pacemakers


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Pacemakers

 

Definition

A pacemaker is a surgically-implanted electronic device that regulates a slow or erratic heartbeat.

Purpose

Pacemakers are implanted to regulate irregular contractions of the heart (arrhythmia). They are most frequently prescribed to speed the heartbeat of patients who have a heart rate well under 60 beats per minute (severe symptomatic bradycardia). They are also used in some cases to slow a fast heart rate (tachycardia).

Precautions

The symptoms of fatigue and lightheadedness that are characteristic of bradycardia can also be caused by a number of other medical conditions, including anemia. Certain prescription medications can also slow the heart rate. A doctor should take a complete medical history and perform a full physical work-up to rule out all non-cardiac causes of bradycardia.
Patients with cardiac pacemakers should not undergo a magnetic resonance imaging (MRI) procedure. Devices that emit electromagnetic waves (including magnets) may alter pacemaker programming or functioning. A 1997 study found that cellular phones often interfere with pacemaker programming and cause irregular heart rhythm. However, advances in pacemaker design and materials have greatly reduced the risk of pacemaker interference from electromagnetic fields.

Description

Approximately 500,000 Americans have an implantable permanent pacemaker device. A pacemaker implantation is performed under local anesthesia in a hospital by a surgeon assisted by a cardiologist. An insulated wire called a lead is inserted into an incision above the collarbone and guided through a large vein into the chambers of the heart. Depending on the configuration of the pacemaker and the clinical needs of the patient, as many as three leads may be used in a pacing system. Current pacemakers have a double, or bipolar, electrode attached to the end of each lead. The electrodes deliver an electrical charge to the heart to regulate heartbeat. They are positioned on the areas of the heart that require stimulation. The leads are then attached to the pacemaker device, which is implanted under the skin of the patient's chest.
Patients undergoing surgical pacemaker implantation usually stay in the hospital overnight. Once the procedure is complete, the patient's vital signs are monitored and a chest x ray is taken to ensure that the pacemaker and leads are properly positioned.
Modern pacemakers have sophisticated programming capabilities and are extremely compact. The smallest weigh less than 13 grams (under half an ounce) and are the size of two stacked silver dollars. The actual pacing device contains a pulse generator, circuitry programmed to monitor heart rate and deliver stimulation, and a lithiumiodide battery. Battery life typically ranges from seven to 15 years, depending on the number of leads the pacemaker is configured with and how much energy the pacemaker uses. When a new battery is required, the unit can be exchanged in a simple outpatient procedure.
A temporary pacing system is sometimes recommended for patients who are experiencing irregular heartbeats as a result of a recent heart attack or other acute medical condition. The implantation procedure for the pacemaker leads is similar to that for a permanent pacing system, but the actual pacemaker unit housing the pulse generator remains outside the patient's body. Temporary pacing systems may be replaced with a permanent device at a later date.

Preparation

Patients being considered for pacemaker implantation will undergo a full battery of cardiac tests, including an electrocardiogram (ECG) or an electrophysiological study or both to fully evaluate the bradycardia or tachycardia.
Patients are advised to abstain from eating 6-8 hours before the surgical procedure. The patient is usually given a sedative to help him or her relax for the procedure. An intravenous (IV) line will also be inserted into a vein in the patient's arm before the procedure begins in case medication or blood products are required during the insertion.

Aftercare

Pacemaker patients should schedule a follow-up visit with their cardiologist approximately six weeks after the surgery. During this visit, the doctor will make any necessary adjustments to the settings of the pacemaker. Pacemakers are programmed externally with a handheld electromagnetic device. Pacemaker batteries must be checked regularly. Some pacing systems allow patients to monitor battery life through a special telephone monitoring service that can read pacemaker signals.

Risks

Because pacemaker implantation is an invasive surgical procedure, internal bleeding, infection, hemorrhage, and embolism are all possible complications. Infection is more common in patients with temporary pacing systems. Antibiotic therapy given as a precautionary measure can reduce the risk of pacemaker infection. If infection does occur, the entire pacing system may have to be removed.
The placing of the leads and electrodes during the implantation procedure also presents certain risks for the patient. The lead or electrode could perforate the heart or cause scarring or other damage. The electrodes can also cause involuntary stimulation of nearby skeletal muscles.

Key terms

Electrocardiogram (ECG) — A recording of the electrical activity of the heart. An ECG uses externally attached electrodes to detect the electrical signals of the heart.
Electrophysiological study — A test that monitors the electrical activity of the heart in order to diagnose arrhythmia. An electrophysiological study measures electrical signals through a cardiac catheter that is inserted into an artery in the leg and guided up into the atrium and ventricle of the heart.
Embolism — A blood clot, air bubble, or clot of foreign material that blocks the flow of blood in an artery. When an embolism blocks the blood supply to a tissue or organ, the tissue the artery feeds dies (infarction). Without immediate and appropriate treatment, an embolism can be fatal.
Magnetic resonance imaging (MRI) — An imaging technique that uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures.
A complication known as pacemaker syndrome develops in approximately 7% of pacemaker patients with single-chamber pacing systems. The syndrome is characterized by the low blood pressure and dizziness that are symptomatic of bradycardia. It can usually be corrected by the implantation of a dual-chamber pacing system.

Normal results

Pacemakers that are properly implanted and programmed can correct a patient's arrhythmia and resolve related symptoms.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

pacemakers

Electronic devices that deliver regular short pulses of electricity to promote contraction of the heart muscle in people with a defect in the heart's conduction system (heart block). Pacemakers may be external or internal (implanted), the latter being buried under the skin of the chest and having an electrode that runs into the heart through a large vein. The rate of the electrical impulses varies with the demands on the heart or can be programmed from the outside by radio signals. External pacemakers are used in the emergency treatment of heart block until more permanent arrangements can be made.
References in periodicals archive ?
"We are replicating nature's way of making the pacemaker cell."
An estimated 750,000 patients with cardiac bradyarrhythmia undergo cardiac pacemaker implantation every year all over the world.[sup][8] Although the clinical application of pacemakers grew rapidly in China, the implantation cases was 35/1 million in 2012, which was significantly lower than the numbers in Europe (951/1 million in 2010).[sup][9] Although great progression has been made in China at the field of cardiac device implantation,[sup][10],[11],[12],[13] we have to recognize that only 3% patients with symptomatic cardiac bradyarrhythmia undergo pacemaker implantation.
The latest approval builds upon the company's portfolio of MRI compatible products, and furthers patient access to the technological benefits of the Nanostim leadless pacemaker, the world's first commercially available retrievable leadless pacemaker.
Recent data from the Leadless II IDE (investigational device exemption) study published in The New England Journal of Medicine confirmed the benefits of the Nanostim leadless pacemaker. The LEADLESS II study also highlighted the retrievability of the Nanostim leadless pacemaker, which allows the Nanostim leadless pacemaker to be repositioned throughout the implant procedure and retrieved even after more than a year implanted in patients when necessary.
They said replacing the batteries in pacemakers and cardioverter defibrillators exposes patients "to a risk of serious complications, including life-threatening infection".
Six months later, only four percent of patients had experienced complications--about half the rate of patients with traditional pacemakers. No device had detached from the heart.
"Theoretically, biological pacemakers, which are composed of electrically active cells that can functionally integrate with the heart, could provide natural heart rhythm regulation without the need for indwelling hardware," says author Vasanth Vedantham, of the University of California, San Francisco.
Consultant Cardiologist Dr Mickey Jachuck said: "Whilst the majority of patients who need treatment with a pacemaker are stable and can have their implant planned, occasionally some cases present in A&E as emergencies needing immediate or urgent intervention.
But now he has his nine lives back as the first cat to have a pacemaker op at the University of Glasgow School of Veterinary Medicine.
But the new device - 10 times smaller than a traditional pacemaker - is embedded in the wall of the heart so no wire is needed.
"Now we have pacemakers that are so small--not much larger than an antibiotic pill--they can be attached directly to the inside of the heart, all the problems related to the old-fashioned pacemaker lead are abolished."
San Francisco, CA, December 31, 2014 --(PR.com)-- Rising incidences of cardiac disorders, especially cardiac arrhythmia globally is expected to give a boost to the pacemaker market.