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Pacemaker Implantation & Surgery

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Pacemaker Implantation & Surgery

Cardiology | by Dr. Ashok B Malpani | Published on 24/08/2021

Cardiovascular problems are one of the most common diseases associated with mortality. Lack of physical activity, modern lifestyle, unhealthy eating habits, lack of nutrition, and various other socio-economic conditions – have increased cardiovascular problems. Even though multiple medical treatments are available to treat heart issues, a pacemaker remains one of the most important advances in providing care for heart patients. 


A pacemaker cures heart problems and also helps retain the patient’s peace of mind, ensuring them a quality of life and providing assurance of safety. A pacemaker continuously monitors the heartbeat to record any erratic movements and sends electrical impulses to the heart muscle to maintain a healthy heart rate. A pacemaker may be recommended for patients that have issues such as arrhythmia, fainting spells, and congestive heart failure. 


Types of Pacemaker

A pacemaker is of three types:

  • Single chamber: Carries electrical impulses to the right ventricle.
  • Dual-chamber: Carries electrical impulses to the right ventricle and atrium.
  • Biventricular: Corrects abnormal electrical systems by stimulating the lower chambers of the heart. 


The objective of a Pacemaker Implantation

The main purpose of a pacemaker is to control irregular heartbeat. For temporary conditions, a pacemaker is placed to correct a slow heartbeat post a heart attack, heart surgery, or a drug overdose situation. However, permanent pacemaker transplantation is done to rectify a prolonged irregular heartbeat or to treat heart failure.

Implanted pacemakers copy the normal action of the electrical system of the heart, and typically comprise two parts:

  • Pulse Generator: A small metal container comprising of battery and electrical circuitry that is responsible for the electrical heart pulse.
  • Leads (Electrodes): These are insulated wires which are placed in the chamber(s) of the heart to deliver the electrical pulses to adjust the irregular heart rate.

Pacemakers only function as per need. When the heart beats slower than normal, the pacemaker automatically generates electrical signals for correcting the heartbeat. Also, the recent advancements in technology have led to the advent of sensory pacemakers, which are capable of detecting body motion and breathing rate, and then sending signals accordingly.


The Procedure of a Pacemaker Implantation

Before the procedure, the patient will be given medications through an intravenous line to relieve pain and help the patient relax. The patient is administered with local anesthesia and is mostly awake during the procedure. 

Post this, the chest is sanitized and then once the patient is sedated, the surgeon inserts one or more flexible, insulated wires into a major vein located under or near the collarbone. The wires are then guided to the heart through X-ray images displayed on the monitor. One side of the insulated wire is attached to the pulse generator that is implanted under the collarbone skin.

After the procedure, the patient is kept under observation for a day or more depending on the recovery and general health. The pacemaker is set to fit the pacing needs of the patient. Once the patient is stabilized, he/she is discharged but advised to be accompanied by a close friend or family to be driven home safely.


Post the Pacemaker Implantation

The pacemaker’s condition including the battery life, heart rate, and rhythm is monitored by the surgeon remotely. In many cases, heavy exercises or physical exertion will need to be avoided. Also, one has to not apply any pressure at the implantation site, and in case of discomfort or pain; medical advice must be taken immediately.

On the other hand, the patient will be asked to take several precautions such as:

  • Using the cell phone at least at a distance of 6 inches from the pacemaker.
  • Avoid unnecessarily lingering near or leaning against a metal detector.
  • Inform all doctors and medical professionals about your pacemaker and ensure it is registered well before any surgery, test, or medical treatment.
  • Keep at least a distance of 2 feet from power-generating equipment such as welding equipment, high-voltage transformers, or motor-generator systems.


Risks of a Pacemaker Implantation

Risks of complications from a pacemaker implantation surgery are very rare but can include:

  • Infection at the site of pacemaker implantation.
  • Allergy or reaction to the dye or anesthesia used during the procedure.
  • Swelling, bruising, or extensive bleeding at the site.
  • Damage to the surrounding blood vessels and tissues.
  • Collapsed lungs.


Results of a Pacemaker Implantation

Once, the pacemaker is implanted, a patient might feel worried about safety measures, precautions, medications, changes in lifestyle, and so many other things. But patients should feel confident and free to ask all questions from the doctors and get clarifications on anything that could cause trouble. As days advance, most patients might not even feel the presence of a pacemaker and go about their daily lives, without thinking about it. However, the patients need to understand that a certain change in their routine and lifestyle would be demanded by the pacemaker to keep the heart healthy. 

A pacemaker tends to positively improve the heart condition and rectify symptoms caused due to slow heartbeat such as fatigue, fainting, lightheadedness, etc. The pacemaker condition should be assessed every three to six months and the patient must inform the doctor about any troubling symptoms after the implantation such as puffy ankles, swollen legs, fainting, dizziness, unexplainable weight gain, etc.

Generally, pacemakers today have a life of 10-15 years, post which their battery needs to be replaced. The battery-changing procedure is simple and requires less recovery time as compared to the implantation one. Since most pacemakers today adjust the heartbeat according to the physical activity of the body, the overall quality of life is not hampered and the patient can resume an active lifestyle.