What are cardiac pacemakers?
Pacemakers are devices used for the treatment of some types of heart beat (cardiac rhythm) abnormalities.
Historic Back Ground
The 1st case of human cardiac pacing was performed by and Australian anesthesiologist, Marck C Lidwalell in 1929. In Ethiopia it has not been a decade since permanent cardiac pacemaker implantation was started and currently Addis cardiac hospital gives such treatment (pacemaker, ICD and CRT) by experienced cardiologist.
Components of pacemaker device.
- Generator; source of energy for the pacemaker
- Pacemaker Leads: special wires which connect the generator with the heart
Types of pacemakers.
- Single chamber: lead implanted into only one cardiac chamber
- Double chamber; leads implanted into two cardiac chambers
Uses of pacemaker.
Pacemakers are used for the treatment of heart beat (heart rhythm) abnormalities such as very slow heart rate causing weakness, shortness of breath loss of consciousness etc.
How are pacemakers implanted?
Pacemakers are implanted in an a wake patient by using local anesthetic and making small incision in the upper anterior chest followed by advancing leads (Special wires) through veins with the help of X-Ray Machine and placing the battery (generator) under the tissue below the skin.
What are the risks of pacemaker implantation?
In skilled hands, the majority of pacemakers (95%) are implanted without any complication
Possible complications in the remaining patients include:-
- The lead or the wire may detach from the heart (1 in 25 people).
- Bleeding into generator insertion site (1 in 30 people)
- Infection of pacemaker insertion site (1 in 100 people).
- Injury to the lung which may require tube insertion in to the chest.
Rarely (1 in 1,000 people), puncture of the heart (Tamponade) may occur and may need removal or at times it could even be fatal
Care and precautions to be taken by the patient who has pacemaker
- The patient is advised to consult the physician if he has pain, swelling or bleeding at the pacemaker insertion site.
- For two weeks after implantation, avoid driving and overuse of the arm on the side of the generator
- Regular follow-up on appointment days or if there are new symptoms
- Depending on how much the patient is pacemaker dependent, generator change may be required after 5-10 years of implantation
- Since some investigations like MRI and some surgical instruments may interfere with the function of pacemaker, the patient should consult the doctor or cardiologist before undergoing such investigations or procedures
- Carry pacemaker identification card
- Pass through security instruments or metal detectors at a faster pace and avoid standing near such instruments for long time
- Avoid keeping activated phones on the same side of pacemaker generator and use the opposite ear when using the phone.
Implantable cardioverte defibrillator (ICD)
An ICD is an implantable device similar to pacemakers used for the detection and treatment of serious and rapid heart beat abnormalities which could be life threatening if not reverted to normal
An ICD revert such dangerous heart beat (heart rhythm) abnormalities by discharging electric shock.
It is commonly implanted for patients who are at high risk of sudden cardiac death such as patients who have survived cardiac arrest and some patients with serious underlying hear disease
A patient with and ICD should avoid driving at least for the first 6 months.
Cardiac resynchronization therapy (CRT)
It is a type of pacemaker used for the treatment of selected patients with medically refractory heart failure