By Dr Aparna Jaswal
The ideal resting heart rate for an adult ranges from 60 to 100 beats per minute, depending on the age and medical condition of the patient. However, some people experience extremely low or high heartbeats that may be controlled by a pacemaker. A pacemaker is an electric medical device that is typically the size of a matchbox. It is placed under the skin by a surgeon to assist in controlling arrhythmias, the condition in which a patient gets abnormal heartbeats. Several types of abnormal heart rhythms can be treated using pacemakers.
A doctor would recommend one of three types of heart pacemakers depending on the condition of the heart. Single Chamber Pacemakers are pacemakers that use one wire lead to thread into the veins of the heart in any of the upper or lower chambers of the heart. Secondly, dual-chamber pacemakers have one lead that connects the pulse generator to one chamber of your heart. Thirdly, a Biventricular pacemaker has three wires leading to the right atrium (right upper chamber), the right ventricle (right lower chamber), and the left ventricle (left lower chamber). This kind of artificial pacemaker is usually prescribed in more severe cases and helps the two ventricles of the heartbeat be in sync.
All pacemakers are not always permanent. Certain issues can be managed using temporary pacemakers. After a heart attack or cardiac surgery, the patient could require a temporary pacemaker.
Advancements in the innovation of pacemakers
In the last few years, there have been tremendous advancements in the field of pacemakers. Long-lasting pacemakers are now readily available. Earlier pacemakers had a lifespan of 9–11 years. However, today, pacemakers have a lifespan of 10–14 years. Nowadays, physicians have access to pacemakers that can identify if the patient has other medical problems like sleep apnea.
Pacemakers, which can identify arrhythmia, are also available. These pacemakers have algorithms that can treat arrhythmia. There are also other types of pacemakers available, like leadless pacemakers. A leadless pacemaker is 90 per cent smaller than a transvenous pacemaker, can go inside the heart, and will not have any leads attached. The removal of the lead and the successful miniaturization of these latest-generation pacemakers have made it possible to implement much less invasive implantation procedures, using catheters with reduced diameters that can be introduced transfemorally, significantly improving patients’ quality of life.
The purpose of pacemaker surgery
A patient must be tested by a physician or cardiologist to determine suitability for a pacemaker. There are many conditions when inserting a pacemaker is advised. Some purposes for a pacemaker are:
- Some types of heart failure
- An uneven or erratic heartbeat
- A heartbeat that pauses
A pacemaker may be necessary if the patient has certain symptoms of arrhythmia or cardiac failure, like fatigue, feeling unsteady or lightheaded, heart palpitations, stiffness or pain in the chest, facing difficulty in breathing and fainting.
Heart pacemaker surgery: the procedure
A pacemaker is implanted surgically by a simple procedure which lasts approximately one hour depending on the type of pacemaker being implanted. A physician can recommend the type of pacemaker after a thorough examination of symptoms and heart function.
During the treatment procedure, a small pocket near the patient’s shoulder is surgically created, which will hold the matchbox-sized pacemaker device. The physician will then place the wires (called leads) in such a way that one end is attached to the pacemaker and the other is located in the targeted area of the heart wall. Once the pacemaker and the wires are in place, the physician will use an electrocardiogram to monitor the heartbeats with which he will evaluate the efficiency of the device. After this, the pocket will be closed, and the patient will be advised further regarding precautions and follow-up.
The risks of pacemaker surgery
One can discuss any potential issues with the doctor after the pacemaker procedure. The following issues could arise an allergic reaction to anaesthesia, infection at the site of the incision or of the leads, misplaced leads that may result in a punctured heart or irregular heart rhythm problems. These complications after the surgery are temporary and can be controlled by taking precautions. Recovering after pacemaker surgery requires rest for a few weeks, and a diet may be recommended by the doctor. A few precautions go a long way in aiding recovery after pacemaker implantation.
Guidelines and protocols for pacemaker implantation
There are specific guidelines and protocols for implanting a pacemaker. When implanting a pacemaker, medical professionals have to consider the patient’s need for the device. If there is a patient who has an abnormal rhythm, which is called atrial fibrillation, with a very poor heart rate, they are given a single-chamber pacemaker for the lower chamber, which is called a VVIR pacemaker. For patients who had no pulse in their hearts in conditions such as sick sinus syndrome or complete heart block, the doctors prefer to give them DDDR pacemakers, which is a dual chamber pacemakers with one pacemaker plug wire in the upper chamber and the other wire to the lower chamber. Patients with heart failure may receive what is known as a ventricular pacemaker, which contains three wires: one wire represents the top chamber and the other two represent the respective two lower chambers. The guidelines allow the doctor to follow them and identify the needs and subsequently give the appropriate treatment for a given patient.
The government has been extremely helpful in assisting patients who cannot afford private health care. The government has announced plans that allow patients to get MRI-compatible dual chamber pacemakers.
The information in this article is for educational purposes only and is not meant to provide any medical or clinical advice. Please consult your doctor for more information
Dr Aparna Jaswal, Director of Cardiology & Electrophysiology, Escorts Heart Institute & Research Center, New Delhi
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