Diagnostics
Pacemaker implantation surgery
What is pacemaker implantation surgery?
Pacemaker implantation surgery is a procedure to place a pacemaker device inside the body. A pacemaker is a small, battery-operated device that helps regulate the heart’s electrical activity and maintain a steady heartbeat.
The heart has its own electrical system that signals its chambers when to contract or squeeze. Sometimes, this electrical system malfunctions, causing the heart’s chambers to contract incorrectly or too weakly, resulting in insufficient blood supply to the body. Pacemakers are designed to fix these issues by sending electrical signals to regulate the heart’s rhythm and ensure proper contractions.
Who performs pacemaker implantation surgery?
What are pacemakers?
A pacemaker is a small, implantable medical device that is used to help regulate an irregular or slow heartbeat. It is primarily used to treat various heart rhythm disorders, also known as arrhythmias.
Traditional pacemakers have three parts: a generator, wires (leads), and sensors (electrodes). Some newer pacemakers are wireless. Wireless pacemakers are more compact compared to traditional ones as they combine the pulse generator and electrodes into a single device. Traditional pacemakers, which use leads and are surgically implanted, require a small incision and the creation of a pocket beneath the skin to house the pulse generator. In contrast, wireless pacemakers, often referred to as “leadless” pacemakers, are inserted into the heart using a minimally invasive procedure involving a catheter. Once positioned, the pacemaker sends electrical impulses directly to the right ventricle to regulate the heart’s rhythm.
What are the different types of pacemakers?
There are different types of pacemakers:
- Single chamber pacemaker: It sends electrical signals to the heart’s lower right chamber.
- Dual chamber pacemaker: This type sends electrical signals to both the upper and lower right heart chambers.
- Biventricular pacemaker: Also known as a cardiac resynchronization pacemaker, it is for people with heart failure and a slow heartbeat. This device stimulates both lower heart chambers, making the heart muscle stronger.
Why does an individual need a pacemaker?
The heart acts like a muscular pump, guided by electrical signals. However, these signals can sometimes get disrupted, leading to various potentially risky heart conditions, including:
- Bradycardia: A heart condition characterized by an abnormally slow heartbeat.
- Tachycardia: A heart condition characterized by an abnormally fast heartbeat.
- Heart block: An irregular heartbeat caused by the improper transmission of electrical signals controlling the heart.
Cardiac arrest: A serious situation where a problem with the heart’s electrical signals causes it to stop beating altogether.
The doctor may recommend a pacemaker if the patient has been diagnosed with a heart condition that causes an irregular or slow heartbeat, leading to symptoms like fatigue, dizziness, fainting, or shortness of breath. The pacemaker will help maintain a stable and regular heart rate, improving the quality of life and reducing the risk of complications.
How is pacemaker implantation procedure performed?
Before the surgery
- Before the surgery, a thorough medical history, physical examination, and diagnostic tests are conducted to determine the need for a pacemaker and the appropriate type of device.
- Electrocardiogram (ECG), holter monitoring, and other cardiac tests help evaluate the heart’s electrical activity and identify any abnormalities.
- Inform the doctor about any bleeding disorders that the patient may have or the use of blood-thinning medications like anticoagulants and aspirin. Some of these medications may need to be stopped before the procedure.
- The cardiologist or cardiac electrophysiologist, along with the team of doctors, will explain the details of the pacemaker placement procedure to the patient. This includes the purpose of the pacemaker, the procedure itself, potential risks, benefits, and alternatives. After the patient has been informed and has had their questions answered, they are typically asked to sign a written consent form.
During the surgery
Before the surgery begins, the patient is given local anesthesia to numb the area where the pacemaker will be implanted. In some cases, general anesthesia might be used to make the patient unconscious during the procedure.
The surgeon makes a small incision, usually near the collarbone, to create a pocket for the pacemaker device.
The pacemaker generator is positioned under the skin, and the leads are attached to it and tested to ensure proper functioning.
After the pacemaker is in position and its functionality is confirmed, the surgeon closes the incision using stitches, adhesive strips, or special glue. A sterile bandage or dressing will be applied.
After the surgery
After the procedure, the patient will be monitored in the recovery or hospital rooms. The patient should inform the nurse immediately if they experience chest pain, tightness, or pain at the incision site. Once the period of bed rest is over, they will be assisted in getting up. The patient should move slowly to prevent dizziness. They can eat and drink once fully awake. Pain medication will be provided if needed for any soreness at the insertion site.
Once the vital signs stabilize and the patient is alert, they can be discharged home or spend at least one night in the hospital for observation after pacemaker implantation.
After the pacemaker implantation, the following instructions are given for proper care.
- Avoid strenuous activities for a few weeks.
- Keep the incision site clean and dry to prevent infection.
- Monitoring and reporting any abnormal symptoms or changes in the heart rate
- Regular follow-up appointments to check the pacemaker’s function and adjust settings if necessary.
Notify the doctor if the patient experiences fever, chills, increased pain or redness or bleeding from the incision site, chest pain, or palpitations.
While pacemaker implantation is generally considered safe, there are potential risks and complications associated with the procedure. These may include infection at the incision site, bleeding, damage to blood vessels or nerves, lead displacement, or an allergic reaction to the materials used.
What are the possible benefits of pacemaker implantation?
Pacemakers improve the patient’s life by:
- Relieving symptoms like chest pain, palpitations, and nausea.
- Preventing fainting caused by irregular heartbeats.
- Saving life by keeping the heart beating regularly and avoiding heart stoppage.
References
- Overview Pacemaker Implantation. Available from: https://www.nhs.uk/conditions/pacemaker-implantation/
- Permanent pacemaker. Available from: https://my.clevelandclinic.org/health/treatments/17360-permanent-pacemaker
- Mayo Clinic. Pacemaker. Available from: https://www.mayoclinic.org/tests-procedures/pacemaker/about/pac-20384689
- American Heart Association. Pacemaker. Available from: https://www.heart.org/en/health-topics/arrhythmia/prevention–treatment-of-arrhythmia/pacemaker
- Pacemaker Insertion. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pacemaker-insertion
