A pacemaker is a device that will stimulate a patient’s heart to beat when the heart rate is too slow or when there are missing beats. In other words, a pacemaker will fill the gaps in the heart rhythm or take over when the heart rate is too slow. A pacemaker does not regulate the heart rhythm. If a patient with an irregular heart rate (e.g. atrial fibrillation) receives a pacemaker, the device will merely ensure a uninterrupted ECG but won’t restore the rhythm.
In special cases where the heart rhythm changes to a potentially lethal rhythm (e.g. ventricular fibrillation) an ICD (Intra Cardiac Defibrillator) can be inserted that will deliver an electrical shock to the heart to restore the rhythm to normal.
The majority of pacemakers that are inserted on a day to day basis are there to restore heart rate and to prevent blackouts or severe dizzy spells caused by a too slow heart rate or pauses in the ECG.
HOW IS IT DONE ?
The procedure is performed in a theatre or Cath Lab under extreme sterile conditions. In the majority of cases general anaesthesia is unnecessary and the procedure is done under local anaesthesia. The patient will be given a mild sedative and pain medication.
Pacemakers are normally inserted beneath the collar bone (clavicle) – under the skin but on the underlying muscle. If a patient is right handed the procedure will be done on the left side and vice versa.
The area were the incision in the skin is made will be cleaned and draped with sterile theatre drapes, and a local aesthetic agent (usually lignocaine) administered to numb the area. Access is gained to the subclavian vein and a sheath inserted through which the intra-cardiac leads (electrical wires from the pacemaker device to the heart muscle) will eventually be inserted.
A “pacemaker pocket” or space is then created between the skin and the muscle where the device will be inserted. The device will be connected to the wires and the skin finally closed with sutures or surgical clips.
WHAT ARE THE POSSIBLE COMPLICATIONS ?
Bleeding at the pacemaker site (never life threatening and easily controlled.)
Puncturing of the lung with pneumothorax – potentially serious condition if not treated and corrected.
Infection at the pacemaker site – this will in most cases lead to the removal of the original pacemaker and a new device to be inserted on the other side.
(extreme care and safety measures are taken to ensure an aseptic technique both during and after the procedure to avoid possible contamination.)
Infective endocarditis (extremely rare but serious infection in the heart / valves.)
Pacemaker eroding through the skin (care must be taken by the patient not to touch or fiddle with the pacemaker site.)
WILL IT CHANGE MY LIFE STYLE ?
Yes – in most cases a PM will improve your quality of life. There are however certain sport activities that should be avoided e.g. – all contact sports, bowling in cricket, certain swimming styles, target shooting with high calibre guns, shooting from the PM site, serving with the pacemaker arm in tennis.
Certain areas and activities to avoid : High voltage areas, Arc welding, MRI scans (the new generation pacemakers are MRI safe.)
Care to be taken at airport security gates.
It is safe to use your cell phone, a hair dryer and a micro wave oven. (vibrator pads for weight loss ?? – still need to add test)
It is safe to have a chest Xray, ultrasound and CT scan of the chest.
WHAT ABOUT THE BATTERY ?
The modern pacemakers have a battery life that can last up to 15 years or more. The life span depends on a number of aspects and varies from the type and model of the device to the number of time the device has to pace per time period.
Like any battery, the more it is used and the higher the current required, the quicker it will go flat. The battery is tested every 6 months and an estimate of remaining battery life is projected.
Testing of the battery and setting of specific features are done by an external interrogation device, placed on skin over the pacemaker site and by bluetooth communication with a specific computer program designed to communicate with the device.
When a battery is near the end of its life, it will be replaced within the last 6 months remaining.
This is done by a small incision in the skin, careful dissection and removal of the generator and then re-connecting and inserting of a new device to the old wires after which the skin is closed again.