The heart spontaneously generates electrical impulses that, when distributed throughout the myocardium, produce cardiac contraction.
When these impulses are blocked, they are not generated or they do it in an abnormal way (either because they do not do it in the right place or because they do not do it with the precise frequency) we say that the heart has an arrhythmia.
A pacemaker can help you generate the electrical stimuli your heart needs.
What is an implantable pacemaker?
The pacemaker is an electronic device that generates impulses that artificially and rhythmically excite the heart when the heart's natural pacemakers cannot maintain the proper rhythm and rate. Furthermore, these devices monitor spontaneous cardiac electrical activity, and depending on their programming, they trigger electrical impulses or not.
A modern pacemaker has an estimated life of 5 to 12 years. Later it can be changed very easily thanks to the standardization (IS-1-standard) of the electrode connections.
The new pacemakers also have other functions:
Synchronization, due to a communication problem, between the atrium and the ventricle ( AV-block ).
Modification of the beat rate to suit the wearer's bodily activity (adaptive rate pacemaker)
Helps prevent atrial rhythm problems through overstimulation (preventive step).
Recording or monitoring of heart rhythm disturbances.
Improvement of the pumping function of the heart by pacing the left ventricle or both in the event of a malfunction of the left ventricle and lack of blood flow (cardiac resynchronization therapy).
Pacemaker functions are also found in:
The cardiac resynchronizer (CRT): a somewhat more complex pacemaker that combines the synchronization between the right and left ventricle with the usual functions of the pacemaker through an additional electrode that stimulates the latter cardiac chamber.
A pacemaker is made up of two elements:
Generator or "battery": includes the battery and various electronic circuits and sensors.
Electrodes or “cables”: they are responsible for transmitting the electrical impulse from the electrode to the heart.
There is a special type of leadless pacemaker that is inserted into the heart through the femoral vein.
It is indicated in patients who do not have adequate endovascular accesses for the implantation of a conventional pacemaker, either because they have had an infection at the access site or because these accesses are essential for other therapies (hemodialysis, for example).
Its durability is 12 to 15 years depending on the use and characteristics of the implant, being able to place up to 3 devices consecutively.
We are trained to implant all these types of pacemakers as well as to remove them if necessary. Make an appointment and we will inform you of the best option for you.
What does the intervention consist of?
Depending on the preferences of the patient and surgeon, the pacemaker is implanted near the deltopectoral groove, near the clavicle, and the right or left pectoral muscle.
The surgeon will locate a vein through which to insert the electrode (s) to be implanted. Using X-rays, he will place the tip of the lead in close contact with the heart muscle at the tip of the right ventricle or with the outflow tract of the right ventricle. If a second electrode is required, the tip of the latter will be in close contact with the wall of the right atrium. Later, with a specific device, it will measure if the electrodes are in the correct location. If so, it will connect the proximal end of the electrodes to the generator, which will be housed in a subcutaneous or infrapectoral bag made for this purpose.
Your pacemaker will be working and sending signals to your heart. Also, they usually stop working to save battery life when your heart is able to “control” itself (pacemaker on demand).
Before the intervention
Except in urgent cases, the intervention will be carried out on a date suitable for you and with the availability of an operating room by the surgeon. You should inform him of your recent health status including if you have had a cold, tooth decay, or fever. Remember to bring the medications you are taking or have taken in recent days to the Hospital. You will probably enter the day before or the morning of the intervention.
The area near the surgical field will be shaved. With this we avoid future infections. After admission, an electrocardiogram, a blood test and a chest X-ray will be performed (if not already done).
As part of your pre-anesthetic medication, you will likely be given a sedative to help you relax before going to the operating room. Once in the operating room, a route will be taken to administer an antibiotic to prevent infections.
During the intervention
The intervention is carried out in the operating room under local anesthesia generally and you will be awake during the entire procedure. The procedure is usually painless, although from time to time you may feel a slight sting or feel that the area is being touched.
The operation can last between half and 1 hour on average, although in the case of cardiac resynchronizers, the duration can be considerably longer.
After the intervention
Generally it only needs to be cured with a local antiseptic until the wound is completely healed. The next day you will be discharged after checking the correct functioning of the pacemaker.
You should not jerk your arm on that side for 1 month.
How often should the pacemaker be checked?
You will have to go to regular annual check-ups to check the functioning of the pacemaker. Pacemakers can also be checked over the phone. This is called "trans-telephone monitoring" or "home monitoring." Even with phone monitoring, you will need to go to the doctor for regular checkups.
Pacemakers are checked with a device called a "programmer." When the programmer is placed on top of the pacemaker, information about its operation can be obtained. The programmer can also be used to change pacemaker controls.
The pacemaker battery typically lasts 7 to 8 years. When the battery runs out, a new pacemaker must be implanted. The procedure to remove the old pacemaker and place a new one typically requires local anesthesia. In most cases it is not necessary to change the original electrodes.
Do electronic devices affect how the pacemaker works?
The devices below do not affect or damage pacemakers. Most of the people can have contact with these devices without needing to worry.
Civil band radios
TV remote controls
Airport security equipment
The devices below do affect pacemakers. Pacemakers may not function properly when in contact with these devices.
Some appliances used by dentists
Radiation therapy machines for cancer treatment
Heavy equipment or motors with strong magnets
Can I use cell phones if I have an implanted pacemaker?
It is convenient to carry the mobile phone more than 15 cm away from the pacemaker. You should also speak with the hand opposite to the place where you have the pacemaker implanted. Although interference with current mobile phones has not been demonstrated, increasing the number of frequencies in use could change this.