In order to understand what biventricular pacemaker is, we need to first understand what cardiac resynchronization therapy is, as that it the principle it is based on. As the name suggests, this pacemaker has the job of pacing both the ventricles of the heart.
What is cardiac tesynchronization therapy or biventricular pacing ?
In cases of advanced heart failure, wherein the heart’s ventricles or the heart’s lower chambers are not working well, Cardiac Resynchronization Therapy (CRT) or Biventricular Pacing is utilized. It is an innovative therapy that is utilized to reduce heart failure symptoms.
Heart failure means the heart is unable to pump as it should. With heart failure, blood accumulates in the heart itself and is unable to move through the heart and body, as it should. This results in increasing pressure on the heart. Heart failure simply put, is biventricular failure, wherein the two lower chambers of the heart do not contract simultaneously.
The pacing device for this Cardiac Resynchronization Therapy (CRT) is known as the biventricular pacemaker.
When are you recommended a biventricular pacemaker as a treatment option?
Cardiac Resynchronization Therapy (CRT) is considered for people who have-
- Severe or moderately severe heart failure symptoms.
- Are on medication for heart failure.
- Bundle branch block or history of cardiac arrest.
- Heart failure with poor ejection fraction (less than 35%) and have fast, irregular and life- threatening heart rhythms. Ejection fraction is the quantity of exactly how much blood is sent out of the heart to be supplied to the body.
CRT definitely improves symptoms, survival, functions of the cardiovascular system and the potential to exercise in patients with severe or moderately severe heart failure, who are not responding so well to medicinal therapy.
How does a biventricular pacemaker work?
The CRT pacing device (known as a biventricular pacemaker) is 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. When your heart rate drops below normal, the device generates or fires diminutive electrical impulses that are conducted through the leads, and travel to the cardiac muscle. These electrical impulses make the lower chambers (ventricles) of the heart muscle contract, bringing about the synchronous action of the right and left ventricles pumping together. The end result is improved cardiac function.
How is a biventricular pacemaker implanted surgically ?
A medication will be given through your IV to relax you and make you feel calmer, but you will be awake for the duration of the procedure (with the endocardial approach). The other approach, or the epicardial approach is performed under general anesthesia (you will not be awake for this). The device implantation procedure may last from 2 to 5 hours.
With the endocardial (transvenous) approach, the site is cleaned, a local anaesthetic is injected and the surgical incision is made in the chest. The parts of the biventricular pacemaker are then inserted- the leads and the generator device. The leads are guided into the incision site, into a vein, and finally into the cardiac chamber with the aid of the fluoroscopy machine. Two leads will be placed in both the right atrium and the right ventricle, whilst the third lead is guided through the coronary sinus to the left ventricle.
One end of the pacemaker is at the lead tips, touching the heart muscle; whilst the other end of the pacemaker is attached to the pulse generator. The generator is placed right under the skin in the upper chest.
How is a biventricular pacemaker different from a conventional pacemaker ?
Compared with the conventional pacemakers, which have only two leads, the first lead in the right atrium and the second one in the right ventricle, implantation of a biventricular pacemaker involves an added lead (a third lead) in a coronary vein and thus result in increased function of the pacemaker, but this also carries with it an increased potential for complications.
What are the complications of biventricular pacemakers?
Biventricular pacing has its share of device complications which include failure to position implant, implant failure, lead or wire dislodgement from actual site, and atrial tachyarrythmias.
Some more complications can be seen & are similar to that of routine pacemakers, such as pneumothorax, perforation of the heart in surgery, increased infections, emboli, bleeding from the site and cardiac arrhythmias.
What is to be expected post biventricular pacemaker implantation ?
As a patient, usually you have to remain in the hospital overnight and are to be discharged the following day.
A pacemaker check and chest x-ray are done to make sure the pacemaker leads are in their correct place.
Discharge instructions include proper care and heeding of the wound, restricting of activity according to your doctor’s guidelines, taking the necessary medications, and turning up for follow-up care. It is important to maintain the surgical site as clean and dry as possible, and inform your doctor, immediately if any signs of infection are seen. Keep a track of your physical activity. Exercise should be avoided for at least 6 weeks post the procedure.
A total check will be done on your pacemaker, after 6 weeks of the procedure, either in the physician’s office or at a clinic. In addition to the initial pacemaker follow-up, you will need to be followed regularly to ensure that the pacemaker is functioning properly. You will need to follow your pharmacologic and lifestyle treatment program, stringently as well.
What are you supposed to be avoiding post biventricular pacemaker implantation ?
Electromagnetic interference can impede the function of the pacemaker. Avoid exposure. Some causes are electrical appliances or electrical equipment that produces a great deal of energy. Many of the home and office appliances are O.K to use, and undergoing certain medical and dental X-rays and diagnostic ultrasounds are also fine. Patients with a biventricular pacemaker should avoid magnetic resonance imaging, diathermy, excessive radiation, cautery, lithotripsy, and radiofrequency ablation.
How to find cardiologists for biventricular pacemaker implantation ?
Now you can find cardiologists for biventricular 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 biventricular pacemaker implantation from various heart hospitals, compare things and then choose a cardiologist for biventricular pacemaker implantation.
Find and choose a cardiologist for biventricular 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.
