An arrhythmia is either an abnormal heart rhythm or heart rate. To simplify that, an arrhythmia is when your heart beats too fast, too slow, or in an irregular pattern. If the heart beats faster than normal, it is known as tachycardia and if the heart beats slowly, it is known as bradycardia. The most common type of arrhythmia that occurs in our body is atrial fibrillation, which is an irregular and fast heart beat.
What causes arrhythmias ?
There are many factors affecting heart’s rhythm, such as congenital heart defects (defect from birth), having had a heart attack, smoking and stress. Certain substances or medicines may also cause arrhythmias.
What are the symptoms of arrhythmias ?
- Either fast or slow heart beat
- If the beats skip
- A feeling of light headedness or dizziness
- Sweating
- Chest pain
- Shortness of breath
Your doctor has to run tests to determine if you have an arrhythmia. Treatment to re-establish a normal heart rhythm includes medicines, implantable cardioverter-defibrillator (ICD) or implanted pacemaker, or sometimes surgery. Your doctor will determine best treatment for you.
What is a pacemaker and when is it required ?
An artificial pacemaker is a petite battery-operated device that makes the heartbeat regain its normal rhythm. An artificial pacemaker could be of two types, that is, either temporary or permanent. If this natural pacemaker in your body develops disease, the heart’s activity starts to get skewed- it either beats too fast (fast heart rate= tachycardia) or too slow (slow heart rate=bradycardia) or in an irregular rhythm. If this progresses, the heartbeat may fully get blocked (AV block).An artificial pacemaker is required when there is malfunction or failure to generate the electrical impulses by the natural pacemaker of the heart.
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’s current electrical activity and transmits this information back to the pulse generator.
What are the types of pacemakers ?
- Artificial Pacemakers
- Single or dual chamber Pacemakers
- Temporary or Permanent Pacemakers
What are the tests to be done prior to placement of pacemaker ?
Routine laboratory tests include chest radiographs, complete blood count, bleeding and clotting times, serum electrolytes and kidney function tests.
How is the pacemaker placed inside your heart ?
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 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. Once the lead wire is 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 are the precautions to be taken post-pacemaker placement ?
You will have a chest X-Ray after your pacemaker placement, to check 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. There will be some physical or occupational restrictions due to the pacemaker implantation including driving. After a pacemaker insertion, regularly scheduled appointments are to be ensured to make sure your pacemaker is functioning properly.
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.
What Is an Implantable Cardioverter-Defibrillator (ICD) ?
An Implantable Cardioverter-Defibrillator (ICD) is a type of pacemaker, but one which regulates extreme disturbances in rhythm and cardiac disturbances. It does not set regular rhythm, like a regular pacemaker. Instead, it is a device that corrects extremely abnormal heart rhythms. It is a battery-driven apparatus positioned below the skin of your upper chest or abdomen, to monitor your heart rate.
The ICD will be connected to your heart through wires called ‘leads’. The heart transmits electric signals, via these leads to the ICD. The ICD, in turn, through a feedback mechanism, delivers an electric pulse or shock to re-establish the usual heartbeat, if your heart is beating irregularly, too slow or too rapidly. The practice of regaining the normal heartbeat from an abnormal or rapid rhythm by delivering an electric shock to the heart is called cardiac defibrillation.
How do Implantable Cardioverter-Defibrillators (ICDs) Work ?
The Implantable Cardioverter-Defibrillators (ICD) is the most effectual means we have to avoid death from ventricular tachycardia/fibrillation. Unlike pacemakers, which are designed to convey low-energy electrical pulses and maintain pacing of the heart, the ICD is designed to deliver elevated energy electrical pulses (shocks) to the heart to rectify severe fast and continuous arrhythmias (such as ventricular fibrillations & tachycardias or atrial fibrillations) that are not easily correctable and can be potentially fatal. Simply put, it knows when the heartbeat is not normal & it tries to return it to normal. It can also work as a regular pacemaker if your heart is beating too slowly. The increased energy shocks are also known as defibrillation shocks and are typically known to be painful or aching by majority of the patients who have undergone it, but these shocks are the life-savers of the ICD. Some patients have described the feeling of shock as being kicked in the upper body for a moment. Usually a single shock is needed, but occasionally, a succession of shocks can be felt if the abnormal heart rhythm does not get corrected. Defibrillation functionality has increased with each new generation of device.
How is an ICD implanted into your body ?
It is implanted under the skin, much like a pacemaker. It will be done under local anesthesia and sedation. You will be awake during the procedure. The conducting leads are attached to the heart, whilst the ICD is placed wither under the collarbone, or abdomen under the ribs, or the bikini line of the abdomen, if cosmetics are a consideration. Patients are usually out of the hospital the day after the device implantation, thus not entailing a lengthy, expensive hospital stay.
How long is an ICD left in the patient ?
The basic objective of ICD treatment is to avert untimely arrhythmic death. So, usually it has to be put in indefinitely, except if there has been a striking change in the patient’s condition, such as getting a heart transplant.
What are the adverse effects of the ICD ?
Short-term complications could include infection or complications at the time of surgery. Long-term complications include pain at the site, cosmetic concerns (the ICD can be seen as a lump) and psychological concerns such as fear or apprehension of the electrical shocks.
What are the follow-up procedures ?
You have to routinely visit your doctor/ cardiologist, every 3 to 6 months. Your heart rate and the physical condition of your heart will be checked through non-invasive testing.
What is the care you have to take post-ICD implantation ?
You have to keep in mind to meet your doctor regularly. The ICD has to be checked at least every six months. There will be specific lifestyle restrictions- such as driving and restriction of physical activity. You will be required to keep away from magnetic and powerful electrical fields. At the airport, inform authorities of your ICD, so they can use the hand-held metal detectors instead of the whole body scanners which disturb the rhythm of the ICD. Carry an ID card of your ICD on your person, so all can know that you have a defibrillator. Microwave ovens, remote controls for TV, cell phones and other common household appliances will not affect the activity of your ICD. However, if you do use your cellphone, use it on the ear, opposite to your ICD. Do not keep your phone in your chest pocket, over the ICD. Medications such as antiarrhythmic drugs may still have to be taken by some patients. The batteries of the device will last for about 4 to 7 years. You should be mentally prepared for re-operation, in case of battery changes for the ICD.
How to find and reach cardiologists for arrhythmia treatment ?
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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.
