Therapies
In the following you can gather information about your newly implanted device, what is recommended after implantation, how to behave and what to have in mind as a device carrier.
Types of Pacemakers
The type of pacemaker you may need depends on your symptoms and the specific heart condition you have. After diagnostic evaluation, the physician´s recommendations are discussed.
...read more
Types of Pacemakers
The type of pacemaker you may need depends on your symptoms and the specific heart condition you have. After diagnostic evaluation, the physician´s recommendations are discussed.
Single-chamber pacemaker
This type of pacemaker has one lead that connects the pulse generator to one chamber of the heart.
For most people, the single-chamber pacemaker is used to control heartbeat pacing by connecting the lead to the patient´s right ventricle (right lower heart chamber). Depending on symptoms and the type of pacing needed, the lead is connected to the heart´s right atrium (upper right heart chamber) to stimulate the pacing in that chamber.
Dual-chamber pacemaker
With two leads, this device connects to both chambers on the right side of the heart, the right atrium (upper) and the right ventricle (lower chamber). The dual-chamber pacemaker is programmed to regulate the pace of contractions of both chambers.
This pacemaker helps the two chambers work together, contracting and relaxing in the proper rhythm, to guarantee sufficient functioning of the heart.
Biventricular pacemaker
This pacemaker, also known as a cardiac resynchronization therapy (CRT) device, has three leads connected to the right atrium and both ventricles (both lower heart chambers). First two leads are implanted as stated above, the third lead will be implanted either by surgical procedure on the outside of the left ventricle or more commonly into the sinus coronarius, a venous blood vessel circling around the left ventricle. The so called CS lead will enter the sinus coronarius via the right atrium.
These devices are used to treat patients with advanced heart failure.
Many systems implanted today feature hysteresis function to relieve the patient from pacemaker associated symptoms (fast heartbeat at rest). This function adapts to the needs of cardiac output by intervening only when necessary above or below a set frequency.
Operation
During the Procedure
A pacemaker implantation procedure may be performed on an outpatient basis or as part of a stay in a hospital. Procedures may vary depending on a patient’s condition and the doctor's practices. The entire procedure usually lasts about two hours.
During the procedure, the patient will lie flat on a table for the duration of the implantation. Arms, legs and torso will be fixed to the table. The upper chest will be scrubbed and shaved (i...read more
Operation
During the Procedure
A pacemaker implantation procedure may be performed on an outpatient basis or as part of a stay in a hospital. Procedures may vary depending on a patient’s condition and the doctor's practices. The entire procedure usually lasts about two hours.
During the procedure, the patient will lie flat on a table for the duration of the implantation. Arms, legs and torso will be fixed to the table. The upper chest will be scrubbed and shaved (if needed) and patients will be covered with sterile drape.
Patients might receive some sedation intravenously to help with relaxation during the procedure.
The physician will conduct a local anesthetic to numb the skin and tissue at the site of the pacemaker implantation.
Incision will be performed, Access to the vein under the collar bone is obtained and one or more leads (thin wire-like tubes) are advanced to the heart. The leads are connected to the pacemaker and closed under the skin.
Once the lead has been positioned, the doctor will create a small "pacemaker pocket." The leads will be connected to the pulse generator, which is then placed into the pocket. The doctor will suture the incision over the pacemaker and place a dressing over it.
Pacemaker Insertion Process
Generally, a pacemaker insertion follows this process:
- Patients will be asked to remove any jewelry or other objects that may interfere with the procedure
- Patients will be asked to remove clothing and will be given a gown to wear
- Patients will be asked to empty their bladder prior to the procedure
- An intravenous (IV) line will be started in the hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed
- Patients will be placed in a supine (on back) position on the procedure table
- Patients will be connected to an electrocardiogram (ECG or EKG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure
- Large electrode pads will be placed on the front and back of the chest
- Patients’ torso, arms and legs will be fixed.
- PECS II block is conducted in case of CRT implantation under the pectoralis muscle.
- Serratus block is conducted in case of S-ICD implantation
- Patients may receive a sedative medication in IV before the procedure to help patients relax. However, patients will likely remain awake during the procedure
- The pacemaker insertion site will be cleansed with antiseptics prior to the procedure, surgical site will have time to dry out completely prior to incision.
- Patient will be covered with sterile drape, surgical site might be covered by incision foil (depending on physician and centre)
- A local anesthetic will be injected into the skin at the surgical site
- Once the anesthetic has taken effect, the doctor will make a small incision at the surgical site, preparation anatomical structures will be conducted.
- A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the pacemaker lead wire will be inserted into the blood vessel and advanced into the heart.
- TauroPace™ is poured onto the lead(s) in position.
- Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two, or three lead wires inserted, depending on the type of device the doctor has chosen for the patient’s condition. Fluoroscopy, (a special type of X-ray that will be displayed on a TV monitor), may be used to assist in testing the location of the leads.
- Pacemaker generator is unwrapped and wiped down with gaze soaked in TauroPace™
- The pacemaker generator will be slipped under the skin through the incision after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side. (If patients are right-handed, the device will be placed in the upper left chest. If patients are left-handed, the device will be placed in the upper right chest)
- TauroPace™ is poured onto the device in final position.
- The ECG will be observed to ensure that the pacer is working correctly, pacemaker testing is conducted to program the device properly
- The skin incision will be closed with sutures and adhesive strips, stains are cleansed with gaze soaked in TauroPace™.
- A sterile bandage/dressing will be applied
After the Procedure
If the procedure is performed on an outpatient basis, patients may be allowed to leave after completing the recovery process.
Patients should be able to return to their daily routine within a few days. The doctor will tell you if you will need to take more time in returning to normal activities. In addition, patients should not do any lifting or pulling on anything for a few weeks. Patients may be instructed not to lift arms above the head for a certain p...read more
After the Procedure
If the procedure is performed on an outpatient basis, patients may be allowed to leave after completing the recovery process.
Patients should be able to return to their daily routine within a few days. The doctor will tell you if you will need to take more time in returning to normal activities. In addition, patients should not do any lifting or pulling on anything for a few weeks. Patients may be instructed not to lift arms above the head for a certain period. Patients will most likely be able to resume their usual diet, unless the doctor instructs differently.
Electromagnetic fields can interfere with the pacemaker's ability to sense an abnormal rhythm. Some devices and machines are safe to use while other devices are not:
- Microwave ovens, computers, VCRs, small electrical tools, and garage door openers are all safe to use
- Avoid devices or areas that have strong electric or magnetic fields such as: leaning over a car engine while it is running, running motorcycle engines, power plants, ham radios, etc.
- Cellular phones, MP3 players, and headphones should be held at least 6 inches away from your pacemaker. Hold the phone on the ear opposite your pacemaker and avoid keeping your phone and headphones in a pocket on top of your pacemaker. Avoid resting your head on the chest of a person with a pacemaker while wearing headphones
- When traveling in the airport, tell security you have a pacemaker and request for a hand search instead of walking through the metal detector. The metal detector will not harm the pacemaker but it may set off the alarm. Limit scanning with a hand-held metal detector over the device no longer than necessary.
- Inform your health care provider that you have a pacemaker before they perform any test or procedure using medical or electronic devices. o If you are to undergo dental procedures or any type of surgery involving electrocautery, have your dentist/physician contact either the device manufacturer or your physician. The electrocautery might be misinterpreted by the pacemaker as heart beats and withhold pacing
Normal electric teeth cleaning devices are safe and require no special instructions.
You cannot have an MRI because of the possible magnetic interference unless stated otherwise by the manufacturer of your device.
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