Introduction
A pacemaker is a device that is placed inside the body to aid in controlling the heart. It is set for a temporary time frame, as suggested by the healthcare provider. A pacemaker is implanted under the skin of the chest. This is not a very invasive surgery and does not require opening the heart. The primary function of the pacemaker is to send electrical signals to the heart in order to stabilize the heart rate and also bring down the contraction of the lower chambers of the heart to standard limits. Pacemakers have established themselves as a long-term treatment modality for life-threatening arrhythmias and can also improve the patient's quality of life. The heart is divided into four chambers. The above two chambers are the left and right atrium, and the lower two are called the left and right ventricles. Generally, a pacemaker contracts the ventricles alone, but this can result in lousy coordination between the atrium and the ventricles. This can result in poor cardiac output, and this entire condition is called pacemaker syndrome.
What Causes Pacemaker Syndrome?
The pacemaker was invented in 1958, and since then, doctors have reported a drastic decrease in cardiac output. Pacemaker syndrome is generally seen in a single chamber of the heart, usually the ventricles. The pacemaker has no signal or programming, with the help of which it notices the contraction of the atrium. Since the ventricular pacemaker has no idea of the rhythm of the atrium, it contracts independently. This leads to the atrium and the ventricle contracting at different times and not in synchrony. The asynchrony leads to abnormal heart rhythms and thus decreases cardiac functioning and output. The incidence of pacemaker syndrome has increased over time. It is equally seen in both males and females. 20 percent of all pacemaker syndromes are due to ventricular pacemakers who work on their own.
What Are the Signs and Symptoms Of Pacemaker Syndrome?
The signs and symptoms of a patient suffering from pacemaker syndrome are generally persistent and are more commonly seen in those who have single-chamber pacemakers such as ventricular pacemakers. Along with age, there may be some confusion in clinical manifestations.
Mentioned below are a few of the signs and symptoms of pacemaker syndrome:
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Fatigue.
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Frequent blackouts.
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Low blood pressure.
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Difficulty in breathing.
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Palpitations.
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Memory loss.
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Neck pulsations.
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Low levels of oxygen saturation.
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Swelling in the lower limbs.
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Dizziness.
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Altered mental status.
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Pulsatile liver.
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Low pulse volume.
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Cough.
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Jaw pain.
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Decrease in the ability to perform regular exercises.
How to Diagnose Pacemaker Syndrome?
There are multiple ways to diagnose pacemaker syndrome. Electrocardiographs are one of the best methods, and chest X-rays also prove to be useful in diagnostic procedures. A chest X-ray can reveal single pacemakers and their location. An electrocardiograph will reveal changes in the cardiac output. Very rarely, laboratory tests are required only if electrocardiographs show drastic changes. A deep medical history and episodes of arrhythmias along with underlying cardiovascular conditions can help the healthcare provider correlate the ongoing pacemaker syndrome. It should be noted that this does not help in all cases. Overall, below are some of the standard diagnostic tools for pacemaker syndrome.
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Electrocardiograph.
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Chest X-rays.
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Holter monitor.
How to Treat Pacemaker Syndrome?
Pacemaker syndrome makes patients feel worse as time goes by. This can also worsen the symptoms of congestive heart failure. The supportive measure should be primarily given. In the long term, changing the pacemaker may be advised by the healthcare professional to restore the contracting balance between the atrium and ventricles.
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Hospitalization and continuous monitoring are a must where the patient may require an additional pacemaker lead.
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Intravenous drugs such as antibiotics should be administered to avoid any infection or prophylaxis or, worse case, infection of the pacemaker surrounding tissues.
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Since pacemakers have different manufacturers and different modules, the respective pacemaker manufacturer should be present with interrogation computers.
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Symptomatic treatment according to different aspects of the body is given.
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Other treatment modalities include a pacemaker pulse generator.
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There should be a revision of the medication regimen.
How to Prevent Pacemaker Syndrome?
A pacemaker syndrome takes place when there is a pacemaker in the ventricle only. To avoid this, whenever there are no risks or complications, it is suggested after multiple studies that a pacemaker in the atrium should also be introduced along with a pacemaker in the ventricles. A few of the additional preventive measures are as follows:
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Post the pacemaker insertion surgery, the healthcare provider must be informed of any symptoms similar to a heart attack.
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The healthcare provider will keep the patient under continuous monitoring, and during this evaluation period, any symptoms or signs of infection should be raised.
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Itching, nausea, discomfort in the chest, racing heartbeat, etc., anything out of the odds should be informed to the healthcare team.
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Post-surgery, any discoloration at the site of surgery that remains for a long time or any wound that has pus discharge should be warned to the doctors.
Conclusion
A pacemaker is a device that helps in the contraction of the heart chambers and is a treatment modality for congestive heart failure. Sometimes this goes wrong, and the heart chambers do not beat in synchrony, worsening the symptoms of heart failure. This is referred to as pacemaker syndrome. Post-correction of this syndrome, a diet that is rich in fruits and vegetables but low in sodium should be followed. Oral fluid rehydration is a must post-surgery. Patients are allowed to incorporate activities into their life that are well-tolerated and do not pose much strain on the heart or the overall body. After the pacemaker is inserted, the patient is requested to visit the doctor every two weeks till the wound heals. An interrogation of the functioning of the pacemaker is done every 1st and 3rd month. A biannual pacemaker is henceforth suggested.
