Permanent pacemaker

Overview

A device known as a permanent pacemaker (PPM) is implanted beneath the skin of the chest to help regulate the heart’s rhythm. PPMs are comprised of two main components: leads that connect to the heart and a minuscule pacemaker powered by batteries. Positioned under the skin in the upper chest area, it can be located on either side. The pacemaker functions by sending electrical signals to the heart to ensure it beats regularly.

Types

These are the main types of artificial cardiac pacemakers:

• Single chamber: One of the heart’s chambers, typically the ventricles receive the electrical signal.
• Dual chamber: Two heart chambers, typically the top chamber (atrium) and bottom chamber (ventricle), can receive the electrical signal.
• Bi-ventricular pacemaker: Three chambers can get the electrical signal. It is possible to stimulate the ventricles, the two sides of the bottom chambers, to pump in unison. The purpose of this pacemaker is to treat heart failure.

Reasons for undergoing the procedure

A pacemaker could be suggested by a healthcare provider if the heartbeat is:

• Too rapid or tachycardia
• Too slow or bradycardia
• Irregular heartbeat or uncoordinated

The heartbeat of a healthy individual is typically consistent and regular, although occasional disruptions can occur. These disruptions are referred to as arrhythmias. It’s important to note that not all arrhythmias necessitate the use of a PPM, as they can have various underlying causes. Before determining whether an individual requires a PPM, healthcare providers will consider factors such as the type of arrhythmia, the patient’s symptoms, and any underlying medical conditions.

Risk

The insertion of a permanent pacemaker is generally considered a safe and common medical procedure, but like any surgery, it comes with potential risks and complications. Some of the risks associated with permanent pacemaker implantation include:

• Allergic reaction: Some individuals may have an allergic reaction to the materials used in the pacemaker or to the medications administered during the procedure.
• Blood clots: To minimize the risk of blood clot formation, your healthcare provider may prescribe blood-thinning medications.
• Pacemaker or lead malfunctions: Occasionally, a pacemaker lead may become displaced or detach. Following your procedure, your healthcare provider may advise you to limit certain activities to prevent this issue.
• External sources of malfunction: Your healthcare provider will provide guidance on avoiding devices or machines that could interfere with your pacemaker, although such occurrences are now infrequent due to advancements in pacemaker technology.
• Unexpected heart rhythm issues: While rare, some individuals may experience heart rhythm problems related to their pacemaker. Your healthcare provider can discuss these potential risks with you and help you take precautions to avoid them.

It’s important to note that the overall risk depends on various factors, including the patient’s health status, age, and the presence of other medical conditions.

Before the procedure

The patient will need to do the following steps in order to get ready before having the PPM inserted:

• Find out from the healthcare provider if the patient is able to take their regular medication, such as blood thinners and diabetes medications.
• Arrange for home transportation. When it’s time to leave the hospital, the patient needs to arrange someone to pick them up from there and assist them in getting home.
• Bring along the necessities for a one-night stay (toiletries, pajamas, slippers).
• If instructed, shower with a specific surgical wash before to the surgery; the healthcare provider will suggest one and go over how and when to use it with the patient.
• Avoid eating or drinking anything prior to the procedure; the patient’s healthcare provider will advise them on how long to fast before the procedure.
• Patient should avoid wearing any jewelries.

During the procedure

A specialized operating room is used for the PPM insertion procedure. In most cases the procedure will take one to three hours.

Prior to the start of the procedure, medical team were able to connect the patient with cardiac monitors and put a cannula, a type of tube, into a vein in their arm to provide medication and fluids.

When the procedure starts, the healthcare provider will:

• Apply anesthesia to the patient’s collarbone area to lessen pain.
• In order to make room for the pacemaker, the healthcare provider will make a little incision close to the collarbone.
• Place the pacemaker leads inside the large vein on the right side of your heart.
• To secure the lead ends inside the heart, healthcare provider use a tiny screws.
• The PPM should be programmed and tested to ensure that is functions correctly.
• Place the PPM in the pocket created under skin.
• Use stitches to close the incision.

PPMs come in a number of types. Before the procedure, the patient and the healthcare provider will consult to decide which device to use.

After the procedure

The patient will be taken to the recovery area or the ward to recover when the pacemaker procedure is completed. The particular dressing will be utilized to cover the incision site, and the patient is advised not to removed it until instructed. Specific directions for wound care will be provided to the patient by the healthcare provider. There can be some bruises and this area might feel sore, but these should fade away in a few weeks.

Overnight, medical team will monitor the heart’s electrical activity. A technician will frequently check the PPM as well. Most of the time, the patient should be discharged between 24 to 48 hours.

During their recovery from surgery, the patient will be informed about what they can and cannot do. This can entail avoiding specific garments that might push against their wound and avoiding heavy lifting.

Outcome

After the PPM is implanted, the patient may observe a small bulge beneath the skin. It is crucial for them to adhere to their healthcare provider’s guidance regarding prescribed medications and any recommended lifestyle changes. Furthermore, if the patient has any concerns or questions following the procedure, they should promptly schedule an appointment with their healthcare provider. The patient will require routine follow-up visits to a pacemaker clinic. Before they leave the hospital, the medical staff will provide them with the contact details.

It is crucial to examine the heart’s electrical function, the PPM’s settings, and the battery life of the device. There is no surgical need for these tests. In order to perform the check in a clinic, the healthcare provider will place a wireless wand on top of the patient’s skin. Certain more recent PPMs enable a healthcare provider to check their device from home via Bluetooth.

Now that a patient has a PPM, it is normal for them to consider the necessary safety measures. The best person to provide them guidance will be their healthcare provider, but generally speaking, there are a few things to think about when living with a PPM.

• Frequent checking of the device
• Keeping the ID card containing the PPM information in a wallet or handbag; it’s a good idea to take a picture of the card and give it to a relative.
• Ensuring that every healthcare provider they visit is aware of their PPM in case they require special attention or guidance. This includes healthcare providers who perform tests on them, such as dentists. If an individual have a PPM, notify the staff ahead of time prior having an MRI.
• As a general safety measure, try not to keep the phone in the shirt pocket or directly near the PPM.
• When traveling, it’s important for patients with a pacemaker to always inform airport security personnel about their medical device. This is because pacemakers are likely to activate security scanners, prompting security personnel to conduct a manual check using a wand.
• Consult the healthcare provider if the work entails using electricity generators or welding. Those who handle heavy machines or are commercial drivers should talk about how a PPM affects their work life.
• Although the majority of sports and activities shouldn’t cause a problem with PPM, it’s a good idea to discuss them with their healthcare provider, particularly if they play high-contact sports where they could be hit or compressed in the chest.