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Cardiac & Heart Surgeries

Pacemaker Implantation

A pacemaker is a small device that can be used to regulate the heartbeat by implanting it into the chest of the patient. It is an electrical device and sends electrical impulses to the heart muscle to maintain a suitable rhythm and heart rate. In dual-chamber pacemakers, two-leads are implanted in the heart. One lead paces the ventricle and one paces the atrium. It closely matches the natural pacing of the heart.  

Types of pacemaker  

Pacemakers are of three types: 

  • Single chamber pacemaker: Single chamber pacemaker usually carries electrical impulses from the pulse generator to the right ventricle of a heart.
  • Dual-chamber pacemaker: A dual-chamber pacemaker carries electrical impulses from the pulse generator to both the right atrium and right ventricle of your heart. 
  • Biventricular pacemaker: A biventricular pacemaker stimulates both lower chambers of the heart (the left and the right ventricles) to make the heartbeat more efficiently. 

Indications for Pacemaker Implantation 

A specialist may consider the pacemaker placement necessary when medications and other less-invasive procedures do not work effectively at correcting heart problems. Some of the conditions that may involve the implantation of a pacemaker are: 

  • Bradycardia: Bradycardia is the condition in which the heart beats too slowly, causing symptoms such as dizziness, fatigue, or fainting spells.  
  • Atrial fibrillation: It is a common heart rhythm disorder in which the upper chambers of the heart beat chaotically and rapidly. Medicines that are used to control atrial fibrillation may result in slow rhythms that can be treated by the pacemaker.  
  • Congestive Heart failure: Congestive heart failure is a condition in which the heartbeat is not sufficient to supply a normal volume of oxygen and blood. A pacemaker can be carefully implanted to increase the force of muscle contractions in the heart.  
  • Syncope (Frequent fainting spells): A pacemaker may be used to prevent the heart rate from slowing down to the point of fainting. 
  • A dual-chamber pacemaker is necessary to the implant when the heart is too weak to maintain the timing of the right ventricle and atrium. 

Tests and diagnosis

  • Medical history and Examination: The consultant evaluates the complete medical history of the patients and performs a clinical examination.
  • Following Imaging Tests are done:
    • Electrocardiogram
    • Echocardiogram: ECG shows the functioning of the heart, and recorded pictures allow the doctor to measure the thickness and size of the heart muscle.
    • Holter monitoring: It records the heart rhythms of the patient for an entire period of 24 hours.
    • Stress test

Pacemaker Implantation Procedure

Before Procedure

  • The cardiologist discusses the procedure with the patient in detail.
  • The patient must inform the doctor about the past and present medical problems and previous operations if any. 
  • Preoperative assessment of the patient is done to check the fitness for surgery. 
  • The patient must discuss with a consultant if he/she is allergic to anesthesia.
  • It is advised to stop certain medications a few days before surgery.
  • Before the surgery, the doctor advises the patient to stop smoking, exercising regularly and eating a healthy diet.

During Procedure

  • Pacemaker implantation usually takes about 1 to 2 hours.
  • A small incision or cut is made in the upper-left side of the chest and the dual-chamber pacemaker is placed just underneath the skin.
  • With the help of X-ray imaging, the surgeon inserts two wires into the subclavian vein and directs them to their respective chambers in the heart.
  • The wires are connected to the pacemaker and tested.
  • The incision is then closed.

After Procedure

  • The patient is hospitalized for 1-2 days to make sure if the pacemaker is functioning properly. 
  • The patient may feel some discomfort or pain during the first 48 hours of having pacemaker implantation and the patient will be given some pain-relieving medication. 
  • The patient may have some bruising at the place where the pacemaker is inserted. This goes within a few days.
  • Painkillers and antibiotics are prescribed to fight infection and pain.
  • Frequent follow-up visits after the first six months of the surgery are important to determine if pacemaker settings are needed to be adjusted.
  • Lifestyle changes, i.e., maintaining a healthy weight and regular exercise are important for improved prognosis.

Placing a pacemaker requires minor surgery. The surgery usually is done in a hospital or special heart treatment laboratory.

Before the surgery, an intravenous (IV) line will be inserted into one of your veins. You will receive medicine through the IV line to help you relax. The medicine also might make you sleepy.

Your doctor will numb the area where he or she will put the pacemaker so you don't feel any pain. Your doctor also may give you antibiotics to prevent infection.

First, your doctor will insert a needle into a large vein, usually near the shoulder opposite your dominant hand. Your doctor will then use the needle to thread the pacemaker wires into the vein and to correctly place them in your heart.

An x-ray "movie" of the wires as they pass through your vein and into your heart will help your doctor place them. Once the wires are in place, your doctor will make a small cut into the skin of your chest or abdomen.

He or she will slip the pacemaker's small metal box through the cut, place it just under your skin, and connect it to the wires that lead to your heart. The box contains the pacemaker's battery and generator.

Once the pacemaker is in place, your doctor will test it to make sure it works properly. He or she will then sew up the cut. The entire surgery takes a few hours.

Expect to stay in the hospital overnight so your health care team can check your heartbeat and make sure your pacemaker is working well. You'll likely have to arrange for a ride to and from the hospital because your doctor may not want you to drive yourself.

For a few days to weeks after surgery, you may have pain, swelling, or tenderness in the area where your pacemaker was placed. The pain usually is mild; over-the-counter medicines often can relieve it. Talk to your doctor before taking any pain medicines.

Your doctor may ask you to avoid vigorous activities and heavy lifting for about a month after pacemaker surgery. Most people return to their normal activities within a few days of having the surgery.

Pacemaker surgery generally is safe. If problems do occur, they may include:

  • Swelling, bleeding, bruising, or infection in the area where the pacemaker was placed
  • Blood vessel or nerve damage
  • A collapsed lung
  • A bad reaction to the medicine used during the procedure

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