Pacemaker Surgery is done to implant a pacemaker under the skin near the heart, to help control the heartbeat. Pacemaker is a small instrument consisting of 2 main parts - an electric pulse generator and electrodes that transmit the pulses to the heart.
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Pacemaker Surgery is done to implant a pacemaker under the skin near the heart, to help control the heartbeat.
Pacemaker is a small instrument of the size of Indian 5 rupee coin. The main function of the instrument is to transmit electrical impulses which keep the heart beating at regular speed. It consists of two main parts, an electric pulse generator and electrodes that transmit the pulses to the heart.
Implanted pacemaker continously monitor the heartbeats, and whenever the beating gets slower that natural, it sends electrical signals to speed up the beating. It keeps the heartbeat regular by creating and transmitting electric pulses at regular intervals of time. This compensates for the lack of electrical activity in the heart and keeps blood flow smooth.
Depending on number of electrodes used, there are 3 types of pacemakers.
- Single Chamber: For carrying electrical signals from generator to the right ventricle of the heart.
- Dual Chamber: Used to control control contractions of the heart, and carry signals to both right ventricle and right atrium.
- Biventricular: Used, only in case of heart failure, to stimulate both left and right ventricles of the heart.
Pacemaker Surgery is mostly recommended by the doctor in following cases:
- Cardiac Arrhythmia - Slow or irregular heartbeat due to normal aging
- Slow heart rate due to medicine overdose, heart attack or cardiac surgery
- Cardiac failure
Before the procedure, the doctor will recommend these tests to find the underlying reason for abnormal beating of heart.
- Echocardiogram (ECG) and Electrocardiogram
- Stress Test
The procedure takes about 2 hours and is generally performed under local anesthesia. During the procedure,
- The surgeon makes a 3 to 4 inch incision in the upper chest area near the collarbone.
- The area underlying the skin and above the veins is made into a pocket.
- The pacemaker is inserted in the body.
- The electrodes are sent down the vein to the inner walls of heart and the battery/timer unit is monitored for inducing rhythm in the heart.
- Upon confirmation on the external monitor, the battery unit is placed in the pocket and incision is sutured.
In most cases, the patient can go home in a day. During the stay, the heartbeat will be constantly monitored and prior to discharge, pacemaker settings will be programmed to match natural heartbeats.
The surgeon will recommmed against any strenuous physical activity for at least a month.
Extra care should be taken while entering areas with magnetic fields, as the presence of magnetic field might hinder the activity of the timer unit. The doctor will also ask to stay away from electromagnetic detectors, scanning machines or laser instruments.
Implanted pacemaker can stay for a lifetime and need not be replaced or readjusted. Battery may have to be replaced.
Although a very safe procedure, a few known risks include:
- Infection at the time of insertion
- Lead dislodge inside the pocket
- Draining at the incision site
- Lung collapse due to electrode insertion
