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What is Pacemaker Implantation?

1. Temporary pacemaker Implantation (TPI)

It is done during emergencies where patient is suffering from low heart rates due to various conditions. This is either done from the right femoral vein (Right Groin) or from the right Jugular Vein (Right neck), under local anaesthesia. It’s a single chamber pacemaker which is operated from outside the body by doctors. If patient doesn’t get back to his normal heart rate or rhythm in a couple of days, permanent pacemaker would be a choice of further management.

When the need for TPI is over, it is taken out from the body & if PPI (Permenant Pacemaker Implantation) is required, a PPI is implanted and TPI is removed.

2. Permanent Pacemaker Implantation (PPI)-

Why is it done?

A pacemaker is implanted to help control your heartbeat. Your doctor may recommend a temporary pacemaker when you have a slow heartbeat (bradycardia) after a heart attack, surgery or medication overdose but your heartbeat is otherwise expected to recover. A pacemaker may be implanted permanently to correct a chronic slow or irregular heartbeat or to help treat heart failure.

The heart's conduction systemOpen pop-up dialog box

How your heart beats

The heart is a muscular, fist-sized pump with four chambers, two on the left side and two on the right. The upper chambers (right and left atria) and the lower chambers (right and left ventricles) work with your heart's electrical system to keep your heart beating at an appropriate rate — usually 60 to 100 beats a minute for adults at rest.

Your heart's electrical system controls your heartbeat, beginning in a group of cells at the top of the heart (sinus node) and spreading to the bottom, causing it to contract and pump blood. Aging, heart muscle damage from a heart attack, some medications and certain genetic conditions can cause an irregular heart rhythm.

What a pacemaker does

Pacemakers work only when needed. If your heartbeat is too slow (bradycardia), the pacemaker sends electrical signals to your heart to correct the beat.

Some newer pacemakers also have sensors that detect body motion or breathing rate and signal the devices to increase heart rate during exercise, as needed.

A pacemaker has two parts:

  • Pulse generator. This small metal container houses a battery and the electrical circuitry that controls the rate of electrical pulses sent to the heart.
  • Leads (electrodes). One to three flexible, insulated wires are each placed in one or more chambers of the heart and deliver the electrical pulses to adjust the heart rate. However, some newer pacemakers don't require leads. These devices, called leadless pacemakers, are implanted directly into the heart muscle.

Risks

Complications related to pacemaker surgery or having a pacemaker are uncommon, but could include:

  • Infection near the site in the heart where the device is implanted
  • Swelling, bruising or bleeding at the pacemaker site, especially if you take blood thinners
  • Blood clots (thromboembolism) near the pacemaker site
  • Damage to blood vessels or nerves near the pacemaker
  • Collapsed lung (pneumothorax)
  • Blood in the space between the lung and chest wall (hemothorax)

What is the time required to do the procedure?

It is done under local anaesthesia, generally can take upto 2-3 hours. However, the amount of sedation needed for the procedure depends on your specific health conditions. You may be fully awake or lightly sedated

A specialist will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax. Your chest is cleaned with special soap.

However, the amount of sedation needed for the procedure depends on your specific health conditions. You may be fully awake or lightly sedated

one lead inserted in the right atrium and another lead in right ventricle-Total 2 leads

Whats the exact procedure?

One or more wires are inserted into a major vein under or near your collarbone and guided to your heart using X-ray images. One end of each wire is secured at the appropriate position in your heart, while the other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone.

What happens after the procedure?

You will be in the ICU for 24 hours for observation and two days in the ward

Your Pacemaker device will be interrogated again before discharged by the company person

You are restricted for the hand movement for 48 hours and then physiotherapy is started

Special precautions

It's unlikely that your pacemaker would stop working properly because of electrical interference. Still, you'll need to take a few precautions:

  • Cellphones. It's safe to talk on a cellphone, but keep your cellphone at least 6 inches (15 centimeters) away from your pacemaker. Don't keep your phone in a shirt pocket. When talking on your phone, hold it to the ear opposite the side where your pacemaker was implanted.
  • Security systems. Passing through an airport metal detector won't interfere with your pacemaker, although the metal in the pacemaker could sound the alarm. But avoid lingering near or leaning against a metal-detection system.
    To avoid potential problems, carry an ID card stating that you have a pacemaker.
  • Medical equipment. Make sure all your doctors and dentists know you have a pacemaker. Certain medical procedures, such as magnetic resonance imaging, CT scans, cancer radiation treatment, electrocautery to control bleeding during surgery, and shock wave lithotripsy to break up large kidney stones or gallstones could interfere with your pacemaker.
  • Power-generating equipment. Stand at least 2 feet (61 centimeters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, ask your doctor about arranging a test in your workplace to determine whether the equipment affects your pacemaker.

Devices that are unlikely to interfere with your pacemaker include microwave ovens, televisions and remote controls, radios, toasters, electric blankets, electric shavers, and electric drills.

Important

  • Bathing- You are supposed to take a bath from below the pacemaker incision for 21 days after discharge.
  • Hand Movement- You are not supposed to raise your hand of the side of pacemaker above the shoulder for next 21 days after discharge. However complete restriction of hand movement is not recommended as it leads to frozen shoulder.
  • Review- 1st review will be after 7 days. We use absorbable suture material , so no question of suture removing arises.