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Pacemaker Implantation

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Pacemaker implantation
Pacemaker implantation

German Medical Group will help find you the best heart clinic in Germany. It is known that constant cardiac rhythm disturbances are of great danger to our lives. If a patient has serious problems with contractile cardiac muscle function manifesting in stable arrhythmia, pronounced bradycardia or ciliary arrhythmia, the only way to escape the danger is pacemaker (electric cardiostimulator) implantation.

Thanks to the progress in modern medicine in Germany things are different now. A pacemaker is fixed inside the body, it has smaller size and weight compared to its prototypes, and it operates on lithium batteries which last from 6 to 14 years and are remotely programmed. A new generation of pacemakers helps to effectively resynchronize cardiac beats due to electrodes which are connected both to right and left ventricles of heart. The impulse first stimulates the left and then the right ventricle, as it normally happens in a healthy heart. Nowadays many patients in need of electric cardiostimulation come to Germany, worldwide leader in cardiosurgery, for pacemaker implantation.

Local anesthesia is used while pacemaker is being inserted. The pacemaker surgery in Germany usually takes about 20-30 minutes, although previously it took up to a few hours. The device is inserted either under the skin or pectoral muscle so that the patient wouldn’t even feel it. Cardiological clinics of Germany use only high-technology pacemakers which can be reprogrammed, if necessary, without surgical procedure. Functions of the pacemaker are checked externally, through the skin.

Normally, in the heart, more precisely in a small node on the right atrium (sinus node), rhythmic electrical excitations are formed. These are passed through the heart wall and lead to a contraction of the heart muscle, the blood is thus pumped through the circulation. Problems in this arousal formation and conduction lead to arrhythmias, in particular to slow down the heart rhythm (bradycardia). A so-called replacement rhythm occurs, which is not controlled by the sinus node as usual, but starts from other structures of the heart wall and is usually much slower.

Various circumstances can lead to such cardiac arrhythmias. Often there is damage to the heart, for example, previous heart attacks, heart valve changes with heavy stress on the heart, coronary heart constrictions (coronary heart disease, CHD) or myocarditis (myocarditis). However, the cardiac arrhythmia can also be triggered outside the heart, e.g. by certain substances (for example, medicines, drugs), by hypothyroidism or by psychic reactions.

Different forms of cardiac arrhythmias are distinguished. They are roughly subdivided into too fast a heartbeat (tachycardia) and too slow a heartbeat (bradycardia). The adult normal rate is around 60 to 100 beats per minute.

Many cardiac arrhythmias have no symptoms and do no harm. However, different species can become life-threatening. Several arrhythmias can occur simultaneously.

If the heart is beating too slowly (bradycardia), the blood supply in the body drops. This is especially noticeable in the brain, it comes to, among other things, fatigue and dizziness. The patient may become unconscious. The slowed or halting heart activity is often directly noticed as heart stumbling, dropouts or the like.

There are several other forms of cardiac arrhythmias, which should not be discussed here, as treatment with the conventional pacemaker is only possible if the heart rhythm is too slow. For too fast cardiac actions, another type of pacemaker, the so-called cardioverter defibrillator, is recommended.

Occasionally, the symptoms, the patient's accounts (anamnesis) and the physical examination already suggest a cardiac arrhythmia. An ECG is performed, which shows typical changes in each case. A long-term ECG (24-hour ECG) is also recommended to detect disturbances that only occur intermittently. Sometimes further investigation methods are used, e.g. experimental medication or a so-called electro-physiological examination (EPU) using a cardiac catheter.

Since other types of cardiac arrhythmias may have similar symptoms, they must be distinguished from bradycardia (slowing of the rhythm).

Cardiologists, experts in cardiac issues and problems, distinguish several forms of cardiac pacemakers. In addition to the classic model, there is also a transcutaneous pacemaker. Furthermore, there is an insertable defibrillator in a greatly reduced form. In addition to the above forms, there are also permanent units that work in one, two or three chamber units. In total, there are five types of pacemakers that differ based on the location of the stimulation.

Extracardiac stimulation

Extra means functioning outside the body In the early stages of pacemaker treatment, electrodes were sutured directly to the heart. Today, the lead wires are routed right through the skin at the bottom of the breastbone. However, this practice is only used after interventions on the heart.

Intracardiac stimulation

An electrode is inserted into the right half of the heart and inserted through a vein. The operation takes place at the open heart. The electrode is thereby fixed to the heart with an external stimulation. Due to the high risk of infection, this therapy is not recommended and is only suitable for temporary treatment.

Transcutaneous Stimulation

This is an external pacemaker that places large stick-on electrodes on the skin, which then deliver small surges that stimulate the heart. Since there is no direct contact between the heart and the surge, higher currents are necessary. The procedure is therefore more suitable for emergency situations, as the increased current strength stimulates the skeletal muscle unintentionally.

Esophageal stimulation

An electrode is pushed through the esophagus and placed at the level of the heart. The procedure is very painful and is rarely used, which is why it is not very common.

Intracardiac stimulation

The most commonly used procedure in practice is intracardiac stimulation by an inserted implant. The HSM is implanted above the left (or right) breast under the skin or under the large pectoral muscle.

Amongst these different types of cardiac pacemakers, there are still different types which, depending on the structure, have a different function.

  • Single chamber pacemaker with models V00 / A00, VVI, AAI and SSI
  • Two-chamber pacemaker with the models VAT, DVI, VDD and DDD
  • Three-chamber pacemaker

The implanted pacemaker can be set wirelessly by using an interrogator or by setting it directly on the external HSM. The pacemaker not only serves the electronic transmission of pulses, it also measures the heart function and creates an ECG which can be evaluated. If no heartbeat is detected within a certain time, stimulation will be by the electrical impulses.

The devices of the single-chamber pacemakers of the VVI series are among the most frequently used. These ensure that there can be no overactivity of the heart. It switches on automatically when needed and acts when the heart ventricle is not active. It then automatically shuts off again when the heart chambers are working properly again. The dual-chamber pacemakers serve as an atrial pacemaker and should prevent ventricular fibrillation.

The functional principle of the pacemaker includes that when measuring a too slow heartbeat or misfires small electrical shocks are delivered to the heart. This will then stimulate one heartbeat at a time.

A pacemaker can be permanently applied depending on the findings or illness and is put into the body, or a temporary pacemaker is used in which only the electrodes are inside the body, but the power supply unit with the battery is outside.

In the procedure of implanting a permanent pacing device, a pocket of tissue is made beneath a collarbone in local anesthesia. In this the pacemaker is inserted. When this is done, an electrode is inserted over the vein below the clavicle (subclavian vein) and brought inside the heart. The electrode is positioned for a single-chamber pacemaker at the lower end of the right ventricle. If a two-chamber pacemaker is installed, another electrode is fixed in the right atrium. The advancement of the electrodes is similar to a cardiac catheter examination and is done by fluoroscopy with an X-ray machine. The electrodes are then connected to the pacemaker.

If a temporary (temporary) pacemaker is applied, only the electrodes are inserted over the vein as in permanent implantation. The connections to the pacer device, which is externally attached, protrude from the lower neck area.

After years of operation, a replacement of the pacemaker is required. If poor battery performance is detected, local anesthesia is given and the bag is reopened to the patient's skin by cutting. After removing the old and inserting a new device, this is connected to the existing electrodes.

After successful insertion of the pacemaker system is checked by control measurements, if the device works.

Occasionally, it may be necessary to add more electrodes or probes.

In some circumstances, it may be that the electrodes can not be inserted through the vein. In this case, it may be necessary to attach the electrodes to the outside of the heart wall via a more complex operation.

Even complications may make it necessary to take other measures than planned.

There is a risk of bleeding and rebleeding. Nearby structures can be damaged, e.g. Nerves with possible signs of paralysis, numbness or other failures. It can not be ruled out that the heart muscle is damaged. The lungs can also be affected under certain circumstances, with defects in the pleura it can come to air accumulation, which hinder the respiration (pneumothorax).

At this point, as well as around the heart, it can also come to effusions, which can severely affect the function. Inflammation, wound healing disorders and scarring can also be triggered.

Also allergic reactions are possible. Blood clots may form that result in deficient blood circulation in various parts of the body, e.g. also the lungs (pulmonary embolism), can lead. Problems with pacemaker components, e.g. Failure, displacement, or damage can not be excluded.

Note: This section can only give a brief outline of the most common risks, side effects, and complications, and is not exhaustive. The conversation with the doctor can not be replaced.

Pacemaker operations are performed very often and many people have become accustomed to living with the device. Life-threatening conditions are usually reliably detected by the pacemaker and can be reversed by targeted stimulation.

Since cardiac arrhythmias often occur as a result of other illnesses, the prognosis also depends on it and on the respective optimal treatment.

Although pacemaker surgery is a relatively safe procedure, complications can not always be avoided. Nearly every 30th pacemaker implantation leads to a misplacement of the probes. Consequences may be functional limitations of the device, vascular injuries or cardiac arrhythmia. The latter are usually recognized and treated in the hospital.

If the patient suddenly hiccups after a pacemaker surgery, this indicates an unwanted electrical excitation of the diaphragm. Normally, you then have to perform a pacemaker operation again, in which the wires are repositioned differently.

Often a bruise (hematoma) forms in the area of ​​the wound below the collarbone. As a rule, it does not need to be treated as it gradually degrades itself. However, the doctor should rule out major bleeding.

If, after a pacemaker operation, the wound swells and reddens, there may be a bacterial infection behind it. In that case, it is important to have regular wound control and doctor treatment, especially if the patient experiences fever or feels weak and beaten. Sometimes antibiotics are needed for treatment or the wound needs to be reopened.

About ten days after the implantation of a pacemaker, the skin has recovered to a normal wound healing at the surgical site under the clavicle so that the threads can be pulled. To avoid delayed wound healing or even germ introduction, it is recommended that the skin be gently wiped clean with a washcloth around the wound (the dressing should not be wet). Once the wound has healed and the threads are pulled, you can again wash normally or shower and bathe.

Arm with new pacemaker not above chest height

In order for the healing process to be optimal and no pacing on the pacemaker probes, the arm on which the pacemaker was inserted should not be raised above chest height for about two weeks after implantation.

In order to ensure optimal functioning of the pacemaker, then later in the course of regular checks are necessary, either in-house cardiologist or in the pacemaker outpatient clinic of the hospital. In the process, the state of charge of the pacemaker battery is checked, the functionality of the pacemaker probes is measured and various data for the pacemaker function are read out, eg. For example, how often has the pacemaker in the past supported the heart rhythm with impulses, or has there been any particular occurrences of cardiac rhythm? The first check-up after discharge from the hospital or the institution where the pacemaker implantation was performed will take one to three months. Subsequently, the follow-up intervals should be six to twelve months.

When the battery of the pacemaker is exhausted

Longer intervals between two follow-up examinations are possible when a so-called telemedicine monitoring takes place, in which the most important pacemaker data is automatically read out automatically by radio from a small additional device outside the body depending on the manufacturer and from there encrypted via the mobile or telephone network to the caregiver Heart center to be transmitted. Shorter intervals between follow-up examinations, on the other hand, are required if the battery gradually becomes depleted and, for this reason, closer monitoring is advisable. In this way, a change of the pacemaker assembly as long as possible delay, without the risk of pacemaker failure due to an empty battery.

Attention with reddened skin over the pacemaker

Complications are very rare after implantation of a pacemaker. Nevertheless, a pacemaker carrier should know the main potential complications and their early signs. In rare cases, pacemaker infections may occur. Usually the skin is stretched over the pacemaker, strikingly warm and reddened. In such a situation, you must see a doctor immediately. Most often, the entire pacemaker system must be removed immediately to prevent the spread of the inflammation on the body or the heart. At a later date, a new pacemaker can be implanted. Note: As a so-called "general signs of infection" in such a situation also fever and chills are possible (similar to a flu), which should understand people with a pacemaker as another alarm signal or as an invitation to go immediately for medical treatment.

You should also seek medical advice if swelling occurs in the area of ​​the pacemaker assembly, even if no simultaneous redness or other signs of infection are detected. It is possible that a bruise has formed which rarely requires surgery but should be controlled.

Heart problems after pacemaker implantation again?

If your heart problems initially improve after pacemaker implantation, but then return later, you should also consult your GP or pacemaker care professional. A pacemaker probe may have slipped to transfer the electrical impulses from the pacemaker pulse generator to the heart, which can be quickly resolved in a control exam. In order to remedy such a problem, it is often sufficient to fix the probes with a small intervention, without having to replace the complete pacemaker.

GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a 76532 Baden-Baden Germany Pacemaker Implantation Pacemaker Implantation 2017-10-13 Pacemaker Implantation

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