Your heart is the chief primary pump of your body, its main function being to pump and circulate oxygenated blood all through your body and deoxygenated blood back to the lungs for removal. It is endowed with a natural rhythm that keeps it beating and allows blood to flow in and out of it.
What is a pacemaker ?
Your heart has a regular, rhythmic pace at which it beats at. This pace is maintained by a natural pacemaker built into the heart. The other name for this natural pacemaker is the SINOATRIAL (SA) NODE, which is a tiny specialized tissue positioned in the right atrium or the upper chamber of the heart, but has a very large part to play in the normal functioning of the heart. This SA node produces an electrical stimulus at the rate of 60 to 100 times per minute (for healthy adults) normally; it is this electrical impulse that commences from the SA node and determines the heartbeat. The heart beat determines normal blood supply and oxygenation to the rest of the body. An artificial/ implanted pacemaker is a miniature device that helps your heart beat in a regular manner as it should. It does so by supplying electric stimulation which in turn controls your heartbeat. So a pacemaker is essentially an electronic, battery-driven appliance that is to be implanted right under the skin, below the collarbone, surgically. This device can pace, sense and defibrillate all together.
How does a natural pacemaker work in the heart ?
The electrical impulse starts from the SA node, descends through the atria to the atrioventricular (AV) node in the lower side of the right atrium. From this AV node, the impulse moves downwards through the Bundle of His. These are bundles of heart muscle fibres, dedicated to conducting electrical impulses. This impulse is then conducted into the ventricles of the heart. As soon as the electrical stimulus is initiated, it results in the muscle contracting and pumping blood to the whole body. This progression of electrical stimulation to muscle contraction is what makes the heart beat, finally.
When is a pacemaker required ?
It is required when there is malfunction or failure to generate the electrical impulses by the natural pacemaker of the heart. An artificial pacemaker is a petite battery-operated device that makes the heartbeats regain their normal rhythm and can be of two types, that is, either temporary or permanent. An artificial pacemaker is required in the following conditions.
- When your heart beats either too slow or too fast.
- When your heart doesn’t beat on a regular basis.
- When there’s a block in your heart’s electric pathways.
How does an artificial pacemaker work ?
The pacemaker has a pulse generator, at one end and either a single lead (or multiple leads), at the other end of which is an insulated wire, placed inside one or more of the heart’s chambers. The pulse generator with its battery is placed under the skin near your right or left shoulder. Pacemaker leads, at the other end may be placed in the atrium or upper chamber; or ventricle or lower chamber or both, as the medical condition requires it. There is an electrode on the end of a lead which is placed touching the heart wall. The lead is in charge of delivering the electrical impulses to the heart. It also has a feedback mechanism, which senses the heart and current electrical activity and transmits this information back to the pulse generator. When your heart rate drops below normal, the pacemaker device generates or fires diminutive electrical impulses that are conducted through the leads, and travel to the cardiac muscle. These electrical impulses make the chambers of the heart muscle contract, bringing about synchronous cardiac action. The end result is improved cardiac function.
What are the types of pacemakers ?
- Natural or Artificial Pacemakers
- Single or dual chamber Pacemakers
- Temporary or Permanent Pacemakers
What are the tests to be done prior to pacemaker implantation ?
Routine laboratory tests include chest radiographs, complete blood count, bleeding and clotting times, serum electrolytes and kidney function tests. Cardiac tests include echocardiograms and cardiac MRIs. After doing a thorough review of your medical condition and history, along with your test results, your doctor will come to a decision if you are a candidate or not. If you are suitable, the doctor will discuss the benefits and risks of the procedure with you so can decide.
How is pacemaker is placed in the chest ?
Before pacemaker implantation, you will have to sign an informed consent. Any anticipated risks and benefits have to be honestly discussed with you and your family by your doctor. Many of the patients requiring a pacemaker may be on oral anticoagulants, so that has to be tapered before surgery. The choice of sedation and antibiotic prophylaxis will often be determined by your doctor.
An intravenous (IV) line will be inserted in your hand or arm preceding the surgery. You will be wired to an electrocardiogram monitor to record the activity of your heart, via electrodes. Your vital signs which include parameters like blood pressure, heart rate, rate of breathing and levels of oxygenation of blood are to be checked meticulously. The procedure will be done mostly under local anaesthesia, which is injected into the skin at the insertion site.
Once the local anesthetic has taken effect, the physician will make a small incision at the insertion site and place the pacemaker leads into the heart. Then the lead wire is inserted inside the heart, it will be checked to see that it is in its place, and that it is functioning properly. There may be one, two, or three lead wires inserted, depending on the sort of device your cardiologist has selected based on your health condition. Fluoroscopy, an imaging technique, will be used to assist in making out the lead location. The pacemaker generator will be slipped under the skin through the incision, after the placement of the cardiac leads. Usually, this pacemaker generator will be positioned on the left side. The skin incision will be approximated with sutures. A sterile bandage or dressing will be applied to protect the wound.
What is to be expected post pacemaker implantation ?
As a patient, usually you have to remain in the hospital overnight and are to be discharged the following day. Discharge advice includes care of the wound, restricted activity guidelines, medications and your follow-up care. You need to keep the insertion site clean and dry, inspect it daily, and report any signs of infection to your physician. You will have a chest X-Ray after your pacemaker placement, to check the pacemaker and the leads. Your pacemaker will be checked with a programmer to make sure your pacemaker is functioning accurately. You will be given an identification card (ID Card) with the model and serial number, and company of your pacemaker and leads. This is to be kept with you, at any given time, on your person. There will be a requirement for lifelong follow-up and there could be change of generator and possible lead replacement in the future. Keep a track of your physical activity. There will be some physical or occupational restrictions due to the pacemaker implantation including driving. After a pacemaker insertion, regularly scheduled appointments with your cardiologist are to be ensured to make sure your pacemaker is functioning properly. Exercise should be avoided for at least 6 weeks post the procedure.
What care do I have to take, after the placement of a pacemaker ?
MRI scans are absolutely contraindicated; you should avoid high intensity electric and magnetic fields (but you may undergo other kinds of radiography). You will be able to use a mobile phone, but do not keep your mobile phone in close proximity to the pacemaker, such as in your breast pocket. It is safe to use microwaves. You need to inform airport security staff as you should not pass through their scanner.
How long will my pacemaker last ?
In general, the pacemaker battery should last between 8-10 years.
How to find and reach cardiologists for heart pacemaker implantation ?
You can find and reach cardiologists for heart pacemaker implantation from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple cardiologists, get approximate cost of heart pacemaker implantation from various heart hospitals, compare things and then choose a cardiologist for heart pacemaker implantation procedure.
Find, reach and choose a cardiologist for heart pacemaker implantation on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
