What you need to know about:

Pacemaker Implantation

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Recovery Period:
4 weeks
Permanence:
5-15 years or more
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Time it takes:
1-3 hours
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Anesthetize:
General anesthesia

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Overview of

Pacemaker Implantation

in Thailand

A pacemaker is a small device used to treat some arrhythmias. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Pacemakers send electrical pulses to help your heart beat at a normal rate and rhythm. Pacemakers can also be used to help your heart chambers beat in sync so your heart can pump blood more efficiently to your body. This may be needed if you have heart failure. Pacemakers use low-energy electrical pulses to control the rate and rhythm of your heartbeat. Traditional pacemakers send the electrical pulses through wires, also known as leads. Wireless pacemakers are a newer kind of pacemaker without wires. Depending on your condition, you might have one of the following types of pacemakers: -Single chamber pacemaker. This type usually carries electrical impulses to the right ventricle of your heart. -Dual chamber pacemaker. This type carries electrical impulses to the right ventricle and the right atrium of your heart to help control the timing of contractions between the two chambers. -Biventricular pacemaker. Biventricular pacing, also called cardiac resynchronization therapy, is for people with heart failure with abnormal electrical systems. This type of pacemaker stimulates the lower chambers of the heart (the right and left ventricles) to make the heart beat more efficiently.

Goals of

Pacemaker Implantation

The most common reason people get a pacemaker is their heart beats too slowly (called bradycardia), or it pauses, causing fainting spells or other symptoms. In some cases, the pacemaker may also be used to prevent or treat a heartbeat that is too fast (tachycardia) or irregular. These problems may be caused by: Problems with electrical signaling in your heart. Learn more in our Conduction Disorder Health Topic. Beta blockers, which are medicines to lower blood pressure but also can slow your heartbeat too much. A pacemaker helps prevent a slow heartbeat when you need to keep taking this medicine. Certain congenital heart defects Heart attack Heart transplant Pacemakers may also be used to help your heart chambers beat in sync if your heart isn’t pumping enough blood to your body. This can happen because of: Certain congenital heart defects Enlarged or thick heart muscle that makes it harder to pump blood out of your ventricles. Learn more in the Cardiomyopathy Health Topic. Heart attack Heart failure

Price of

Pacemaker Implantation

Average Cost

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Price Range

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Pros and cons of

Pacemaker Implantation

Pros

-Relief from symptoms almost immediately after the surgery is over. Any feelings of dizziness, shortness of breath and fatigue will be replaced with increased energy and renewed vigor for life.  

-Pacemakers are also long-lasting. They can last anywhere from 5 to 15 years depending upon individual needs, with the average lifespan of the device spanning 6 to 7 years.  

-Pacemakers can be configured in multiple distinct ways. Some models have electromagnetic resistance built into them. This means that with those models, you won’t have to be concerned about avoiding electrical devices.  

Cons

-Like any surgical procedure, there can be downsides or risks involved with getting a pacemaker although very low risks but it is important to discuss these risks with your doctor. Infections can occur even after a successful surgery, or there can be sensitivity to the device material.  

-The pacemaker can also fail to deliver therapy when it is needed or provide overactive therapy when it is not needed.  

-If there are problems with the device, you may need another surgery to fix it.  

-Depending upon the model of pacemaker, you may also have to avoid exposure to certain fields of energy including metal detectors, electric generators and some medical machines like an MRI.

How It Works:

Pacemaker Implantation

You'll likely be awake during the surgery to implant the pacemaker, which typically takes a few hours. You'll have an intravenous line placed, through which you might receive medication to help you relax. Most pacemaker implantations are done using local anesthesia to numb the area of incisions. When choosing the most appropriate method, the doctor must consider the age, overall health, and lifestyle of the patient. There are two primary methods of pacemaker implantation. 1. Endocardial lead placement 2. Epicardial lead placement Endocardial lead placement: The doctor inserts the lead(s) (thin insulated wires) and guides it through a vein to the patient’s heart. Once the lead(s) have reached the heart, the surgeon will then attach the lead tip to the heart muscle, guided to the correct position with the aid of x-ray images. After this, the doctor will connect the lead(s) to the pacemaker generator and insert the device under the skin through the small incision either on the right or left side of the patient’s upper chest (just below the collarbone). The patient may feel slight pressure while the lead(s) and pulse generator are inserted under the skin. Once the implantation has been completed, the doctor will then check the x-ray images and test the pacemaker to ensure it is in the correct position and that it is working properly to meet the patient’s medical needs. Epicardial lead placement: An incision is then made in the chest, after which the lead(s) are attached directly to the surface of the heart. The pulse generator is then placed under the skin in the upper abdomen, or may be placed in the upper chest area, although this method is less common.

Preparation before

Pacemaker Implantation

Pre - treatment

Before your doctor decides if you need a pacemaker, you'll have several tests done to find the cause of your irregular heartbeat. These could include:  Electrocardiogram (ECG). In this noninvasive test, sensor pads with wires attached, called electrodes, are placed on your chest and sometimes your limbs to measure your heart's electrical impulses. Holter monitoring. This is a portable version of an ECG. It's especially useful in diagnosing rhythm disturbances that occur at unpredictable times. You wear the monitor, and it records information about the electrical activity of your heart as you go about your normal activities for a day or two.  Echocardiogram. This noninvasive test uses harmless sound waves that allow your doctor to see the action of your heart. A small instrument called a transducer is placed on your chest. It transmits the collected sound waves (echoes) from your heart to a machine that uses the sound wave patterns to compose images of your beating heart on a monitor.  Stress test. Some heart problems occur only during exercise. For a stress test, an electrocardiogram is taken before and immediately after walking on a treadmill or riding a stationary bike. In some cases, an echocardiogram or nuclear imaging are done.

Recovery after

Pacemaker Implantation

Post - treatment

You will need to rest in the recovery room for close observation and monitoring of vital signs. Expect to stay in the hospital for 1-2 days following surgery so that the doctor can ensure the pacemaker is working properly and that the heart is beating at its correct natural rhythm. Avoid lifting with or reaching the affected arm above shoulder level on the side the pacemaker was inserted. Refrain from lifting any heavy objects for at least 1 month following surgery. Meet with the doctor for regularly scheduled appointments in order to monitor progress, during which the doctor will check to ensure the pacemaker is functioning properly. On average, a pacemaker battery lasts for about 10 years.

Risks & side effects

Bleeding or blood clots due to internal bleeding or hemorrhaging under the skin Infection at the site of the pacemaker implantation Allergic reaction to medications used during the procedure Damaged blood vessels Pacemaker leads dislodged or pulled out of their original position Lung or heart leaks Thrombosis, causing the cerebral blood flow to be constricted, myocardial infarction or death of heart muscle tissue, as well as other related conditions – all of which are rare Death (life-threatening complications of pacemaker implantation are extremely rare)

FAQs:

Pacemaker Implantation

What kinds of devices do I need to avoid once I have a pacemaker implanted in me?

If you have a pacemaker, avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields. These devices can disrupt the electrical signaling of your pacemaker and stop it from working properly. You may not be able to tell when this happens. To be safe, keep your pacemaker at least 6 inches away from such devices or only use them briefly, when needed. Devices that you should avoid include;  - Cell phones. Use your speaker phone setting or hold the cell phone to the ear on the opposite side of your body. For example, if you have an ICD on the left side of your chest, hold your cell phone to your right ear. Avoid putting your cell phone in your shirt pocket.  -Electronic cigarettes  -Headphones. Most headphones have a magnet in them. Wear them as far away from your ICD as possible. Do not carry your headphones in a chest pocket.  -Household appliances, such as microwave ovens, major appliances, electric blankets, and heating pads are usually safe if they are working properly.  -Metal detectors, such as those used for airport security. The risk of harm is low, but your device may set off the metal detector.   -Body scanners used at airports appear to be safe for people with pacemakers, but you can show your ID card and ask for a separate screening.  If something disrupts your pacemaker, step away from whatever is disturbing it to help your pacemaker return to normal. Talk to your doctor right away about what else to avoid, as any kind of powerful electrical or industrial equipment can interfere with your pacemaker. This includes welding machines or electric fences for pets.  Medical and dental procedures that can affect your pacemaker include:  -Electrocautery used during surgery to stop blood vessels from bleeding -Magnetic resonance imaging (MRI) -Microwave diathermy for physical therapy -Radiation therapy to treat cancer -Shock-wave lithotripsy to treat kidney stones -Transcutaneous electrical nerve stimulation (TENS) to treat pain

Can I exercise if I have a pacemaker?

Most people can and should exercise, because physical activity is an essential part of a heart-healthy lifestyle. However, check with your doctor for recommendations and advice before returning to, or beginning, any exercise program. For example, your doctor may specifically advise that you do not exercise for a certain amount of time after the pacemaker implantation procedure and then return to exercise gradually. Make sure you have full information on these recommendations.

How long will a pacemaker last, and when do I need to replace the battery?

The average lifespan of a pacemaker battery is about 6-7 years and the procedure for changing the battery is much simpler than when pacemakers are put in. It is performed as a day case under local anaesthetic.   The wound is reopened and the pacemaker box is removed, but the leads stay in place. The new box is substituted and the wound is sewn up. Most people go home the same day. There is plenty of warning before the battery runs out and patients are regularly checked for that.

Why do I need a pacemaker?

The heart is a pump made of muscle, which is controlled by electrical signals. These signals can become disrupted for several reasons, which can lead to a number of potentially dangerous heart conditions, such as:  -An abnormally slow heartbeat (bradycardia) -An abnormally fast heartbeat (tachycardia) -Heart block (where your heart beats irregularly because the electrical signals that control your heartbeat aren't transmitted properly) -Cardiac arrest (when a problem with the heart's electrical signals cause the heart to stop beating altogether)

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