Pacemakers

A pacemaker is a small medical device that is implanted under the skin in the chest to help regulate a person’s heartbeat. It is used to treat conditions such as bradycardia, which is an abnormally slow heartbeat where the electrical impulses that control the heart’s rhythm are blocked or delayed. A pacemaker surgery can help restore a normal heart rate, which can improve symptoms such as fatigue, dizziness, and shortness of breath. Pacemakers are commonly used in older adults who have heart conditions that affect the electrical system of the heart. However, they can really be implanted at any age even in infants.

The pacemaker is programmed to monitor the heartbeat and deliver electrical impulses as needed to keep the heart beating at a normal rate. It can be adjusted by a doctor to ensure that it is providing the appropriate level of support for the patient’s needs.
Fig 88

The pacemaker works by sending electrical signals to the heart to stimulate contractions and maintain a regular heartbeat. It is made up of a small electronic chip, a battery, and wires with electrodes that are connected to the heart (pacemaker leads). These components are typically implanted during pacemaker surgery.

Fig 59 Pacemaker xray

The first practical pacemakers were developed in the mid-20th century. Over the years, pacemaker technology has continued to evolve, with improvements in battery life, programming, and size. Today, pacemakers are much smaller and more reliable than early models, and are used to treat a wide range of heart conditions. This advancement has greatly enhanced the effectiveness of pacemaker treatment.

Fig 60 pacxemaker
There are several types of pacemakers available, each designed to meet the specific needs of patients with different types of heart conditions. Some of the most common types of pacemakers include:
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Single-chamber pacemakers

These pacemakers have one lead that is placed in either the right atrium or the right ventricle of the heart. They are typically used to treat bradycardia (slow heart rate)


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Biventricular pacemakers

Also known as cardiac resynchronization therapy (CRT) pacemakers, these devices have three leads that are placed in the right atrium, right ventricle, and left ventricle of the heart. They are used to treat heart failure in patients with a weakened heart muscle.

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Dual-chamber pacemakers

These pacemakers have two leads, one placed in the right atrium and the other in the right ventricle. They are used to treat heart block, where there is a delay or complete blockage in the electrical impulses that regulate the heartbeat.

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Leadless pacemakers

These pacemakers are much smaller than traditional pacemakers and do not require leads to be implanted into the heart. Instead, they are inserted directly into the heart through a vein in the leg.


The type of pacemaker that is most appropriate for a patient will depend on their specific heart condition and medical history, as well as other factors such as age and overall health. Your electrophysiologist will recommend the most appropriate type of device based on your medical condition.
The procedure to implant a pacemaker typically takes 1-2 hours and is performed under local anaesthesia, with the patient awake but sedated. Here are the general steps involved:
The patient is prepared for the procedure by having an IV line inserted and being connected to monitors to track their heart rate, blood pressure, and oxygen levels. The skin is sterilised and the patient is covered with sterile drapes.
A small incision is made in the chest near the collarbone, and the electrophysiologist creates a pocket under the skin for the pacemaker device.
One or more leads are inserted through a vein in the chest and guided to the heart. The leads are then attached to the pacemaker device and tested to make sure they are working properly.
The pacemaker device and leads are then inserted into the pocket created earlier under the skin. The device is then tested to ensure that it is functioning properly and delivering the correct electrical impulses.
The incision is closed using sutures or surgical staples.

The electrophysiologist will use a special programmer to communicate with the pacemaker and program the parameters depending on the case.

After the procedure, the patient is taken to a recovery room and monitored for a few hours. They will need to avoid strenuous activity and heavy lifting for several weeks while the incision heals.
The patient will need to have regular check-ups with their doctor to ensure that the pacemaker is functioning properly and to make any necessary adjustments to the device’s programming.
Overall, pacemakers are an important tool in the management of heart disease and can help improve the health and quality of life of individuals with certain heart conditions through pacemaker treatment.

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