PACEMAKER APPLICATIONS CLASSIC PACE MAKER

Our heart is an organ that works with the electrical impulses it produces. The impulses coming from the right atrium of the normal heart, from what we call the sinus node, spread to the ventricles after passing through the atrioventricular node, which is located between the atria and ventricles of the heart. Thus, the electrical impulse produced in the sinus node is transmitted to all heart muscle cells, causing the heart to contract. Any problem that may occur in the production of these electrical impulses in the heart or any disruption in their transmission will affect normal heart contractions and cause arrhythmia. As a result, the heart cannot pump enough blood that the body needs, and the patient experiences complaints such as palpitations, dizziness, fatigue, fainting (syncope), and dizziness. In people whose electrical system of the heart is interrupted due to any disorder such as the heart not being able to create sufficient electrical stimulation or not being able to deliver sufficient electrical stimulation to the entire heart tissue, devices used to ensure the regular functioning of the heart by creating electrical stimulation and producing the rhythmic electrical impulses necessary for heart contraction are used. It is called pace maker. While the first introduction of pacemakers (Pace Maker) was intended to be used in diseases that develop as a result of slow heartbeat (bradycardia), in recent years, pacemakers (antitachycardic batteries, implantable cardioverter-defibrillators, which we call automatic shock devices (ICD)) and heart failure (Bi-ventricular Pacemaker, CRT/CRT-D) has also begun to be used. Pacemakers can be divided into temporary and permanent pacemakers. While temporary pacemakers are designed to be used in emergencies, permanent pacemakers are designed for situations where continuous use is required. Temporary pacemakers are designed to be used in emergencies or abnormal heart conditions. It is used when the condition causing the rhythm is expected to improve, for example, in cases where the heart is working slowly due to medication. Temporary pacemakers can also be used when necessary to provide adequate heart rate until a permanent pacemaker is placed. Temporary pacemakers can be used in heart attack patients, patients with tachycardia, after open heart surgery. and can be applied in other situations where necessary. Provide electrical stimulation in temporary pacemakers The moment generator is quite large and outside the body. The electrode provides the connection to the heart. Temporary pacemakers do not remain in the patient for a long time. If the event is thought to be permanent, the temporary pacemaker is removed and a permanent pacemaker is implanted in the patient. Permanent pacemaker is used in cases where the event requiring battery insertion is permanent. The generator that will provide electrical stimulation is placed in the chest or abdomen by creating a pocket under the skin. In practice, the battery is usually placed on the left side of the chest wall. If the pacemaker will be placed on the chest wall, the patient may be asked to choose which side the pacemaker will be placed. In general, we can say that a pacemaker consists of two parts. The first of these is the generator, which is the part where electrical impulses are generated and can be described as the brain of the battery. The second part is called the Electrode, which resembles a wire or cable that transmits electrical impulses to the heart's destination. The generators of Permanent Pacemakers that produce electrical stimulation weigh 12.5-15.5 grams, and the weight varies depending on the brand or the battery to be used. Permanent pacemakers carry lithium-containing batteries. These batteries can be placed on the right or left side of the body, within the chest wall, or in the abdomen when necessary. One end of the electrode wire, which transmits the electrical stimulus produced by the generator to the heart tissue, is connected to the generator. The other end of the electrode wire is passed through the blood vessels and placed into the atrium or ventricle of the heart. The operating speed of the implanted Permanent Pacemaker can be adjusted externally according to the patient's needs. The average lifespan of batteries varies depending on the disease state of the patient, the characteristics of the battery and some environmental factors, but it is between 5-10 years. Thanks to the electronic system in the generator, the device shows the average lifespan of the battery during periodic battery checks. Depending on the results of the checks, generator replacement can be done on time. Before implanting a pacemaker, approval is obtained from the patient/patient's relatives for pacemaker application. Temporary pacemaker applications are usually performed while the patient is hospitalized due to heart disease. Temporary battery application depends on urgency and the circumstances. Depending on the procedure, the procedure is performed in the patient's room or in the catheterization laboratory. The patient may be given a sedative if necessary, and after local anesthesia is applied to the area to be applied, a small sheath is placed in the neck or groin area, and the electrode is passed through this sheath and delivered to the heart. If necessary, the electrode is placed in the most appropriate place in the heart with X-rays called scopy. The generator remaining outside is fixed to a suitable place. Patients should avoid touching an outdoor generator and limit their activities while the temporary battery is in use. In some necessary cases, a temporary pacemaker can be connected to the heart through a needle passing through the patient's chest wall or, in rare cases, through the esophagus. Permanent pacemaker application is a more invasive procedure that can be performed in the cardiac catheterization laboratory, electrophysiology laboratory, hospital operating room, or outpatient surgery department, and is considered a minor surgical procedure. By monitoring the patient. Local anesthesia is applied to the area to be treated. The application area is cleaned and shaved. If the pacemaker is to be placed in the chest wall, which we call endocardial placement, the procedure begins with a small incision just below the collarbone to create a small surgical pocket. Electrodes from the generator are placed in the right atrium or right ventricle. The tip of the electrode is attached to the inner surface of the heart. If there is more than one electrode, the process is repeated. The generator is placed in the pocket below the collarbone. After the procedure, the incision is closed by stitching. The application time of the procedure is approximately 1 hour. After the procedure, after the wound has completely healed, the pacemaker placed under the skin on the chest wall can be noticed as a swelling under the skin. However, in some patients, if the subcutaneous fat layer is high, this bulge may not be noticeable and it may not be obvious that a battery has been inserted when looking at the patient from the outside. Epicardial placement is rarely performed in pacemaker applications and is used in some congenital heart diseases or when the patient is a child and it is not suitable for the wire to pass through the veins to reach the inner surface of the heart. In epicardial placement, the electrode is placed on the heart. placed on the work surface. In this method, the surgeon opens the chest wall and places the electrode on the surface of the heart. The generator is placed under the skin in the upper abdomen. Shortly after placement, a chest x-ray is taken for post-procedure follow-up purposes to check that the device has been placed properly. Short-term hospitalization is recommended after permanent pacemaker application. In the period after the procedure, the patient is informed about the activities he can and cannot do. In order to avoid dislodging the electrode, patients should avoid contact sports, heavy lifting, and sudden and violent movements of the arm on the side where the pacemaker is located. After the seam where the pacemaker is placed is closed, there may be stiffness at the seam for a certain period of time, but the stiffness will disappear over time as the wound heals. However, if there are any signs of infection such as discharge, redness, fever, inflammation of the surgical wound, the doctor who performed the procedure should be notified immediately. The stitch area heals in approximately 7 to 10 days. The patient can wash and shower, paying attention to the stitch area and drying this area. Approximately one or two weeks after the application, the patient is called for a check-up. During the check-up, if necessary, the stitches are removed and the stitch area is examined for signs of infection. A pacemaker ID card is prepared and given to patients with permanent pacemakers on the day the pacemaker is inserted. The patient must carry this card at all times to have it with him in case of emergency. Following the patient's 1 or 2 week check-up, subsequent battery checks are performed approximately two months later and then every 6 or 12 months. During these checks, various features such as the operation of the battery and the remaining life of the generator are examined and evaluated. Serious complications are rare in pacemaker application. These adverse events occur in 1-2% of cases. Some of these are serious bruising or bleeding, clot formation, rupture of blood vessel, stroke, heart attack, air leakage into the space between the chest wall and lung, electrode coming out of the heart, malfunction of the pacemaker and infection. Patients who have received a pacemaker should immediately inform their doctors if certain symptoms and complaints occur. These symptoms and complaints are �to the hair; Discharge from the wound site with or without fever, redness at the stitch site, increased temperature, tenderness or swelling, swelling in the arms, legs, wrists and ankles (edema), increasing shortness of breath, prolonged hiccups or difficulty breathing, fainting, dizziness, blackout. , palpitations, chest pain and recurrence of any complaints that existed before the procedure.

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