fainting.Shortness of breath, when you’re more active.
• Irregular heartbeat or arrhythmia – A heartbeat that skips beats or adds in extra beats.
• Heart palpitations – This usually happens when you can feel your heartbeat in a unpleasant way and it might feel like your heart is “flip-flopping” or pounding in your chest.
• Needing to urinate multiple times at night.
• Swelling in your ankles, legs and abdomen.

Risks

You can discuss any potential issues with your healthcare professional after the pacemaker procedure. The following issues could arise generally:

Allergy symptoms: 

These could be brought on by a medication you’re taking or a material used in the pacemaker itself that you’re allergic to.

Blood clots : 

To lower the risk of developing a blood clot, your doctor may recommend blood-thinning drugs.

Defects in the pacemaker’s leads or other components: 

A pacemaker lead may occasionally be knocked out of place or release itself. To prevent this, your doctor may advise you to reduce your activity for some duration after the treatment.

Procedure – Before , during and after

Before the procedure

To implant a pacemaker, surgery is required. Typically, the procedure takes a few hours.A unique soap is used to wash your chest. A member of your medical team inserts an IV into your hand or forearm. Sedative medication is administered by IV. It promotes relaxation.

The skin where the pacemaker will be implanted is typically numbed with local anaesthesia. You can be completely awake or under minimal sedation throughout the pacemaker procedure.

During the procedure

A doctor inserts one or more wires into a significant vein under or close to the collarbone to implant a pacemaker. To direct the wires to the heart, the doctor uses X-ray pictures. Each wire has an end that is attached to the appropriate spot in the heart. The pacemaker’s opposite end is connected to the component that generates electrical pulses. It is known as a pulse generator. Typically, it is positioned beneath the skin just below the collarbone.

A pacemaker without leads is smaller. One unit contains every component. Using a catheter, a small, flexible tube, it is inserted into the heart. The tube is inserted into a blood vessel by the doctor, typically in the groin. The tube is used to insert the leadless pacemaker. 

After the procedure

Following the installation of a pacemaker, you can spend a day in the hospital. Before you depart, the gadget is configured to your specific heart rhythm requirements. Make arrangements for a ride home from the hospital.

You might be suggested to avoid strenuous exercise or heavy lifting for the first month after obtaining a pacemaker. Avoid applying pressure to the region where the pacemaker was inserted. Your doctor might advise you on the medications you are supposed to take if you’re in pain.

Special precautions

Electrical interference normally does not cause a pacemaker to stop functioning. However, if you have a pacemaker, it’s a good idea to adhere to a few safety precautions.

Cellular phones

Talking on a cell phone is secure. However, keep your pacemaker at least 6 inches (15 centimetres) away from the phone.Never put your phone in a shirt pocket. Talk on the line that isn’t your pacemaker’s side while holding your phone up to your ear.

Medical equipment

Inform all members of your medical team, including your dentists, that you have a pacemaker. Several imaging procedures and therapies might hamper the device. MRI or CT scans, radiation therapy for cancer, the use of an electric current to stop bleeding after surgery, and sound wave therapy to break up big kidneys or gallstones are some of the examinations and therapies mentioned here.

Security system

 A pacemaker won’t be affected by going through a metal detector at the airport. However, the pacemaker’s metal could set off the alarm. Avoid spending too much time close to a metal detection system. Keep a pacemaker ID card on you at all times.

Apparatus for generating power

Stand at least 2 feet (61 centimetres) away from motor-generator systems, high-voltage transformers, and welding equipment. If you use such equipment at work, inquire with your medical team about whether a safety test can be performed there. The test can determine if the apparatus has an impact on your pacemaker.

Living with a pacemaker

Your heartbeat can be monitored and recorded by your pacemaker. Your doctor or cardiologist can remotely monitor your pacemaker to assess how it is doing for you as you go about your regular activities. Most people only need to visit their doctor’s office once or twice a year to have their pacemaker examined.

Your pacemaker’s battery and operation will be examined during this period. Batteries for pacemakers typically last 6 to 10 years. When it’s time to change your battery, your doctor will let you know. Typically, a straightforward method to replace the pulse generator is required.

Alternatives to a pacemaker

In some circumstances, controlling an irregular heartbeat (arrhythmia) might be achievable without having a pacemaker implanted.For instance, medication or a procedure known as catheter ablation can occasionally be used to treat atrial fibrillation.But not all arrhythmia sufferers can be treated in this way; in many cases, a pacemaker is seen to be the best option.

Ask your cardiologist why they believe getting a pacemaker implanted is the best course of action and go over any other alternatives you may have.

Summary

Extreme fatigue, dizziness, and fainting are signs of a sluggish heartbeat and should be alleviated with a pacemaker. Most contemporary pacemakers automatically alter cardiac rate to correspond with degree of physical activity. You might be able to lead an active lifestyle with a pacemaker.

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