Heart pacemaker: indications for installation, possible complications and recommendations. Indications for surgery to install a cardiac pacemaker Installation of a cardiac pacemaker

A heart pacemaker is a medical device that helps create the correct sinus rhythm. This can be a device for temporary use, if it is necessary to alleviate the condition after surgery, to prevent vascular pathologies after taking the drug or to relieve an attack of ventricular fibrillation, or permanently - in case of serious violations of the contractility of the heart.

Long-term devices come in one-, two- and three-chamber types. The choice depends on the purpose of the pacemaker and the diagnosed disease.

The principle of operation of a cardioverter-defibrillator is to reprogram the heart to restore the correct rhythm through stimulation of the myocardium. If a pacemaker is used, it is responsible for ensuring the release of blood into the vessels; it is usually used during slow contraction.

General information about the pacemaker

To explain what a pacemaker is, it is necessary to note that the device records the rhythm of contractions and generates impulses that cause the heart to contract correctly.

Implantation of the device is carried out in case of pathologies caused by slow contractions of the chambers, when proper blood circulation is not carried out and the healthy functioning of the body is disrupted.

Before receiving the current version of the device, cardiac surgeons had to work with various devices that did not respond to the independent heart rhythm and functioned only at a given pulse generation frequency.

This could not always meet human needs. So, when running and walking, the load is completely different, therefore, the frequency of contractions should be different.

At the moment, the devices can synchronize the own contraction of the atria and ventricles. If there is no response to contraction of the heart muscle, the pacemaker is triggered, impulses are sent, and the device starts operating. When the heart is functioning normally, no impulses are sent.

Some devices have the ability of frequency adaptation, which, using a sensor, allows you to increase sensitivity to changes in the patient’s physical activity. As the load increases, the device sends faster pulses. Most current ECS accumulate information and, if necessary, display it on a monitor and digital media.

The most common reasons for implantation of the device are severe heart attack, heart failure, cardiosclerosis, life-threatening fibrillation and severe ventricular tachycardia, which are resistant to drug therapy.

You should know that indications for installation can be absolute and relative. If the former are present, the device can be installed both routinely and urgently. In this case, contraindications are not taken into account.

The absolute criteria include:

• Bradycardic attacks with manifestations in acute form Morgagni-Adams-Stokes syndrome, spontaneous and severe dizziness, syncope.
• Asystoles recorded on the ECG and exceeding 3 seconds.
• Low frequency of contractile movements (less than 40 beats/min under load).
• Atrioventricular block of 2-3 degrees, following a heart attack or combined with 2-3-fascicular block in severe form.

If there are only relative indications, the operation should take place after the recommendation of a cardiologist. In this case, the doctor pays attention to age, activity, history of diseases and contraindications.

Relative factors include:

• Atrioventricular block of the 3rd degree does not manifest itself clinically, and the heart rate is more than 40 beats under load.
• Absence of clinical symptoms with atrioventricular block of 2 or 3 degrees.
• Syncope with 2- or 3-branch block without ventricular tachycardia or transverse block.

Also, a pacemaker is not installed in case of 1st degree atrioventricular block, proximal, if they do not have clinical symptoms, and in case of atrioventricular block with the possibility of progression.

When should you get rid of a pacemaker?

For absolute readings, limitations are not taken into account. In general, patients do not have age-related contraindications.

Implantation can be delayed for people with:

• Exacerbation of chronic diseases such as ulcers, asthma, bronchitis.
• Infectious diseases in the acute stage with the presence of fever.
• Mental pathologies with severe genesis.

Patients with poor blood clotting, obesity, abusing bad habits or using special medications that affect this factor should be careful.

Operating principle of the device

The modern device consists of:

• Microcircuits. This is the main component of the device; it produces and produces impulses that control cardiac activity. This is where the abnormal heart rhythm is corrected. There are various forms of operation of the device. It can function either regularly, creating a certain constant rhythm, or start working only during the period when a heart rhythm disturbance occurs.
• Batteries. Modern devices are usually made of lithium and work for about 8 years without replacing the device. The power source itself is located inside the device body, and the battery depletion occurs gradually. Its condition is checked automatically every 12 hours, and information about the battery's shelf life is provided.
• Electrodes. These components allow the creation of a connecting structure between the heart and the device. They are attached through vessels in the cavities of the heart. The products conduct an electrical impulse from the pacemaker to the heart, and they also transmit data in the opposite direction about the correct functioning of the heart and pacemaker. They can have 1, 2, 3 electrodes. Single-chamber ones produce an impulse in only one place - the ventricle or atrium. Two-chamber devices are responsible for pulses simultaneously in the lower and upper chambers. Three-chamber ones are ideal for heart failure.

The principle of operation of the device is to endlessly analyze the generated impulses and conduct them from the pacemaker to the heart with constant synchronization control. The electrode is a conductor that carries an impulse in one direction and back data on the activity of the organ.

A metal head is attached to the end of the electrode. By contacting the heart, it allows you to collect data on electrical activity and send impulses when necessary.

If the rhythm fails, a signal is sent to the product. As a result, under the force of the discharge, a programmed rhythm is imposed on the organ. The device works according to physiological fluctuations in contraction frequency, which makes it possible to change the value based on the force of the load.

In standby mode, the pacemaker starts only when the heartbeat fails.

Products with a cardioverter-defibrillator have a program to activate cardioversion in case of ventricular fibrillation or life-threatening tachycardia.

Types of pacemakers

These devices can be used for both temporary and permanent wear. Products are divided based on configuration and purpose. Temporary ones can be set:

• During heart surgery.
• To prevent illnesses vascular system caused by medications.
• To eliminate ventricular fibrillation.

Long-term devices are grouped into the following types:

• Single chamber. The device has 1 electrode, it is not used for cardiac arrhythmias and is implanted in the left ventricle.
• Two-chamber. Equipped with two electrodes, it allows you to control the rhythm of the ventricles and atria; they are installed in the atrium and ventricles.
• Three-chamber. The most modern, optimally synchronizes contractions. Indicated for severe cardiac arrhythmia, ventricular fibrillation or ventricular tachycardia. Can also be used to prevent sudden death. Located in the left ventricle and right parts of the muscular organ.

Advantages and disadvantages of installing a pacemaker

There are pros and cons to using the device.

Advantages: the operation is less traumatic and there is no need for a long stay in the clinic. If the procedure was successful, then on the third day you can go home.

Other advantages include:

• The effectiveness of the device, which ensures normalization of heart rhythms in the shortest possible time.
• The use of local anesthetic due to minor trauma.
• There is a low threshold of contraindications; the procedure can also be performed on elderly patients.
• Minimum recovery period.
• Can be worn during pregnancy. Although he is delivered by caesarean section.

The disadvantages of installing a pacemaker include the need to comply with certain restrictions and rules. Sometimes patients with it experience a deterioration in their condition when operating household appliances.

In addition, a significant disadvantage is the cost of the pacemaker if it is not installed according to the quota.

Patients with a pacemaker should monitor their level of physical activity and avoid heavy exercise. Also, you should not use a mobile phone for a long time, and its location should be located on the opposite side from the pacemaker, no closer than 30 cm.

When using the device, some medical examinations are prohibited, including physical procedures, such as warming up and magnetic therapy. The activity of the pacemaker changes the ECG picture, which does not allow the functioning of the heart to be assessed correctly, and there is a risk of late diagnosis of coronary artery disease.

Preparation

In case of emergency installation of the device, no preparation is performed. If planned implantation is prescribed, doctors recommend undergoing a special examination. It may differ depending on the specific pathology of the patient.

In general there should be:

• ECG with 24-hour monitoring to record rhythm disturbances within 24 hours.
• EchoCG.
• Gastroscopy to prevent complications when there is a peptic ulcer.
• MRI in case of diagnosing early stroke.
• Urine and stool tests.
• General and biochemical blood test for hormones thyroid gland, HIV, clotting, hepatitis, syphilis.

An examination by an ENT doctor or other specialists may be required, depending on the presence of chronic pathologies.

It is used to stabilize the condition in the shortest possible time. In this case, it is possible to install a permanent device in the future.

For external stimulation, two plates are placed. The impulse provokes contraction of the heart muscle located between the plates. Basically, at this moment the patient experiences unpleasant feelings, this is due to significant muscle contraction. This method can also be used if the person is unconscious.

The temporary device is secured by inserting electrical probes into the central venous catheter. The kit includes sterile terminals, electrodes and delivery devices.

Such devices allow you to normalize rhythm and contraction in an emergency situation during surgery or taking special medications.

Depending on where and for what the pacemaker is used, the devices are divided into:

• Epicardial.
• Endocardial.
• Transesophageal.
• Outer.

An endocardial device is considered the best; it is located near the patient. An electrical probe passes through the catheter in the subclavian vein, the process is monitored by ultrasound. If this is not possible, the doctor may take an x-ray. The echocardiogram records a rise in the ST interval.

The epicardial device is used only on an open heart during surgery.

Intraesophageal installation is performed to eliminate supraventricular arrhythmias.

The process of attaching a permanent pacemaker

The operation takes place under local anesthesia. The cardiac surgeon adheres to the following algorithm of actions:

• An incision is made in the subclavian region, and an introducer is installed.
• Electrodes are passed through the subclavian vein to the heart chamber. All actions are monitored by X-ray equipment.
• The electrode is placed on the wall of the heart chamber in the right atrium and ventricle.
• After fixation, a test of various excitability thresholds is performed, which should lead to contractile movements of the heart.
• If the surgical intervention is successful, as confirmed by the ECG, then a pocket is made in the subclavian region and a housing with a pacemaker is installed.
• Once the device is placed in the pocket, the electrodes are secured, and the incision is sutured.

The procedure can last up to 3 hours. It depends on how long the device is installed. A single-chamber stimulator is attached within 30 minutes, a two-chamber one will take 1-1.5 hours, a three-chamber one will take 2.5-3 hours.

Recovery and rehabilitation period

In order for the device to take root well and not cause inconvenience, the recommended rehabilitation after installation must be strictly followed:

• Observation by a cardiologist and ECG are performed every six months.
• During the first 1.5 months after surgery, the electrode head is encapsulated in tissue. Psychological rehabilitation requires approximately the same amount of time.
• You can return to light work after 1-1.5 months, but not earlier.
• It is forbidden to lift weights exceeding 5 kg, as this may cause the seams to separate. Difficult homework should also be avoided. For mild cases (for example, washing dishes), you need to listen to how you feel and, if necessary, postpone the task until the condition improves.

Features of the first week after surgery

It is recommended to protect the wound from moisture, dust and dirt for several days. You are usually allowed to get out of bed on the second day. If healing is good, water procedures can be performed on the fifth day. They are usually discharged home after a week.

At first, physical activity that falls on the chest, shoulders or arms is prohibited. It is advisable to abstain from it for about 3 months. It is not recommended to suddenly raise the arm under which the stimulator is installed and move it to the side.

Rehabilitation after a month

Patients with a pacemaker are prohibited from heavy physical activity; however, long walks, swimming pool exercises, tennis, and golf are recommended. Depending on the state of health, the scope of activities may expand in the future. At first, it is recommended to visit a doctor every three months, then once every six months or a year.

Usually sick leave is given for a month. If the device is installed after a heart attack, the vacation may be extended. After surgery there are often painful sensations in the field of device localization.

Features of life after surgery

After installation, certain restrictions appear:

• In everyday life, you should avoid putting pressure on the area where the stimulator is embedded. Injury to the sternum is unacceptable; this can lead to damage to the device or to displacement of the electrodes.
• When using household appliances, you should maintain a certain distance from it (usually 30 cm) and monitor your condition. Regarding welding equipment, the following rule: it is not allowed to come closer than 60 cm to a device up to 160 Amps. If the indicator is higher, then the distance should be at least 2.5 m.
• When choosing a profession, it should be remembered that the patient cannot occupy the following positions: welder, electrical engineer, electrician, loader.
• Contact with electromagnetic sources must be avoided.
• When using mobile phones, it is recommended to place it on the side opposite the stimulator, at least 30 cm from it. You should also not wear the product on your body; it is better to place the device in a briefcase or purse.
• It is not recommended to expose the area with the installed pacemaker to direct sunlight; it must be covered with a T-shirt or towel.
• Patients are not recommended to bathe in ice water.
• When repairing a machine, do not touch live wires.
• Living with a pacemaker involves taking sedatives of natural origin.
• It is necessary to limit the amount of table salt and liquid in the diet. Only lean meat is allowed; it is better to exclude spicy foods, smoked meats, chocolate, flour products, alcohol, fatty meats and fish.

Restrictions in the medical field

Patients with a pacemaker are not allowed certain examinations and physical procedures, such as:

• MRI. In some cases, the model allows tomography with a certain risk.
• Physiotherapy and cosmetic manipulations using magnetic radiation or electric current. These include geothermal therapy, electrophoresis, heating, magnetic therapy, and electrical nerve stimulation.
• Ultrasound, if the beam is directed to the device.

Restrictions on playing sports

After 3 months have passed from the date of surgery, if everything goes smoothly, minor physical activity is allowed.

Sports in which there is a high risk of a blow to the sternum or pacemaker remain prohibited. Extreme types of activity, sparring, and activities with a heavy load on the upper body are also unacceptable.

It is better to give up basketball, football, hockey, rugby, skydiving, martial arts, boxing, and shooting.

Flying and the pacemaker

It does not pose a danger to humans, which cannot be said about the frame of the metal detector, where a magnet with a closed circuit is placed. Its impact can damage the device or interfere with its operation.

Therefore, before air travel, it is necessary to register as a disabled person when purchasing a ticket and warn about the presence of ECS.

When passing through the frame, you must notify security by presenting the patient's passport. In this case, a personal search may be used, but if a document is presented, a metal detector will not be used, which is very important for health.

Complications after surgery

In the first week, unpleasant sensations may appear in the implantation area; in addition, the following may appear:

• Hematomas.
• Bleeding.
• Swelling.
• Phlebitis or thrombophlebitis.
• Changing the position of the electrodes.
• Inflammation, infection of a postoperative wound.
• Damage to blood vessels.
• Thromboembolism.
• Pneumothorax.

Complications appear no more often than 5% of cases. To relieve pain, analgesics can be used. To prevent blood clots, acetylsalicylic acid is prescribed. Antibiotics are prescribed to prevent infection.

Sometimes, after a certain time after surgery, other complications arise:

• Swelling of the limbs on the side where the device is located.
• Inflammation of the cardiac chamber with the electrode located.
• Offset the device side.
• The appearance of atrioventricular fistula.
• Endocarditis.
• Thrombus formation in the atrium.
• The effect of an electrical impulse on the chest muscles or diaphragm. This usually occurs when the device is installed incorrectly or is damaged.
• Older people may experience increased fatigue during physical activity.

The risk of such complications is also low, they occur in 6-7% of patients with a pacemaker.

Getting a disability

If the device is installed for a severe form of heart failure, the patient is immediately assigned a disability group, usually 2 or 3. Only a medical social examination can determine it accurately.

In general, the presence of the product implies correction of arrhythmia, so if the device works effectively, then disability is not provided. However, you can appeal this decision by submitting documents for examination.

The following factors will be considered:

• The patient's ability to perform previous work activities.
• The need for light work, a change in qualifications due to the presence of illness.
• Efficiency of the operation, operation of the device.
• Presence of complications.
• The degree of patient dependence on the device.

If the commission decides to assign disability, a second or third group may be appointed on a temporary or permanent basis.

Replacing components or the pacemaker itself

Current devices can operate on average from 7 to 9 years, with a warranty period of about 5 years. After the battery is discharged, the pacemaker needs to be replaced. If the electrodes are working, then they are not removed, but only the electrical pulse generator is removed.

When a device breaks down prematurely, it is sometimes replaced under warranty, unless it broke down through no fault of the patient.

According to emergency indications, the device is replaced if a breakdown, critical discharge or suppuration occurs. In other cases, a planned manipulation is carried out, and when the doctor says it is necessary to replace the device, it can serve perfectly well for several more months.

The operation is performed under local anesthesia with a minimum amount of time.

The effect of the device on life expectancy

Typically, patients with installed pacemakers live no less than the average person without devices. In addition, after attaching the pacemaker, the patient is protected from the occurrence of heart diseases that accompany a person during aging.

The device may also be useful in cases of hypothermia, when the risk of spontaneous cardiac arrest is high.

Life expectancy can be measured in decades only if recommendations are followed, timely examinations and replacement of the device.

How to determine if a pacemaker is working correctly

To understand that the device is working correctly, certain measures are carried out in medical institution. The monitor monitors the heart rate according to a given rhythm. Vertical bursts are accompanied by ventricular complexes. Frequency disturbance occurs when the battery is discharged.

Contractility is also clearly visible from the pulse in the area of ​​the ulnar artery.

If the rhythm is higher than the set one, then the tone of the vagus nerve is reflexively increased. To do this, massage the carotid area or perform a Valsalva maneuver with a period of straining while the respiratory reflex is delayed.

A patient at home should be alert to changes in heart rate, dizziness, fainting, swelling, pain or redness at the implant site.

The main danger is the failure of the pacemaker, which can lead to sudden death. The condition is accompanied by malaise, dizziness, and nagging pain.

Price issue

The device can be implanted on a quota basis or on a paid basis. The total amount includes the price for being in the ward, the cost of a pacemaker, electrodes, and the operation itself. The amount of payment is influenced by the qualifications of the doctor, the type of surgical intervention (on a closed or open heart), the type of device, the time of stay in the cardiology center and the rehabilitation period.

A lot depends on the material and functionality of the device.

The cost of electrodes is 2-4.5 thousand rubles. when choosing domestic products, and imported ones will cost 6,000 rubles. and higher. The cost of the operation itself ranges from 7.5 to 10 thousand rubles.

The price of stay and the number of days in the clinic are determined individually depending on the location of the center and the characteristics of the patient’s pathology and recovery period. Based on these data, we can say that the cost of the operation will cost from 20 to 500 thousand rubles.

Obtaining a quota for installing a pacemaker

Not all patients have the money to undergo the operation, so many wait their turn to receive a free device implanted. This procedure is carried out according to the federal and regional quota.

Now many surgical interventions in Russia they are produced free of charge. In the capital, single-chamber devices are installed under the Health Insurance Policy, 2-3-chamber devices are installed at the expense of Moscow.

Quota installation involves implanting a preferential stimulator that is available.

To receive benefits, you must first consult with a local cardiologist, then with the head physician. With all analyzes and conclusions, you need to contact the city health department, where they will consider the issue of quota distribution.

If you cannot get the required permit there, you can send a request to the regional Ministry of Health.

An artificial pacemaker is a lifesaver for many patients with heart disease. Their lives are literally divided into the time before and after the operation.

The attending cardiologist will tell you what kind of device the patient needs, he will also give directions and help you sign up for a quota to receive a free device.

In order for the device to last a long time, it is necessary to follow the doctor’s recommendations, do an ECG on time and undergo medical examinations. Replacement is usually needed after 7-10 years of wear, and the life expectancy of patients with a pacemaker is no less than that of healthy people.

The operation to install a pacemaker occurs under local anesthesia and lasts about 40–60 minutes. When the patient has already been given a heart pacemaker, he is taken to the intensive care unit and left here for 2 - 2.5 hours, after which several tests are performed, an x-ray is taken and, if all is well, the patient is taken to the general ward, where he will undergo the following 10 days.

How is a heart pacemaker placed - for arrhythmia, sick sinus syndrome, blockades and other diseases? The pacemaker is placed over the shoulder (under the collarbone), above the left or right breast, in one of the least mobile areas human body, which allows you to avoid kinks and, as a result, frequent breakdowns of the electrodes (wires) of the pacemaker.

The pacemaker can be re-installed on the same side (after removing the old device) with the same or new electrodes (up to 5 electrodes can remain in the blood vessel at the same time). A pacemaker for the heart can be placed on the opposite side, or even in the abdominal cavity - the implantation site is chosen by the doctor.

The procedure for installing a pacemaker is identical for men and women, children, adults and the elderly. The operation is usually performed under local anesthesia, although a pacemaker can be installed under general anesthesia. In specialized centers (cardiology, thoracic surgery) and large hospitals, pacemakers are installed almost on the fly.

What is a pacemaker and how is it implanted?

An electric pacemaker (PAC) or an artificial heart pacemaker (driver) is a device for maintaining the heart rate at a level not lower than a predetermined one. As a rule, for healthy person The norm is heart rate (heart rate) at the level of 70 - 80 beats per minute, for athletes and athletes this value can be lower - and be up to 54 - 60. At the same time, the heart rate should never slow down more than 3 s between heartbeats.

When the heart rate drops below 54 or the interval between contractions reaches 3 seconds or more, installation of an pacemaker is recommended. My heart rate dropped to 26 beats per minute (at night), and the time between contractions reached 5 seconds. With this, I ended up having an operation to implant a pacemaker.

The pacemaker is implanted under local anesthesia (in some cases, general anesthesia may be required) - in my case, if my memory serves me correctly, a drug based on novocaine was used. But a lot depends on availability allergic reactions. First, a painkiller is injected (I had to inject it 3 or 4 times: I worked out for a long time in gym- more than 10 years, since 2005 - and, as it turned out, it pumped up the pectoral muscles quite well: in several layers, each of which required “chipping”).

If the anesthesia is not enough, it is injected again. Possible pain during the operation: pain and burning - you need to inform the surgeon about this, and they will give you an additional injection of painkiller. The operation itself consists of several stages:

incision of the skin and subcutaneous tissue, muscle tissue; cutting out a hollow under the pacemaker (a small piece of meat is physically removed); moving electrodes through the veins to the heart and fixing them here; testing the operation of electrodes; pacemaker implantation and suturing.

How long does the surgery to install a pacemaker take?

The operation itself to install a pacemaker lasts 40 - 60 minutes, in my case it took about 45 minutes. This includes the time for treating the incision site with an antiseptic and applying sutures. The operation is considered as a minor surgical intervention, but at the same time, it is classified as heart surgery and is included in the list of medical services covered by the compulsory medical insurance policy or performed according to quotas (but not always - there are bureaucratic snags).

After the operation, I was placed for 2 hours next to the intensive care unit (there were no places here - they were all occupied by patients with a more real threat to life). After about one and a half to two hours, an electrocardiogram (ECG) is taken and an x-ray is taken. After which, if all is well, the patient is transported to the general ward.

How is a pacemaker installed from the patient’s point of view?

Nothing was required of me - just lie still. The operation was carried out under local anesthesia, the head was asked to turn in the direction opposite to the implantation site - and throughout the operation I watched a monitor with data on my blood pressure and heart rate. There was music playing in the background (which characterizes the complexity of the operation as not very high).

So that I could not see the incision and the progress of the operation, even turning my head or squinting (if I had such a desire), a bar was installed above my neck, and a towel was hung on it - as a result, I did not see anything that was happening “below” the chin. Thus, my entire participation in the operation came down to observing the monitors (I even saw an x-ray of how the electrodes were being pushed towards the heart - already on the second monitor that appeared in my field of vision at the final stage).

It was also my responsibility to inform the surgeon if I felt pain at the incision site. Actually, a slight pain, burning, pressure and, when the first impulses were sent through the electrodes, a strange, non-painful sensation, as if a current was running through the veins - that’s all I felt. In the first two hours after the operation, I also felt that something was touching my heart (electrodes) - this feeling persisted, gradually fading, for a couple of days after the operation.

Overall, the operation was completely painless for me. And, as I later learned, this is the case for the vast majority of patients. However, with me, the man spent the night in the intensive care unit after the operation (he did not appear in the ward since the evening when he was taken to the operation - and showed up the very next day, however, he remained in good spirits). Doctors consider the operation to be a stream operation and told what kind of recent years 10 there was not a single case of failure.

And here is how to live with a pacemaker:

Pacemaker Insertion

Description

The procedure is performed to install a pacemaker. A pacemaker is a small, battery-powered device that helps maintain normal heartbeats by sending electrical impulses to the heart.

Reasons for installing a pacemaker

A pacemaker may be installed in the following cases:

The body's natural pacemaker, the sinoatrial (SA) node, does not work properly. When the SA node is not working properly, the heart may beat too slowly; There is a malfunction of the atrioventricular (AV) node, the part of the heart's electrical system that sends signals from the SA node to the ventricles. This results in a very slow heartbeat; Heart function should be improved in people with severe symptoms of congestive heart failure and weakened heart muscle (cardiomyopathy); After heart surgery.

Possible complications of pacemaker installation

Complications are rare, but the procedure is not guaranteed to be risk-free. If you are considering a pacemaker, your doctor will review a list of possible complications, which may include:

Heavy bleeding; Infection; Pacemaker malfunction; Rupture of the heart muscle (rare); Stimulation of the diaphragm (the large muscle between the chest and abdominal cavities) is unnecessary in this case.

Factors that may increase the risk of complications:

Obesity; Smoking; Excessive alcohol consumption; bleeding or blood clotting disorders; Taking certain medications regularly.

You should discuss these risks with your doctor before the procedure.

How is a pacemaker installed?

Preparation for the procedure

Before the procedure, the doctor may prescribe:

Blood tests; Radiography chest- a test that uses X-rays to take pictures of the structure inside the breast; An electrocardiogram is a test that records the activity of the heart by measuring the electrical current through the heart muscle.

A few days before the procedure:

Consult your doctor about any medications you are taking. In the week before surgery, you may be asked to stop taking certain medications: Anti-inflammatory drugs (such as aspirin); blood thinners such as clopidogrel (Plavix) or warfarin (Coumadin); Eat a light meal the night before your procedure. Don't eat or drink anything after midnight.

Anesthesia

Local anesthesia will be used. This means that only the surgical area will be numbed. Anesthesia is given by injection.

Description of the pacemaker installation procedure

You will lie on a hard table. Heart rate will be monitored, blood pressure and breathing. The doctor makes a small incision under the collarbone. A pacemaker will be inserted through this incision. The wires are led through a vein under the collarbone to the heart. Once installation is complete, the cut will be closed with stitches.

Immediately after the pacemaker procedure

Heart rate and blood pressure will be monitored.

How long will it take to install a pacemaker?

About 2 hours.

Installing a pacemaker - will it hurt?

Anesthesia will prevent pain during surgery. You may experience pain and tenderness after surgery. Your doctor will give you pain medication to reduce discomfort.

Care after pacemaker installation

Before leaving the hospital, the pacemaker will be programmed according to your pacing needs. When you return home, follow these steps to ensure a normal recovery:

Ask your doctor when it is safe to shower, swim, or expose the surgical site to water; Once you feel normal, you can return to your daily activities. This may take about two weeks; Avoid strenuous activities, especially those involving the upper body, for 4-6 weeks; Avoid excessive arm/shoulder movement on the pacemaker side for two weeks. This will help prevent the wires from moving; Do not drive for one week after surgery; The stitches will be removed within one week; Procedures to avoid after pacemaker insertion: MRI; Heat therapy (often used in physical therapy); High-voltage or radar technology (for example, electric arc welding, high-voltage wires, radar installations or smelting furnaces); Radio and television transmitters; Do not carry your mobile phone in your pocket directly above the device. In addition, headphones and MP3 players near the pacemaker may cause interference; Turn off your car or boat engine when working around it. (They can confuse the device); Tell your doctor and dentist that you have a pacemaker; Consult a physician regarding the safety of passing through airport security detectors with your device; Be sure to follow your doctor's instructions.

A hard ridge may form on the skin along the incision, which usually resolves as the wound heals.

Contacting your doctor after having a pacemaker installed

After leaving the hospital, you should consult a doctor if the following symptoms appear:

Signs of infection, including fever and chills; Redness, swelling, strong pain, heavy bleeding or any discharge from the incision; Pain that does not go away after taking prescribed pain medications; Cough, shortness of breath, chest pain; Heartbeat disorders; New painful symptoms.

If a life-threatening situation arises, you should immediately seek medical help.

A pacemaker (Pacemaker) is a small device that generates electrical impulses to cause the chambers of the heart to contract in a specific pattern. In other words, it is an artificial pacemaker that synchronizes the work of the atria and ventricles. The purpose of its implantation is to replace the lost function of the natural source of electrical impulse - the sinus node.

Most often, surgery to install a pacemaker is performed when the sinus node has failed. The second option is the appearance of a block in the conduction system of the heart.

Purposes of pacemaker installation

Pacemakers are divided into temporary and permanent. The first ones are used when a short-term problem with the heart occurs, for example, arrhythmia appears against the background of acute myocardial infarction. If heart rhythm disturbances have become chronic, then a permanent CS is established. There are absolute and relative readings to implantation of pacemakers for long periods.

Absolute readings:

Sick sinus syndrome;

Symptomatic sinus bradycardia;

Tachycardia-bradycardia syndrome;

Atrial fibrillation with sinus node dysfunction;

Complete atrioventricular block (third degree);

Chronotropic incompetence (a condition in which the sinus node does not respond adequately to physical or emotional stress; even with maximum physical exertion, the heart rate does not exceed 100 beats per minute);

Long QT syndrome;

Cardiac resynchronization therapy with biventricular pacing.

Relative readings:

Cardiomyopathies (hypertrophic or dilated);

Severe neurocardiogenic syncope.

Back in 1958, cardiac surgeon Ake Senning was the first to implant a CS in a human. Since then, the installation of a pacemaker has been considered the treatment of choice for the treatment of bradycardia and heart block. The number of operations performed is steadily growing. For example, the annual increase in implantation of conventional pacemakers in England is 4.7%, and cardiac defibrillator implantation - 15.1%.

treat sinus bradycardia

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Types of pacemakers

“Adaptation” to each type of heart rhythm disturbance prompted the development of various types of pacemakers and their modes of operation. All modern CS are capable of sensing the internal electrical activity of the heart and stimulating it only when the heart rate drops below a programmed level. Essentially, they all have a built-in “sensor” that senses the need to change your heart rate in response to physiological needs.

For permanent cardiac pacing, three types of devices are used:

● single-chamber (PM-VVI): the electrode is placed either in the right ventricle or in the right atrium;

● two-chamber (PM-DDD): two electrodes are installed (in the right ventricle and in the right atrium), this is the most common type of CS;

● three-chamber (PM-BiV): used in so-called cardiac resynchronization therapy. As a rule, one electrode is implanted in the right atrium and in both ventricles. These pacemakers are usually installed in patients with chronic heart failure. They are able to “resynchronize” the work of the ventricles, which helps improve the pumping function of the heart. They are also called biventricular pacemakers. Cardiac resynchronization therapy may include implantation of a cardioverter-defibrillator.

Implantation technique

How is surgery to install a pacemaker performed? The procedure is performed in a specially equipped operating room under local anesthesia (general anesthesia is rarely used). It belongs to the category of minimally invasive surgical interventions.

Transvenous access to the chambers of the heart is used. That is, the wires (electrodes) coming from the pacemaker are placed intravenously.

To do this, the subclavian vein is most often catheterized. After which a small incision (3.8 - 5.1 cm) is made in the subclavian region, where a subcutaneous pocket is created where the pacemaker is implanted. Less commonly used for this purpose is the lateral saphenous vein hands. Very rarely, access to the chambers of the heart is used through the axillary, internal jugular or femoral veins.

The guide catheter(s) are then inserted through a puncture in the vein into the right atrium. If necessary, a second catheter is sent along the same route and installed in another chamber. Or a puncture in another vein is used for this. After which the electrodes are directed through the conductors into the chambers of the heart.

Electrodes are attached to the endocardium (the inner lining of the heart) in two ways. Passive fixation - at the end of the electrode there is a hook that “clings” to the endocardium. Active fixation - using a special fastening resembling a corkscrew, the electrode is screwed into the inner shell.

At the end of the procedure, specific tests are done to ensure the reliability of the installed pacemaker. Self-absorbing sutures are placed on the skin, and the arm is immobilized with a bandage for 24 hours.

How long the operation to install a pacemaker lasts will be influenced by its course and possible force majeure circumstances during the procedure. The CS implantation procedure itself, as a rule, does not exceed 3 hours. The duration of hospitalization is usually 24 hours.

Prevention of infectious complications with antibiotic therapy is mandatory. Cefazolin 1 g is usually prescribed. One hour before the procedure or alternatively 1 g of vancomycin in case of allergy to penicillin and/or cephalosporins. The day after implantation, chest x-rays are performed to ensure that the electrodes and pacemaker are correctly positioned and that there are no possible complications (for example, pneumothorax).

To learn how to install a pacemaker, watch this video:

Complications

Naturally, many patients, worried about future intervention in the body, think about how dangerous the operation to install a pacemaker is. Although CS implantation is considered a minimally invasive procedure, there is still a possibility of complications occurring both during and after the operation. In large clinics with extensive experience in performing implantations, the rate of early complications, as a rule, does not exceed 5%, and late complications – 2.7%. The mortality rate ranges from 0.08 - 1.1%.

Fistula in the area of ​​pacemaker implantation

Early complications:

Bleeding (formation of hematomas in the pocket where the CS is installed);

Thrombophlebitis and phlebitis;

Electrode displacement;

Infectious inflammation in the implantation area;

Pneumothorax;

Hemothorax;

Infarction of the area of ​​the heart wall where the electrode is fixed;

Anaphylaxis;

Air embolism;

Device malfunction.

Late complications:

pocket erosions (destructive changes in the tissues around the joint); electrode displacement; phlebitis or deep vein thrombosis; systemic infection; atrioventricular fistula; device failure; endocarditis; thrombus formation in the right atrium.

Technological progress and improvement surgical procedures led to a significant reduction in the incidence of complications. Recovery after the procedure is usually quick. However, during the first two to four weeks there is pain and discomfort that limit mobility in the hand. Displacement of the electrodes, their separation from the place of fixation, is the most common problem that can arise after implantation.

Recovery period

Most people feel great, much better than before the procedure. Usually, on the second day after implantation, they can return to their daily lives in full.

How rehabilitation goes after surgery to install a pacemaker is also influenced by the patient’s behavior and compliance with the doctor’s recommendations, which include:

During the first 48 hours, it is necessary to avoid getting moisture into the postoperative wound.

If swelling, pain, or local warmth appears in the area of ​​the sutures, you should consult a doctor.

During the first 4 weeks, you must limit movement in the arm on the side of which the pacemaker is installed.

Further observation

People who have a permanent pacemaker should follow their doctor's recommendations and adhere to certain restrictions. The first examination is usually scheduled after 3 months, then after six months. The frequency of subsequent examinations is twice a year, provided there is nothing disturbing. If you experience fainting, dizziness, or your heart rate drops below the programmed level, you should visit a doctor earlier than planned.

Sometimes a problem can occur when the lead loses contact with the heart. This situation requires its replacement. As a rule, it is not removed from the vein, but is disconnected from the pulse generator. A new electrode is attached, which is first moved along the vein along the old one and fixed to the heart.

Battery Replacement

The energy source used in a permanent pacemaker has a limited lifespan (5 to 10 years). The battery is located inside the metal case of the device and is its integral part. Therefore, when its charge is depleted, a procedure is required to replace the pulse generator.

Under local anesthesia, a skin incision is made in the pocket area, the old device is removed (the electrodes are first disconnected), and a new one is implanted in its place. The operation of the new pacemaker is checked, after which stitches are placed. The patient is sent home on the same day.

To see what signal a pacemaker gives when its battery runs out, watch this video:

Cost of the procedure

The cost of installing modern pacemakers, not including their cost, can range from $3,500 to $5,000.

As a rule, the installation of a pacemaker significantly improves the patient’s quality of life if he suffers from arrhythmia, which is accompanied by severe symptoms of heart failure. These electrotherapeutic devices have proven themselves and have been used effectively for the past 60 years. Complications during their installation and further use are very rare.

The process of installing a pacemaker is not as complicated as it may seem. Today, such manipulation is equivalent to an operation to remove appendicitis. Patients have more questions about how to live after having an pacemaker installed, but the process of surgical intervention itself is also important.

A pacemaker (pacemaker) is an electronic device that is equipped with a special circuit and is capable of generating electrical impulses. For normal operation of the device, there must be sufficient charge of the battery built into its small body. Thin electrodes extend from the pacemaker, which during surgery are applied to one, two or three chambers of the heart.

Every year, about 300 thousand pacemakers are implanted around the world, which makes it possible to prolong the lives of patients suffering from severe cardiac disorders.

There are pacemakers various types. Most often, single-chamber and double-chamber ones are installed, with and without frequency adaptation. Before the operation, the patient is necessarily examined and the indications for implantation are determined, which can be absolute and relative. Most often, an pacemaker is installed for bradycardia, atrioventricular block, and sick sinus syndrome.

Video Pacemaker implantation

Stages of pacemaker implantation

1. Local anesthesia is administered, which is sufficient to perform a minimally invasive operation lasting 40-60 minutes. In rare cases, general anesthesia is performed.
2. A small incision is made above the left or right pectoral muscle through which electrodes are inserted into large vessels.
3. Using X-ray examination, the electrodes are installed at one end in the cardiac cavity, and the other is attached to the device.
4. The pacemaker is placed in a small niche made above the pectoral muscle.
5. A small test of the implanted device is carried out.
6. Sutures are placed at the incision site.

The pacemaker can be installed on both the right and left sides. Also, depending on the indications, the localization of the device in the abdominal cavity can be selected. The final decision on the location of the device is made by the attending physician.

The area of ​​the pectoral muscle is the most immobile in the human body, therefore, when installing the pacemaker in this place, bending and breakage of the electrodes can be avoided.

Re-implantation of a pacemaker is possible both in the same place and in a new, more suitable one. The old device must be removed first. New electrodes can be installed or old ones can be connected. In the latter case, the total number of those in blood vessel electrodes should not exceed five pieces.

Duration of surgery to install a pacemaker

The operation is increasingly moving to the level of a minimally invasive procedure, as a result of which the time it takes is an inconspicuous 40-60 minutes. The fewer complications during implantation, the faster it goes. However, the operation time depends a lot on the type of pacemaker:

• single-chamber installation takes approximately 40-60 minutes;
• two-chamber - approximately 1.5 hours;
• three-chamber - up to 2.5 hours.

The most time from the entire operation is spent on antiseptic treatment and suturing, but in large-scale clinics, even these manipulations take a minimum of time.

After surgery, the patient usually spends several hours in the intensive care unit. If there are no places in it, they can be placed in the ward closest to it. In the absence of any complications, x-rays and electrocardiography are performed. A patient with a normal course of the postoperative period is sent to the general ward after approximately 2-3 hours. In the future, you need to strictly adhere to the doctor’s recommendations and undergo timely examinations, which will extend the life of the device, and therefore significantly improve the patient’s quality of life.

What should a patient know about pacemaker implantation?

There are several features that patients who are preparing for pacemaker implantation should be aware of. In particular, during the operation you need to lie still and, as a rule, look in the direction opposite to the surgical field. Some clinics play pleasant music to make the patient more comfortable.

The surgical field is often completely fenced off from the patient's field of vision. For this purpose, a special partition is used, on which a towel is hung. Therefore, even turning your head or squinting your eyes, you will not be able to see the progress of the operation or the incision. Thus, most often you have to look at monitors or watch x-rays, which are used to move electrodes through the vessels.

It is often the responsibility of a patient undergoing pacemaker surgery to inform the doctor about any discomfort that often occurs at the incision site. In most cases, a burning sensation and pressure are felt, and after connecting the electrodes, there may be a feeling that current is running through the veins. But this manifestation gradually disappears after a few days.

It is important to remember that the vast majority of patients note that the surgery to implant a pacemaker is absolutely painless. In extremely rare cases, it may occur early complications: bleeding, thromboembolism, postoperative wound infection. Some patients experience long-term complications in the form of pacemaker tachycardia, pacemaker syndrome, and premature failure of the pacemaker. But at the same time, many doctors assure that there are practically no unsuccessful operations, so this procedure is considered a stream procedure.

Pacemaker replacement surgery

Regular examinations by a cardiologist allow you to timely determine a decrease in the charge of the pacemaker. This often happens when the battery life is approaching the end, then during the next test the device emits a signal. Also, an indication for replacing the pacemaker is inflammation in the implant area and its breakdown.

To replace the device, surgery is performed under local anesthesia. The electrodes may remain old, but it is better if they are replaced with new ones. Today, bipolar ones are increasingly used, which are considered more durable and reliable. With proper attitude towards the device on the part of the patient, it is possible to lead a better quality of life for 7-10 years.

If you have been diagnosed with heart problems that could be fatal, do not despair. Modern medicine Today, you may be offered to install an assistant to resume normal cardiac activity.

For many patients, living with an implant may seem like a challenge, but this little device will give you a chance at a new life. You will be able to go to work, play sports, walk with your children as before - everything that you did before and that brought you positive emotions.

Qualified cardiologists will tell you how to behave correctly after surgery. In the article you will learn all the intricacies of choosing and installing a device, as well as side effects and how to eliminate them.

Unfortunately, over time, a person does not become younger. Every year they appear and appear after a certain period of time various diseases. With each passing year, each person begins to notice the appearance of certain complaints: there is a stomach ache, there is a “shot” in the knee, there is a “jammed” back.

But the most common thing that causes anxiety in the patient is probably the appearance of pain in the heart, or the feeling of its normal functioning. At the same time, sometimes no special research methods are required. People themselves note these disturbances and characterize them as “interruptions in the heart,” perhaps this is where the expression “heart is acting up” came from.

Currently, thanks to the development of medicine, it has become possible to study the mechanisms of these disorders and appropriate treatment. One of the options for correcting these disorders and the possibility of restoring lost function is the installation of an electrical pacemaker (pacemaker).

The modern device is a complex device in a sealed housing made of a special inert medical titanium alloy with small dimensions. The case itself contains a battery and a microprocessor unit.

Modern stimulators are guided by the heart’s own electrical activity; when contractions slow down, are disrupted, or a pause occurs, within a programmed time, the stimulator begins to generate an electrical discharge to stimulate myocardial contractions.

And if there is a normal rhythm of impulses, the pacemaker does not generate these impulses. These are so-called “on-demand” stimulants. Currently, there are several types of pacemakers. There are single-chamber, two-chamber, three-chamber.

A pacemaker is a small device, about the size of a half dollar, placed under the skin near your heart to help control your heartbeat. The pacemaker is introduced as part of what is often referred to as "cardiac resynchronization therapy."

People may need a pacemaker for a number of reasons - mainly one group of conditions called arrhythmia, in which the heart's rhythm is abnormal.

• Normal aging of the heart can disrupt your heart rhythm, causing it to beat too slowly.
• Heart muscle injury resulting from a heart attack is another common cause disturbances in your heartbeat.
• Some medications may also affect your heart rate.
• For some, hereditary diseases are the cause of irregular heart rhythms.

Regardless of the root cause of the irregular heart rhythm, a pacemaker will help you fix it.

Today, there are such types of pacemakers as single-chamber, two-chamber and three-chamber.

1. Single chamber pacemaker

Single-chamber pacemakers appeared first, initially pacing at a given frequency, but models soon appeared that sense the heart's own activity and operate as needed. A single-chamber pacemaker is equipped with one electrode installed in one chamber of the heart (ventricle).

2. Dual chamber pacemaker

The next generation pacemaker is a dual-chamber pacemaker. The peculiarity of this model is the presence of two electrodes, which ensures synchronous contraction of the ventricles and atria and, as a result, stimulation becomes physiological, significantly increasing the patient’s functional capabilities.

The electrodes of a dual-chamber pacemaker are installed in the ventricle and atrium. An example of such effective devices can be Medtronic pacemakers, and these are the models that the Cardiodom clinic uses.

The Medtronic pacemaker is a reliable device that can provide the highest quality of life to the patient for many years. The latest developments of pacemakers operating in a dual-chamber mode are capable of detecting the presence of atrial fibrillation and atrial flutter in a patient and automatically switching to another, safe (single-chamber) stimulation mode - the so-called “switch mode”.

Thus, the possibility of maintaining supraventricular tachycardia is excluded.

3. Three chamber pacemaker

These EX models are among the most modern and high-tech. Unlike a two-chamber pacemaker, there are already three electrodes that stimulate contractions of the three parts of the heart in a certain sequence.

A pacemaker or cardioverter-defibrillator of this type can be placed in a patient with the most dangerous form arrhythmias (ventricular tachycardia and ventricular fibrillation) or for the prevention of sudden cardiac death.

Thus, today there are Various types pacemakers, which allows you to select best option in each specific case. By installing a pacemaker with appropriate characteristics, we can confidently say that the quality and life expectancy of the patient will increase significantly. You can read more detailed information in the section “Main types of pacemakers.”

Electrodes used in ECS are of two types - models with active and models with passive fixation. Active fixation involves attaching an electrode inside the heart using a special attachment that resembles a bottle opener. Passive fixation is carried out using special antennae at the end of the electrode.

Indications for surgery to install a pacemaker are the following conditions:

• bradycardia with clinical manifestations (pulse less than 40 beats/min);
• bradycardia accompanied by Morgagni-Adam-Stokes syndrome (MAS);
• severe disturbances of myocardial contractile function during physical activity;
• a combination of increased and decreased heart contractions;
• insufficient increase in heart rate under load and sufficient contraction of the myocardium at rest (chronotropic competence);
• carotid sinus syndrome;
• atrial fibrillation (pacemakers are indicated for atrial fibrillation);
• A-B blockade 2-3 degrees;
• incomplete blockade;
• sick sinus syndrome (SSNS).

A pacemaker can be installed permanently, but a temporary pacemaker can also be used. The indications for the use of this device are varied, for example, an external pacemaker can be installed for diagnostic or preventive purposes, as well as in preparation for surgery to install a permanent pacemaker.

In addition, the use of a temporary pacemaker is advisable in cases where it is necessary to correct any condition - paroxysmal tachyaarthymia, bradycardia due to CVS or acute infarction.

An external pacemaker consists of oversized electrodes placed on the heart area on the anterior surface of the chest and between the left shoulder blade and the spine in the projection of the heart.

For those who need a pacemaker, there are practically no contraindications; the only contraindication to installing a pacemaker may be the unreasonableness of the operation. Studies have shown that the longer the arrhythmia lasts, the more difficult it is to restore normal sinus rhythm of the heart.

The use of a pacemaker for arrhythmia guarantees constant maintenance of such a rhythm - new generation devices recognize paroxysms and instantly stop them, preventing disorders from developing. Thus, a pacemaker for arrhythmia can be confidently called the most effective remedy.

The need for cardiac surgery can be emergency, when the patient’s life is impossible without an operation to install a pacemaker, or planned, when his heart can work independently for several months even with rhythm disturbances.

In the latter case, the operation is carried out as planned, and before performing it it is advisable to conduct a full examination of the patient.

IN different clinics The list of required tests may vary. Basically the following must be done:

• ECG, including daily monitoring of ECG and blood pressure according to Holter, which allows you to register even very rare but significant rhythm disturbances over a period of one to three days,
• EchoCG (ultrasound of the heart),
• Blood test for thyroid hormones,
• Examination by a cardiologist or arrhythmologist,
• Clinical tests blood - general, biochemical, blood test for coagulation,
• Blood test for HIV, syphilis and hepatitis B and C,
• General analysis urine, stool test for worm eggs,
• FGDS for exclusion peptic ulcer stomach - if it is present, treatment by a gastroenterologist or therapist is mandatory, since after surgery, medications are prescribed that thin the blood, but have a destructive effect on the gastric mucosa, which can lead to gastric bleeding,
• Consultation with an ENT doctor and a dentist (to exclude foci of chronic infection that can have a negative effect on the heart; if detected, foci should be promptly sanitized and treated),
• Consultations with narrow specialists, if available chronic diseases(neurologist, endocrinologist, nephrologist, etc.),
• In some cases, an MRI of the brain may be needed if the patient has had a stroke.

How to place a pacemaker

Now let's talk about how a pacemaker is placed. If you watch a video of how a pacemaker is installed, you will notice that the cardiac surgeon performs it under X-ray control, and the total procedure time varies depending on the type of implanted device:

• a single-chamber pacemaker will require half an hour;
• for a two-chamber pacemaker – 1 hour;
• A three-chamber pacemaker requires 2.5 hours to install.

Typically, surgery to install a pacemaker occurs under local anesthesia.

The operation to implant an pacemaker consists of the following steps:

1. Preparing for surgery. This includes debridement of the surgical site and local anesthesia. An anesthetic drug (novocaine, trimecaine, lidocaine) is injected into the skin and underlying tissues.
2. Installation of electrodes. The surgeon makes a small incision in the subclavian region. Next, the electrodes under X-ray control are inserted sequentially through the subclavian vein into the desired cardiac chamber.
3. Implantation of the pacemaker housing. The device body is implanted under the collarbone, and it can be installed subcutaneously or deepened under the pectoral muscle.

In our country, the device is more often implanted in right-handed people on the left, and in left-handed people on the right, which makes it easier for them to use the device.

4. The electrodes are connected to the already implanted device.
5. Device programming. It is produced individually to suit the patient’s needs, taking into account the clinical situation and the capabilities of the device (which also determine the cost of the pacemaker). In modern devices, the doctor can set the basic heart rate, both for the condition physical activity, and for peace.

Essentially, this is all the basic information about how a pacemaker is installed.

The operation to install a pacemaker can last from forty minutes to three and a half hours, depending on the type of device. IN general view any of the stimulators consists of an electronic circuit - a pulse generator and conductor electrodes.

The power source for the device is a battery, designed for an average of 7-8 years of continuous operation. To avoid rejection of the foreign body by the body, the circuit is placed in a titanium case.

The invasive intervention is performed by a cardiac surgeon under the control of X-ray equipment. The presence of an anesthesiologist is also mandatory, despite the fact that in most cases local anesthesia is used.

Direct implantation includes the following steps:

• tissue incision in the collarbone area;
• sequential insertion of electrodes through the subclavian vein into the corresponding parts of the heart;
• placing the stimulator body in the prepared bed;
• connecting electrodes to the body;
• individual setting of the device operating mode.

In order not to create discomfort in the patient’s daily life, modern devices are programmed in the “on demand” mode.

This means that the device delivers impulses until the heart begins to contract on its own in the desired rhythm, after which the device turns off - the next time it turns on when the organ stops sending a signal in a timely manner.

It is worth knowing that complications after installing a pacemaker occur in no more than 3-5% of cases, so you should not be afraid of this operation.

Early postoperative complications:

• violation of the tightness of the pleural cavity (pneumothorax);
• thromboembolism;
• bleeding;
• violation of insulation, displacement, fracture of the electrode;
• infection of the surgical wound area.

Long-term complications:

• EX syndrome - shortness of breath, dizziness, decreased blood pressure, episodic loss of consciousness;
• pacemaker-induced tachycardia;
• premature failures in the ECS.

Surgery to insert a pacemaker should be performed by an experienced surgeon under X-ray guidance, which avoids most of the complications that arise at an early stage. And in the future, the patient must undergo regular examinations and be registered with a dispensary.

If there are complaints about deterioration in health, the patient should immediately consult with the attending physician.

A pacemaker is a small electrical device that, once implanted in the body, is designed to artificially create electrical impulses and ensure regular heartbeats. In essence, this device is a customizable pacemaker, which, in the process of its operation, “imposes” the correct beat on the heart.

Installing a pacemaker is a rather serious and responsible step that requires good reasons. The process itself is invasive. The unjustification of implantation is the only contraindication to its implementation.

The decision about surgery is made on a strictly individual basis, depending on clinical picture the underlying disease, concomitant diagnoses, age, gender, lifestyle of the patient. However, there are a number of diagnoses, the formulation of which is an absolute indication for pacemaker implantation.

These include:

• bradycardia with severe symptoms - a decrease in heart rate to less than 50 beats per minute;
• complete heart block - discrepancy between the rhythms of the atria and ventricles;
• severe heart failure;
• some forms of cardiomyopathies, in which the resulting structural changes significantly affect the contractile activity of the heart.

Artificial pacemakers can be:

• single-chamber, regulating the functioning of only one part of the heart - the atrium or ventricle;
• two-chamber, perceiving and stimulating simultaneously two chambers of the organ;
• three-chamber, having a special device for the treatment of heart failure.

The development of science and technology has divided all pacemakers into frequency-adaptive ones, which automatically increase the frequency of generated impulses with increasing physical activity, and non-frequency pacemakers, which work in accordance with specified indicators.

The requirements of modern life have forced each of the devices, especially imported ones, to be equipped with many additional parameters and functions that allow the device to be maximally adapted to each patient.

A modern pacemaker is not just a heart simulator, it is a high-tech device that allows for multi-stage safety for the patient. The developers provide protection from interference, such as external electromagnetic or mechanical influence, protection from tachysystolic rhythm disturbances, etc.

Even in cases where the pacemaker battery cannot be replaced, which could cause death, key vital functions are identified and maintained in emergency mode. Programming is carried out in the proximity of a special programmer head and the device, which eliminates failures, reconfiguration or accidental interference with the operation of the device.

The main danger that interests patients is the failure of the pacemaker and, as a result, instant death. However, despite this possibility, the probability of failure is negligible. More precisely, a few hundredths of a percent.

Another thing is that the presence of an electronic device, albeit a high-tech one, requires a special attitude towards it, towards your rhythm of life and living conditions, and special attention during pregnancy. One more dangerous consequence The use of a cardiac stimulator may cause pacemaker syndrome.

Then implantation leads to a number of reasons that cause dizziness, nagging pain in the chest, malaise, or even pain in the jaws.

The operation of the stimulator changes the ECG picture. Artificial impulses lead to the fact that the ECG cannot reflect the real and objective situation and condition of the patient’s heart. In this regard, there are risks of untimely detection of such a dangerous disease as ischemic disease hearts.

A patient can receive a disability group due to a pacemaker, but the decision to assign a specific group is made collectively and requires a thorough analysis of the loss of performance. Modern pacemakers allow patients to feel good during pregnancy.

Pregnancy proceeds as usual, the only thing is delivery by caesarean section, and Special attention to the use of electrical tools and appliances. Pregnancy will be under the supervision of a physician who will rule out dangerous or harmful factors that could lead to serious consequences.

Basic laws of life with a pacemaker

Implantation of a pacemaker conventionally divides the patient’s life into “before” and “after”. The new rules after surgery include a number of requirements and restrictions, compliance with which should become the daily norm. Reviews from people who have been living with a pacemaker for several years generally indicate an increase in the quality of life after its installation.

Strict adherence to the instructions will avoid complications, side effects, painlessly and quickly adapt to new living conditions. Life with a pacemaker is divided into three stages, each of which has its own requirements:

1. First week after surgery

During this period the patient is in the hospital. Under the close supervision of the attending physician and medical personnel, the sutures heal.

It is important to keep the surgical wound clean and dry. The cardiologist takes regular measurements of heart rate.

In the absence of negative factors, on the fifth day after implantation it is already possible to take a light shower, and a week later the patient is discharged from the medical institution.

2. The first three months with the device

A person with a pacemaker is placed on a dispensary register. The first scheduled examination is carried out after three months. However, you should immediately consult a doctor if the patient feels unwell, dizziness, tachycardia, swelling or pain in the area where the device is installed, unreasonable attacks of hiccups occur, or any sound signals from the device are heard.

During this period, it is recommended to listen especially carefully to your body. The mode of life and work should be as gentle as possible. Lifting loads heavier than five kilograms is prohibited. Even light work should be done with the hand opposite the pacemaker area.

3. The remaining period before replacing batteries

Six months later, a follow-up examination of the patient is scheduled again; from this point on, the frequency of visits to the cardiologist is normally once every six months. Skipping scheduled procedures is prohibited. Even if the date of the examination coincides with the period of the business trip, you must find out in advance about the possibility of undergoing a scheduled consultation at local clinics.

If there are no warning factors, your doctor may gradually lift some restrictions. However, among them there are those that are permanent, regardless of the time after implantation of the pacemaker and the patient’s well-being.

Before leaving the hospital, the pacemaker will be programmed according to your pacing needs. When you return home, follow these steps to ensure a normal recovery:

1. Ask your doctor when it is safe to shower, swim, or expose the surgical site to water;
2. Once you feel normal, you can return to your daily activities. This may take about two weeks;
3. Avoid strenuous activities, especially those involving the upper body, for 4-6 weeks;
4. Avoid excessive arm/shoulder movement on the pacemaker side for two weeks. This will help prevent the wires from moving;
5. Do not drive for one week after surgery;
6. The stitches will be removed within one week;
7. Procedures to avoid after pacemaker insertion:

• Heat therapy (often used in physical therapy);
• High-voltage or radar technology (for example, electric arc welding, high-voltage wires, radar installations or smelting furnaces);
• Radio and television transmitters;

A hard ridge may form on the skin along the incision, which usually resolves as the wound heals.

Replacement of a pacemaker can be indicated both for emergency reasons (suppuration of the pacemaker bed, critical charge or breakdown of the installed device), and on a planned basis - if the pacemaker test reveals a depleted battery.

It is worth noting that pacemaker replacement is always performed under local anesthesia, even if the installation was performed under general anesthesia. The operation to replace a pacemaker takes a minimum amount of time, and after it the patient recovers as quickly as possible.

When a pacemaker is replaced, the operation is often also the least expensive. How much does it cost to install a pacemaker? How much will a pacemaker cost for atrial fibrillation, and how to choose the right model? You will find answers to these and other questions about pacemaker implantation below.

For those who need to install a pacemaker, cost plays a significant role. Of course, it is optimal to install the best pacemaker at an affordable price, and this option is quite possible. Where is a pacemaker installed inexpensively and with high quality? Of course, at the CardioDom clinic! What factors shape the total cost?

Installing a pacemaker in Moscow may not cost much at all - it depends, first of all, on what kind of pacemaker you plan to buy, as well as on the pricing policy of the clinic where the preparation for the operation, the operation itself, and the rehabilitation period will take place.

The Cardiodom Clinic offers to buy a pacemaker at the best price, and you can also count on the highest quality of medical care!

Depending on which generation of pacemaker you choose, the price may vary significantly. So, there are models of several categories:

1. category.

In this case, implantation of a pacemaker will be quite expensive, but we are talking about the best pacemakers that exist today.

These are imported models, the quality of workmanship is the best, many devices are characterized by the presence of a second sensor, a wide range of settings, the presence of a sleep mode, Holter monitoring, etc.

Thus, implantation of a pacemaker in this category means ensuring quality of life and health due to the high quality of the device. At the same time, it is worth remembering that by purchasing a pacemaker of this category, you get increased energy consumption of the device and, as a result, a shorter service life.

In addition, regardless of whether you are going to install a pacemaker in Moscow or in another city, its price will always be high.

2. category.

Buying pacemakers in this category is the best option in terms of cost and quality of the devices.

In this case, installing a pacemaker in Moscow will be much cheaper, although, of course, models in this category are somewhat inferior to models of the first category in terms of functionality, but are not inferior in reliability!

3. category. Outdated models. They are quite reliable, but they are inferior to models of the first two categories in functionality, appearance, and ease of use. The main advantage of this category is the minimum price.

1. Electrical devices

Although pacemakers are equipped with protection against interference from other electrical devices, strong electric fields should still be avoided. The use of almost all household appliances is allowed: TV, radio, refrigerator, tape recorder, microwave oven, computer, electric razor, hair dryer, washing machine.

To avoid interference, you should not approach the pacemaker implantation site closer than 10 cm to an electrical appliance, lean against the front wall of the microwave (and generally avoid it) or the screen of a working TV. You should stay away from welding equipment, electric steelmaking furnaces, and high-voltage power lines.

It is not advisable to go through control turnstiles in shops, airports, and museums. In this case, upon discharge from the hospital, the patient is given a device passport and an owner’s card, which must be presented during the search, after which it can be replaced by a personal search.

The KS is also not afraid of most office equipment. It is advisable to develop the habit of grasping appliance plugs and other voltage sources with the hand further away from the pacemaker.

2. Mobile phone

Long conversations on it are undesirable, and you need to hold the receiver 30 cm or more from the CS. When talking, hold the tube to the ear on the opposite side of the implantation site. Do not carry the handset in your breast pocket or around your neck.

3. Sport

It is prohibited to engage in contact and traumatic types sports, that is, team games, martial arts, since any blow to abdominal cavity or chest may damage the device. For the same reason, shooting with a gun is not recommended.

With a pacemaker, you can return to walking, swimming and such physical exercises that allow constant monitoring of your well-being and allow you to follow safety rules.

The area of ​​the body where the pacemaker was implanted should not be exposed to direct sunlight. It should be kept covered with some kind of cloth at all times. Also, don't swim in cold water. It is especially important for car enthusiasts to remember that they should not touch live wires while repairing a car or replacing a battery.

Validity period and how long they last with the device

On average, the lifespan of a pacemaker is determined by the capacity of the battery, designed for 7-10 years of operation. When the battery life is approaching, the device will give a signal during the next scheduled examination.

After this, you should replace the battery with a new one. Therefore, the question of how long people can live with a pacemaker also depends on the regularity of visiting the doctor. There is an opinion that, being foreign body, CS can harm a person. This is not at all true, despite the fact that often there is no alternative to installing it.

In order to continue a fully fulfilling life, you have to put up with only minor restrictions that are worth it. In addition, it can be installed completely free of charge.

You can often hear the question of how long people can live with a pacemaker, especially from those for whom such surgery is recommended. Medical practice shows that people with an implanted pacemaker, provided they follow all the doctor’s recommendations, live no less than other people. In other words, having a pacemaker can only prolong life, not make it shorter.

There is a misconception that sports and life with a pacemaker are incompatible concepts. This is not entirely true. There are a number sporting events and physical exercises, which six months after installation of the device are not only not contraindicated, but are also extremely beneficial for the cardiovascular system, namely:

• measured swimming without diving,
• hiking and race walking,
• gymnastics and yoga,
• golf,
• tennis.

The main rule in training should be moderation - you cannot overexert yourself and do something through force. Diving, rifle and shotgun shooting, powerlifting, as well as all contact sports during which the patient may receive a blow to the area of ​​the installed pacemaker are prohibited.

The number of workouts, their duration and feasibility should be agreed with the treating cardiologist.

A pacemaker is a device that responds extremely sensitively to changes in the surrounding magnetic field. This circumstance must be taken into account in life “after” implantation. Reviews indicate that among the electrical appliances that surround a person in everyday life, the most dangerous are a microwave oven, a TV, and a power tool (hammer, drill, jigsaw).

It is not recommended to approach these devices while they are running. As for the mobile phone, it also belongs to the risk group. Completely abandon this “good” in modern world It's unlikely to succeed. But you will have to minimize its use, as well as carry it not in your pocket, but in a bag or purse.

A heart pacemaker is an absolute excuse to avoid a metal detector test. However, in order to avoid awkward situations, you should have with you the passport of the owner of the pacemaker, which is issued upon discharge from the hospital.

Caution should also be exercised when passing medical examinations according to concomitant diagnoses. Some types of tests are prohibited for people with a pacemaker. Despite the fact that the fact of implantation is usually indicated in the patient’s medical record, it should be reminded of it when visiting any doctor.

In addition, the installation of the implant should be reported to all those who most often surround the patient, be it relatives or the workforce. This will make it possible to react promptly and correctly in the event of emergency situations in the work of the pacemaker.

Despite numerous positive reviews When thinking about living with a pacemaker, you should remember that an artificial pacemaker is by no means a new heart or a cure for disease. This is just an opportunity to live, observing the safety rules.

Further lifestyle with a pacemaker can be characterized by the following components:

• Visiting a cardiac surgeon once every three months during the first year, once every six months in the second year and once a year thereafter,
• Counting your pulse, measuring blood pressure and assessing your well-being at rest and during exercise, recording the data obtained in your own diary,
• Contraindications after pacemaker installation include alcohol abuse, prolonged and exhausting physical activity, non-compliance with work and rest schedules,
• Exercise of the lungs is not prohibited physical exercise, since it is not only possible, but also necessary to train the heart muscle through exercises, if the patient does not have severe heart failure,
• The presence of an pacemaker is not a contraindication for pregnancy, but the patient must be monitored by a cardiac surgeon throughout the pregnancy, and delivery must be carried out by cesarean section as planned,
• The working capacity of patients is determined taking into account the nature of the work performed, the presence of concomitant ischemic heart disease, chronic heart failure, and the issue of loss of ability to work is decided collectively with the involvement of a cardiac surgeon, cardiologist, arrhythmologist, neurologist and other specialists,
• A patient with an pacemaker may be assigned a disability group if the working conditions are determined by a clinical expert commission to be severe or that could cause harm to the stimulator (for example, working with electric welding or electric steel-smelting machines, other sources of electromagnetic radiation).

Except general recommendations, the patient must always have a pacemaker passport (card) with him, and from the moment of surgery it is one of the patient’s main documents, because in case of emergency care The doctor should be aware of the type of pacemaker and the reason why it was placed.

Despite the fact that the stimulator is equipped with a built-in protection system against electromagnetic radiation, which interferes with its electrical activity, the patient is recommended to be at least 15-30 cm away from radiation sources - TV, cell phone, hair dryer, electric razor and other electrical appliances. It is better to talk on the phone using the hand on the opposite side to the stimulator.

MRI is also strictly contraindicated for persons with pacemaker, since such a strong magnetic field can damage the stimulator microcircuit. MRI can be replaced if necessary computed tomography or radiography (there is no source of magnetic radiation). For the same reason, physiotherapeutic treatment methods are strictly prohibited.

A healthy heart that works without interruption does not cause us any unpleasant sensations. But as soon as some kind of malfunction occurs in its work, we feel pain in the chest, dizziness, rapid or slow heartbeat, all this occurs due to poor blood supply to all organs.

If you notice one of the symptoms, rush to see a specialist. He will prescribe all the necessary diagnostic measures and after establishing the diagnosis will offer necessary treatment. In cases where drug treatment does not bring results, you will be advised to install a pacemaker.

This mechanism will allow your heart to work as before and increase your life expectancy. In this material we will tell you what a heart pacemaker is, what it is needed for, and what recommendations after installation.

Heart pacemaker - general characteristics

Heart pacemaker

In less than 70 years since the development of the first portable pacemaker, the pacing industry has come a long way. The late 50s - early 60s of the 20th century were the “golden years” in cardiac stimulation, since a portable pacemaker was developed and the first implantation of a cardiac pacemaker was performed.

The first portable device was large and dependent on external electricity. This was its huge disadvantage - it was connected to an outlet, and if there were power outages, the device turned off. In 1957, a 3-hour power outage led to the death of a child with a pacemaker.

It was obvious that the device required improvement, and within a few years scientists developed a completely portable portable stimulator that was attached to the human body.

In 1958, a pacemaker was first implanted, the device was located in the abdominal wall, and the electrodes were directly in the heart muscle. Every decade, electrodes and the “filling” of devices, appearance improved:

• in the 70s, a lithium battery was created, due to which the service life of devices increased significantly;
• Dual-chamber pacemakers were created, making it possible to stimulate all cardiac chambers - both the atria and ventricles.

In the 1990s, ECS with a microprocessor were created. It became possible to store information about the rhythm and frequency of contractions of the patient’s heart; the stimulator not only “set” the rhythm itself, but could adapt to the human body, only by adjusting cardiac work.

The 2000s were marked by a new discovery - biventricular stimulation became possible for severe heart failure. Thanks to the discovery, cardiac contractility has significantly improved, as has patient survival.