Listed below is the step by step procedure of pacemaker implant:
- What is Pacemaker Surgery?
- Why is Pacemaker Surgery Required?
- Pre-operative Preparation
- Day Before Surgery
- Procedure Day
- Methods / Techniques of Pacemaker Surgery
- Post Procedure
- Risks and Complications
What is Pacemaker Surgery?
Pacemaker is an electronic device that is programmed to make the heart beat in a certain way. When the sinus node, which is the natural pacemaker in the human body does not function well, the heart rhythms are disrupted. Pacemaker implant thus comes into the picture.
Abnormal heart rhythms are controlled with the help of an implanted pacemaker. It is a very reliable option for people suffering from a slow heart rate. A pacemaker is a small rectangular device containing few insulated wires and a battery and circuit for controlling the rate of electrical signals getting sent to the heart.
Pacemakers are of different types. Their functioning too differs according to type. Single chamber pacemaker has wires or leads that transmit electrical pulses from the pulse generator to the right ventricle which is in the lower right chamber of heart. Likewise, in a dual-chamber pacemaker, the leads transmit pulses from generator to right ventricle and right atrium. Another type is a biventricular pacemaker which transmits pulses from generator to an atrium and 2 ventricles. Pacemakers can be implanted either permanently or temporarily.
Why is Pacemaker Surgery Required?
There are a variety of reasons behind a doctor recommending you for a pacemaker insertion surgery. Few of them are as listed below:
- Heart Block: A heart block occurs in people either at birth or when the heart is damaged in event of a heart attack. A pacemaker implant is usually done when symptoms of heart block become unbearable.
- Long QT Syndrome: Long QT Syndrome is the body's response to exercise or stress in the form of an affected heartbeat. A pacemaker or defibrillator implant can help control abnormal heart rhythms.
- Sick Sinus Syndrome: Also known as tachy-brady syndrome, it is characterized by fatigue, shortness of breath, angina, heart palpitations etc. This disorder signifies an affected and poorly functioning sinus node. A permanent pacemaker implant regulates the heartbeats.
- Heart Attack: Cardiologists recommend fitting a temporary pacemaker implant in a person who has just suffered a heart attack.
- Congestive Heart Failure: When the heart's pumping power reduces, it is termed as congestive heart failure. This condition can be cured through implant of pacemaker.
- Cardiac Arrest: The electrical system of the heart collapses in event of a cardiac arrest. Pacemaker implant is done in such events when the heart stops beating altogether. This makes the pacemaker implant a life-saving procedure.
Following are the few diagnostic tests a patient has to undergo once he gets the nod from the doctor for pacemaker implant.
- Echocardiogram: The size and thickness of heart muscle need to be known to the surgeon. An echocardiogram is thus useful to know that. The electrocardiogram also provides information of the heart's response to electrical signals through placement of sensors.
- Holter Monitoring: Holter monitoring is helpful to the doctor as it maps your heartbeats and patterns for a day prior to the surgery.
- Stress Test: A stress test helps the cardiologist in observing your changing heart rate while you walk on the treadmill.
Along with these diagnostic tests, some other preoperative measures as mentioned below are necessary to be followed:
- Pregnancy: You should notify the doctor if you are pregnant or suspect that you are pregnant.
- Medications: Notify your doctor of all medications (prescription and over-the-counter) and herbal or other supplements that you are taking.
- Blood clotting medications: If you are on blood thinning medications for any bleeding disorders you may be having, you need to go off them in the period before the procedure.
Following given are the instructions patient needs to follow once surgery date is decided. The date for surgery is also then scheduled.
Day Before Surgery
- Blood tests: The doctor may order a blood test to check the rate at which blood clots take place.
- Consent form: A consent form is supposed to be signed that cites your approval for undergoing the implant.
- Sensitivity or allergy: Alert your doctor if you are allergic to any medications, local and general anesthetics, iodine, latex, tape that would be used during implant surgery.
- Overnight fasting: It is important to be on an empty stomach before the surgery. The fasting window prior to the surgery is usually a night before procedure.
- Heart valve disease: If you suffer from heart valve disease you will have to notify your doctor about the same. As that will alert the doctor to administer antibiotics before commencing the procedure.
- Comfortable clothing: Make sure to go dressed in comfortable and loose attire.
- Sedative: You may be given a sedative before the surgery commencement.
On the day of procedure, following things happen before you are taken into the operation theater for pacemaker implant:
- Gown: You will be asked to change into a hospital gown before the procedure starts.
- Jewelery and metallic accessories: Also, you are asked to take off any metallic accessories and jewelery as those would come into contact with the surgery apparatus.
- IV drip: An intravenous drip will be connected to your vein in your arm or hand for providing medication through it.
- Electrocardiogram monitor: Before the actual procedure starts, the heart's electrical activity is tracked through connecting the body with the electrocardiogram monitor.
Methods / Techniques of Pacemaker Surgery
The cardiologist will use an anesthetic agent to desensitize the region which requires fitting the pacemaker. This makes the patient feel very less to absolute zero pain when it is being fitted. The doctor may also administer antibiotics for reducing infection through the IV drip connected to the patient's arm.
Thereafter, the doctor uses a needle to thread the wires of pacemaker into the vein for subsequently placing it into the heart. An X-ray machine helps the surgeon in guiding the wires into the correct place. A small cut is made in the abdomen or chest once the leading wires of pacemaker are in proper place.
After the incision is made, a plastic tube is used for guiding the lead wire into the blood vessel and then into heart. The lead wire is thereafter tested once it is inside the heart. After that, the pacemaker is placed under your skin through the incision. Once the pacemaker is in the intended place, the doctor will need to test it to be sure enough to know whether it is functioning properly. The incisions are then sealed using sutures.
- Recovery area: Post procedure, you may be moved to the recovery area. You will have to spend the same night in the hospital room for ease of observation for the doctor after implant. This also ensures that the pacemaker functions properly.
- Food: You can resume consumption of fluids and solids immediately after you gain consciousness.
- Discharge: You maybe discharged from hospital once your pulse rate and heart rate are found to be stable.
Do's and Don'ts Post Pacemaker Surgery
A little precautionary care can go a long way in improving the quality of a heart patient's life. Following listed are the precautions to be followed in the period post undergoing pacemaker implant:
- Remain active: After undergoing the implant, one must always ensure to remain physically active.
- Alert your doctor if: Contact your doctor as soon as possible if you experience fainting, nausea, excessive sweating, chest pain, bleeding or discharge from the insertion of implant.
- Regular appointments: Schedule regular appointments with your cardiologist for checking the smooth functioning of the device.
- Avoid heat therapy Heat therapy should be avoided at all costs by heart patients who have undergone pacemaker implant. As that is likely to trigger burns in the tissues surrounding the implanted device.
- Detectors: If travelling, ensure that metal detectors do not hover directly above the region of pacemaker implant. You need to carry the pacemaker identification cards as the siren is likely to go off if it may come in contact with security system at the airport.
- Contact sports: You maybe discharged from hospital once your pulse rate and heart rate are found to be stable.
- Avoid arm movement: In the 6-8 weeks post implant, you should avoid lifting heavy objects as the wires used for fitting the device in your heart are likely to come out.
Risks And Complications
There are few complications associated with pacemaker implant surgeries mentioned ahead:
- Swelling and blood clots: Formation of blood clots in veins near the region of arms near to the region of implant is possible. Swelling can happen on that arm, but is no cause of worry as the swelling disperses within few days.
- Bleeding: Bleeding from the site of device insertion is completely possible.
- Blood vessel damage: There are also chances of damage happening to blood vessels near the implanted pacemaker post surgery.
- Difficulty in breathing: If during the surgery, air gets trapped in the area outside the lung, the lung gets punctured. This is a very minute risk.
- Cardiac perforation: Although a very rare complication, it is a very serious one. In cardiac perforation, there is a literal hole in the heart due to negligence of surgeon. Perforations lead to chest pain and cardiac tamponade (compression of the heart) or in rare cases, results in death.
- How Long Does a Pacemaker Battery Last?
A. The average battery life in pacemaker is anywhere between 5-15 years. The doctor in your follow up visits may have a discussion with you if he feels the need for replacement of the same.
- How much gap should be there between follow up visits?
A. The follow up visits to the doctor's clinic should be done every 3 months. Also, you need to visit the doctor when the pacemaker does not function properly due to dislodgement or external electronic devices disrupting its working.
- Do pacemakers need to be adjusted periodically?
A. Yes, they need to be adjusted periodically. That can be done easily through the telephone and a transmitter and magnet.
- Can I return to my previous occupation after having a pacemaker fitted?
A. After the recovery period and prescribed rest taken, the person who has been fitted with the pacemaker can return to his work-life.
Pacemaker implant is as aforementioned, a life-saving procedure for many and a very commonly performed surgery. It is always apt to discuss the risks, benefits and possible alternatives to the same with your cardiologist before making the decision.
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