How to Insert Pacemakers?
The heart has a flawless electrical transmission network within itself that keeps it working properly. Unlike other organs, it produces electrical stimuli and can pump blood in a healthy way by means of these stimuli. If there is a problem in this electrical transmission system, if the heart cannot generate enough stimulation, a pacemaker can be required. A pacemaker helps the heart send out electrical impulses at the right rate and at the right time. Thus, it allows the person to continue his life in a healthy way. How are pacemakers inserted? In the continuation of our article, we will find the answer to this very curious question about pacemakers. For more detailed information about heart diseases and their treatments, you can contact clinic of Prof. Basri Amasyalı in Ankara.
Why Pacemakers Are Inserted?
Heart beats thousands of times during the day according to the physiological needs of the person. Meanwhile, it ensures the distribution of both oxygen and clean blood to our body. It is a vital organ. If the heart loses its strength and cannot pump blood properly, complaints such as fainting, dizziness, palpitations and drowsiness can occur. Fainting (syncope) can occur and the ground for more serious problems that will affect the patient’s health in the future can be preparing. A pacemaker supports the heart that slows down and weakens due to problems in the electrical conduction system. It allows the heart to transmit electrical impulses again, and prolongs the life of the patient.
There are also specialized pacemakers (3-wire pacemakers) that are used in the treatment of heart failure and serious arrhythmias. You can find more detailed information on this subject in the 3-wire pacemaker section.
How to Insert Pacemaker?
One of the most curious things about pacemakers is how pacemakers are inserted. The pacemaker is usually inserted in a catheter laboratory where angiography is performed. Performing the procedure by an experienced team is extremely important in terms of minimizing the risks and ideally fitting the pacemaker that you will carry for life.
Pacemaker; It is inserted in the environment where scopic imaging methods are used. In other words, the fluoroscopy system used in coronary angiography is used. Scope imaging is a special imaging method that works with X-ray and is used to take images and monitor the progress of battery electrodes. After the patient is taken to the angio laboratory, a number of drugs are given intravenously, and the patient is brought into a state of sedation, which we call sleepiness. Then, local anesthesia is applied 2-3 cm below the left collarbone. Then, an average of 3-4 cm incision is made and the cables (electrodes) belonging to the battery are advanced to the heart thanks to the vein (subclavian vein) located here. Subsequently, the electrodes are connected to the generator and the pacemaker generator is placed in a pocket opened under the muscles in this area. Finally, a 3-4 cm skin incision is sutured and the procedure is terminated. Total elapsed time is on average 25-30 minutes.
The most preferred place for insertion of a pacemaker is the left shoulder area. This is because the majority of the population is right-handed. However, if the person is left-handed and the battery to be inserted is suitable for the right shoulder region, the right shoulder region can be used in left-handed patients.
In addition to permanent pacemakers, there are also temporary pacemakers that we use in some cases. Temporary pacemakers are used to treat damage to the electrical system of the heart due to a cause that can be recovered later, such as heart attacks, drug poisoning, traffic accidents, and inflammation of the heart muscle. As the name suggests, these batteries are temporary and are removed after 10-14 days from the patient. The way temporary pacemakers are inserted is completely different. Here the pacemaker is outside the patient. The battery cable is sent to the heart via the “femoral vein” in the groin area or the “jugular vein” in the neck area, and the cable is connected to the pacemaker generator located outside the patient. Cardiac surgeons also use temporary pacemaker frequently. Especially in heart valve diseases, the electrical system of the heart can be damaged during surgery. In such cases, a temporary pacemaker is connected to the patient with a cable (epicardial electrode) inserted directly to the heart muscle during surgery. It is waited for 10 days after the operation and if the damaged electrical system of the heart does not recover on its own, a permanent pacemaker is inserted.
Some special procedures can be required to insert shock devices (in medical terms, these are called ICDs) used in heart failure. Although it is generally considered to be a more complex procedure than normal pacemaker implantation, the procedure is roughly the same. Due to the Shock feature of the inserted battery, some issues need to be considered. You can find more detailed information on this subject in the section “3-dimensional pacemakers” and “types of pacemakers”.
Is Pacemaker Insertion Risky?
The risks that can be encountered while placing a pacemaker are closely related to the experience of the center and the skill of the physician performing the procedure. Especially if it is performed by a well-trained specialist physician and team, there is almost no life-threatening risk, except for insignificant risks. Problems encountered while wearing a pacemaker include:
- Vascular injuries
- Damage to the lung tissue and accumulation of air between the pleura
- Electrodes coming out of the inserted place
- Infection and clot formation.
What Should Be Taken Care After Pacemaker Is Inserted?
After a pacemaker is inserted, the patient has to come to regular check-ups every 6 months or sometimes 1 year for life. Average battery life is between 5-10 years. During each control, the life of the battery is checked again, the necessary information is shared with the patients by checking whether there are any problems in the settings of the battery. During periodic controls, a socket is placed on the skin over the pacemaker and the memory of the battery is examined in detail in the computer system. In the latest developed batteries, these controls can also be examined with a wireless system. The patient can check the battery from sitting in a room.
Things to take care immediately after the pacemaker is inserted in the first 3-6 months;
Healing of the incision site where the battery is inserted and returning to our daily life is actually within 10-15 days in most cases. However, we need to pay attention to the mentioned points so that the cables of the battery, which is installed in the first month, are not dislodged. In the first 10 days, care should be taken to make the wound dressing regularly and to keep the procedure area sterile. In particular, we need to stay away from activities that will make us sweat. After the operation, the sutures are removed in about 8-10 days and the patient begins to return to his daily life. However, since we have internal stitches or invisible stitches applied to almost all patients in our center, patients do not need to go to the hospital again after 10 days and have stitches removed.
- There can be some restrictions in arm movements for the first 1.5 – 2 months, which is the healing process. Care should be taken not to open the arm on the treated side more than 90 degrees.
- The patient should not bear weight with his/her arm in the treated area for the first 3 months.
- It should not be laid on the side where the battery is inserted for one month.
There is also a lot of curiosity about the effect of mobile phone carrying, driving and the effects of detectors after the pacemaker is inserted:
- The mobile phone can be used after the pacemaker is inserted. However, electronic devices kept closer than 15 cm have a risk of adversely affecting the pacemaker. For this reason, care should be taken to keep mobile phones and other electronic devices as far away from the pacemaker as possible. Therefore, our advice to our patients is to use their hands and ears on the side where the battery is not installed for the phones.
- Driving is not recommended within 15 days – 1 month after the battery is inserted. However, after the healing process is completed, the car can be used again with the approval of the doctor.
- Hand-held metal detectors and x-rays can very rarely cause changes in pacemaker settings. For this reason, they should ensure that the patients are checked manually by telling the officer that they have a pacemaker while passing through places with security units such as airports and shopping centers. Metal detectors should be kept at least 15 cm from the pacemaker. However, the latest batteries are quite safe in this regard. There is little to no interaction. Therefore, even if our patients pass through metal detectors absentmindedly, they should not panic; the interaction is less than one in a million. In such cases, it is recommended that our patients come to the control and have their battery settings checked again.