Why does a patient need a pacemaker/defibrillator?

A pacemaker/defibrillator is needed when the heart either beats too slow or too fast. In both these cases, the heart is unable to pump enough blood for the daily needs of the body. Some of the symptoms, which might occur include:

Lightheadedness or fainting / loss of consciousness

Fatigue

Damage to vital organs

Shortness of breath

Eventual death

The electrical system of the heart, which helps in controlling the rhythm of the heart is regulated by the pacemaker. With every single heartbeat, electrical impulse travels from top to bottom of heart, which signals the muscles of the heart to contract. The function of the pacemaker is also tracking and recording the heartbeat. With the record in place, the doctor is able to study and understand the pattern of arrhythmia better.

All pacemakers are not permanent. Temporary pacemakers help in controlling various types of problems. In many cases, temporary pacemakers are needed after a heart surgery or heart attack. Some medications tend to slow down the heart rate considerably and hence a pacemaker might be needed. The cardiologist will carry out tests and then say if pacemaker is needed for you.

What are the preparations needed for a pacemaker?

Various kinds of tests and investigations are needed to be taken before getting a pacemaker. Some of these include:

Echocardiogram – Sonography of heart.

Electrocardiogram – the heart’s electrical signals are measured with the help of this 49 ECG test.

Holter monitoring – a device which tracks the rhythm of the heart for 24 to 48 hours.

Stress test – helps in monitoring the heart rate while exercising.

What is the procedure followed in pacemaker implantation?

It mainly takes 1-2 hours for pacemaker implantation. Sedatives might be administered to keep you relaxed. Local anesthesia is provided for numbing the incision site. A small incision is made below the collar bone. A small wire is guided through the incision into a major vein in the collarbone area. The wire is then led through the vein to the heart. The surgeon is guided through a X-ray machine in the whole process. Using the wire, an electrode will be attached to the right ventricle of the heart. The ventricle is actually the lower chamber of the heart. The other end of the wire is attached to the pulse generator, where the battery and the electrical circuits are present. Usually, the implantation of the generator takes place under the skin near the collarbone.

If you are being implanted a biventricular pacemaker, the second lead will be attached to the right atrium of the heart, which is the upper chamber of the heart.

The incision is finally closed with stitches.

Are there chances of complications taking place after pacemaker surgery?

All surgical procedures come with their set of complications and risks. The major risks which are associated with pacemaker usually emanate from surgical installation. Some of the complications include:

• Bleeding
• Allergic reaction to anesthesia and to the foreign body installed inside the body
• Bruising
• Infection at incision site
• Damaged blood vessels and nerves
• Rarely a punctured heart or lung

Most of the complications are temporary and go with time.

What happens post pacemaker surgery?

Usually the patient is discharged on the same day of the surgery or might be kept at the hospital overnight. The pacemaker is programmed properly as per the needs of the patient’s heart conditions. The device can be reprogramed as needed in the following follow-up appointments.

In the next one month, heavy weight lifting and rigorous exercises should be avoided. Medications also need to be taken as per the prescription of the doctor. Regular checkup initially is needed so that both the doctor and the patient know that the device is running fine and in a hassle-free manner. Nowadays, the pacemaker can be integrated to a phone line using some special equipment, which the doctor gives. The doctor will get all the required information about the working of the pacemaker, without the need of visiting the doctor physically.

Do not do these things:

• Avoid standing in front of metal detectors for long
• Refrain from high voltage transformers
• Don’t stand near microwaves and similar appliances for long
• Don’t keep a cell phone in the pocket over a pacemaker

You can lead an absolutely normal life with a pacemaker implanted. Just follow the instructions of the doctor and there will be no problems at all.