Pacemaker Implantation - Indications, Types, Procedure, and Precautions

Introduction

A pacemaker is a cardiovascular device positioned inside the body to aid in controlling the heart. It is set for a brief time frame as suggested by the healthcare professional. A pacemaker is surgically placed under the skin of the chest below the collarbone. The procedure is not very invasive and does not require opening the heart. The primary role of the pacemaker is to send electrical signals to the heart in order to stabilize the heart’s rate of beating and reduce the contraction of the heart's lower chambers to standard limits. Pacemakers have firmly established their role as a durable treatment method for life-threatening arrhythmias over time and can also improve the patient's quality of life. The heart can be divided into four chambers. The two upper chambers are known as the left atrium and the right atrium, while the two lower chambers are referred to as the left ventricle and the right ventricle. Generally, a pacemaker contracts the ventricles alone, which can result in miscoordination between the atrium and the ventricles. To avoid these, certain precautions need to be taken in order to increase the effectiveness and life of a pacemaker.

When Is a Pacemaker Indicated?

Several cardiovascular conditions result in abnormal electrical activity of the heart, but not all the conditions would require corrections and treatment with a pacemaker. Only the healthcare provider will determine the right candidate for a pacemaker, and there are several factors to keep in mind for the same. Mentioned below are a few of the cardiovascular conditions that require the implantation of a pacemaker.

• Arrhythmia.

• Heart block.

• Heart failure.

• History of a heart attack.

• Tachycardia (increased heart rate).

• Bradycardia (decreased heart rate).

• Irregular and constant chest pain.

• Heart palpitations.

What Are the Types of Pacemakers?

Depending on the kind of heart problem or cardiovascular issue the patient is facing, a distinctive kind of pacemaker is chosen by the healthcare provider. Mentioned below are the different kinds of pacemakers.

• A leadless pacemaker is a tiny pacemaker, similar to the size of a large pill, that is inserted with the help of a catheter. This particular device is attached to the inner wall of the heart, and it does not require any wires.

• A single-chamber pacemaker is a kind of pacemaker that uses a single wire that is attached to any one of the chambers of the heart.

• A dual-chamber pacemaker is a kind of pacemaker that uses two wires that are attached to any two chambers of your heart.

• A biventricular pacemaker is a kind of pacemaker that uses three wires, two of which are attached to the lower chambers of the heart, called the ventricles and the third wire is connected to the right upper chamber, called the right atrium of the heart. This kind of pacemaker is also referred to as CRT or cardiac resynchronization therapy.

What Are the Surgical Approaches to Pacemaker Implantation?

There are several types of pacemaker implantation surgeries, and the right choice is made by the healthcare provider. The candidate suitable for a particular type of pacemaker implantation is selected after keeping in mind several factors. Mentioned below are a few of the surgical approaches to pacemaker implantation.

• A catheter-based approach is a method that is used to place a pacemaker with the help of leadless pacemakers, which only treat cardiovascular conditions that involve a single chamber of the heart.

• A transvenous approach is the approach of pacemaker implantation through the vein. This kind of implantation method is generally used in adults. In this procedure, the healthcare provider makes a tiny incision in order to access a nearby vein that is close to the heart. With the help of a fluoroscopy type of X-ray, the healthcare provider threads the wires and the leads through this particular vein and then attaches them to a certain point in the heart. The leads and wires are then attached to the pacemaker device, and this pacemaker is eventually placed into a small area under the skin of the chest.

• An invasive surgical-based or epicardial approach is when a healthcare provider creates a small incision in the chest and then inserts the wires and leads through that incision, and then attaches them to the heart. This is connected to the pacemaker, which is situated under the abdomen.

What Precautions Are to Be Taken With a Pacemaker?

A pacemaker is a device that is surgically inserted into the body to help in the smooth functioning of the heart. When this device fails to function properly, it results in various complications, leading to the malfunctioning of a pacemaker. This should be immediately corrected after prompt diagnosis. The majority of pacemaker malfunctions get corrected with suitable programming as well as addressing the root cause of the cardiovascular condition. In such situations, patient education plays a vital role. Individuals should promptly consult medical professionals if they experience any unusual symptoms.

Listed below are some essential precautions to bear in mind when it comes to pacemakers:

• Avoid any contact with or pressure on the area where the pacemaker is implanted.

• Stay away from high magnetic resources, which do not include telephone or television remotes.

• Activities such as bowling, swimming, and gold should be avoided.

• Weightlifting and strenuous exercise should be strongly discouraged.

• One can use a mobile phone, but it should be held on the opposite side of the cardiac implant, away from the heart device.

• Avoid leaning forward for a long period.

• Refrain from prolonged proximity to electrical appliances.

• Stay clear of significant magnetic fields.

• Always carry an identity card (with information about implanted pacemaker) for those with pacemaker.

• Steer clear of direct contact with electronic devices.

• Refrain from engaging in physically demanding activities like vacuuming, operating lawn mowers, or mopping the floor.

• Do not elevate the left hand.

• Restricting the usage of small electronic devices can also be appropriate.

Conclusion

The pacemaker is a great invention in the field of cardiology, and it serves a therapeutic purpose in several cardiovascular conditions. Not everyone is eligible to undergo pacemaker implantation. The healthcare provider, after several measures, chooses the right candidate for the same. Living life with a pacemaker does not mean a lot of obstacles but instead a heart-healthy life with precautions that must be taken care of.