PERMANENT PACEMAKERS
Our heart has a center that generates a stimulus and pathways that transmit this stimulus, similar to an electrical network. This is how this event happens in our hearts. After the impulses coming from the main center (sinus node) located in the right atrium pass through an intermediate station (atrioventricular node) located between the atria and ventricles with a short delay, they spread to the ventricles through specialized conduction pathways, and thus the electrical impulse produced in the main center is transmitted to all heart muscle cells and the heart's heartbeat. contraction is achieved. As a result of a malfunction in any of these foci, heart rhythm-conduction disorder diseases occur. The causes may be due to medications used, age-related impairments in the conduction system, procedures such as artificial valve placement or ablation, or unknown reasons. These rhythm disorders usually cause a slowdown in heart rate (pulse), thus causing complaints such as weakness, fatigue, palpitations and fainting (syncope).
What is a permanent pacemaker and why are these procedures needed?
If the stimulation center (sinus node) cannot generate a stimulus at a sufficient speed or if the heartbeat slows down excessively due to any interruption in the conduction pathways, the patient cannot provide the required heart rate to continue his normal life. Permanent pacemakers constantly sense the functioning of the heart and are activated when necessary. In some types, they respond by accelerating when the patient's heart rate needs to increase. Thus, the patient's complaints such as fainting, fainting, dizziness and shortness of breath due to the slowing of the heart rate will disappear, and the quality of life will also improve.
IMPLANTABLE DEFIBRILLATORS;
Life-threatening effects on the heart due to heart conduction system diseases, heart failure and some structural heart diseases. Rhythm disorders may develop. In such special cases, an event called sudden cardiac death may occur. An implantable cardiac defibrillator (electrodefibrillator) can be used in patients at risk for sudden cardiac death and especially in patients with dangerous rhythm disturbances that may occur in heart failure patients. Pacemakers with shock feature are required.
Life-threatening heart rhythm disorders (ventricular tachycardia, ventricular fibrillation) may develop due to heart conduction system diseases, heart failure and some structural heart diseases. In such cases, an event called sudden cardiac death may occur. An implantable cardiac defibrillator, that is, a pacemaker with electroshock feature, is required for patients at risk for sudden cardiac death and for the purpose of protecting patients from dangerous rhythm disturbances that may occur especially in heart failure patients. This device does not provide any improvement in the functioning of the heart and is used only for protection purposes. The device detects when a dangerous rhythm disorder develops, applies shock when necessary, and acts as a battery when necessary. The procedure begins by anesthetizing the area where the battery will be inserted with local anesthesia (regional anesthesia method) without putting the patient to sleep. A pocket large enough to contain the battery is opened in the subcutaneous area 1-2 cm below the patient's left or right collarbone. One or two thin wires called leads (battery cables) are placed in the heart chambers through the large veins leading to the heart, which will provide the transmission between the heart and the generator to be placed under the skin. These electrodes are then connected to the generator to be placed under the skin. This procedure takes approximately 30-60 minutes and the hospital stay is approximately 1-2 days. Installing an implantable cardiac defibrillator (ICD) is done in the angiography (or catheter) laboratory. Permanent pacemaker implantation is performed by a team of specially trained interventional cardiologists, nurses and technicians.
Where, how and by whom are permanent pacemaker and defibrillator made, what is the estimated duration?
It starts by anesthetizing the area where the battery will be inserted with local anesthesia (regional anesthesia method) without putting the patient to sleep. A pocket large enough to contain the battery is opened in the subcutaneous area 1-2 cm below the patient's left or right collarbone. A thin wire called a lead (battery cable) is placed inside the large veins going to the heart and will provide communication between the heart and the generator to be placed under the skin. The cells are placed in one or both heart chambers. These electrodes are then connected to the generator to be placed under the skin. This procedure takes approximately 30–60 minutes and the hospital stay is approximately 1–2 days. Permanent pacemaker installation is done in the angiography (or catheter) laboratory. Permanent pacemaker installation is performed by a team of specially trained interventional electrophysiologists, cardiologists, nurses and technicians.
Can there be undesirable events (complications) related to the procedure during permanent pacemaker and defibrillator application, what is the risk of the procedure?
Permanent pacemaker application is a small-scale surgical procedure. Therefore, undesirable situations may arise in practice. This rate is 4-5% for a new pacemaker to be installed, and 2-3% for battery generator replacement where a battery has been installed before but has expired. Undesirable situations that may occur during the application include rupture of the lung membrane when entering the vein, bleeding due to the needle entering the artery instead of the vein, rhythm disturbances, pacemaker lead (transmission cable) separation from its placement, puncture in the heart walls, and infection of the wound site after the procedure. can be considered among the possibilities. Preventive antibiotic treatment is given to patients to prevent wound infection. Again, rarely, after a period of pacemaker implantation, the battery generator or cables may spontaneously come out of the skin. In this case, the permanent pacemaker pocket may need to be reopened and repaired.
How are patients with permanent pacemakers monitored?
You must stay in the hospital for at least 24 hours after the procedure. If the patient has no additional problems, he is discharged the next day. The patient is given a battery card that indicates the features and brand of the installed battery and includes a contact person who can be reached in case of emergency. The stitches are removed 6-10 days after the procedure. After a pacemaker is installed, patients are called for battery checks every 6 months, and these checks can be more frequent if necessary. The average lifespan of a pacemaker is 6-7 years, but this may vary depending on the patient's condition. Check how long the battery lasts at each battery check. It can be determined that the reputation remains. When it is time to replace the battery, only the generator of the battery is replaced and the wires are left untouched.
Although permanent pacemaker application is necessary, what kind of problems may be encountered if it is not performed and what kind of procedure should be followed when we decide to have it performed?
The patient's existing complaints will continue and in some cases may cause life-threatening consequences. If the heart rate slows down excessively or fainting occurs in an undesirable environment, trauma or even death may result. If the patient refuses treatment and later decides to have a permanent pacemaker implanted, it is recommended that the patient apply to the cardiology outpatient clinic. After the necessary evaluations here, an appointment day and time will be determined for the patient to perform the procedure.
Are there alternative examination methods that can replace a permanent pacemaker?
There is no alternative treatment option that can replace this treatment in patients requiring permanent pacemaker implantation.
What are the lifestyle changes that need to be made and the issues that need to be taken into consideration?
After the permanent pacemaker is placed, there will generally be no significant changes in your life. However, your physician will inform you about behaviors and environmental conditions that may negatively affect your pacemaker. Pacemaker application is not a procedure that restricts the patient, on the contrary, it is a treatment method that improves the patient's quality of life and supports the patient's heart.
Points to consider:
At home, the shoulder on the side where the wound is located should not move much for 1 month. Apart from the shoulder, the forearm and hand can be moved. It is not right to stick the arm to a fixed body. The arm should be free and only shoulder movements should be restricted.
Pressure should not be applied to the area where the permanent pacemaker is placed and one should not lie face down for a while (20-30 days).
The side where the wound is located should be kept clean and dry. Wound care should be done by your doctor at the check-up after the first week.
Each patient with a permanent pacemaker is given a special card by the battery company. on this card The patient's identity information and permanent pacemaker information are written. Patients must carry this card with them at all times.
Read: 0
