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Permanent Pacemaker Implantation

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Permanent Pacemaker Insertion - An Overview

Your heart is powered by an electrical system that generates heartbeats and fulfills the oxygen supply to all other organs. What if this electrical system malfunctioned? It can lead to many consequences. Without adequate electrical impulses, your heart may slow down or even stop functioning for a few seconds.

Another probability is that despite generating electrical impulses, they may not be passed from the atria to the ventricles that pump your blood around the heart. Such a condition is called a “heart block.” The term does not refer to arterial blockage but rather an electrical blockage in the system, which can also momentarily stop or slow down your heart.

If you are diagnosed with a slow heart rate, Dr. Karthigesan may suggest a permanent pacemaker implantation, a minimally invasive procedure where the pacemaker is placed in your chest. This amazing device stimulates your heartbeat and keeps your heart beating at a normal pace. In short, it supports your heart’s weak electrical system.

There is no one better than Dr. Karthigesan when it comes to pacemaker implantation. He is one of the most renowned pacemaker specialists in Chennai. Having performed more than 2000 pacemaker implantation procedures, he has played a significant role in helping restore cardiac health in thousands of patients.

The image illustrates the Permanent Pacemaker Insertion procedure.
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Types of Permanent Pacemaker Implantation

Depending on your condition, you might have one of the following types of pacemakers.
Single Chamber Pacemaker
In this pacemaker, a single lead connects the pulse generator to the right ventricle.
Dual Chamber Pacemaker
This is the most commonly used pacemaker. It has two leads connecting to the right atrium and right ventricle, enabling them to work normally. As a result of the contractions, the blood flow from the right atrium and right ventricle is normal.
Physiological Pacing
The physiological pacing technique engages the cardiac conduction system while pacing the lower chambers of the heart by stimulating the HIS Bundle or left bundle.
Leadless Pacemaker
A leadless pacemaker is a self-contained device that is inserted through the groin and placed directly into the heart, eliminating the need for surgical incisions. This innovative device doesn't rely on insulated wires (known as leads) and is implanted directly into the heart's lower chambers (ventricles).
Biventricular Pacemaker
Biventricular pacemaker, also known as CRT therapy, aims to reinstate the coordinated pumping rhythm of the heart's ventricles. This procedure involves incorporating a third lead into the system alongside the standard leads present in a regular dual-chamber pacemaker.
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Permanent Pacemaker Insertion: Evaluative Tests

Dr. Karthigesan may recommend several diagnostic tests to identify the reasons for your abnormal heartbeat before deciding on pacemaker implantation. The tests include:

  • Holter monitor test
  • Cardiac event monitor
  • External Loop recorder
  • Electrocardiogram
  • Stress test
  • Echocardiogram

Permanent Pacemaker Implantation: The Procedure

  • The procedure is done in a Cardiac Cath Lab and begins with administering a local anesthetic to numb the pain and make you comfortable. You may only feel a mild, painless pressure in your shoulder region.
  • The pacemaker is inserted under the collarbone in the left front portion of your chest. The procedure will last for approximately an hour. Depending on your post-procedural condition you may be discharged in a day.
  • Essentially, the pacemaker stimulates the heartbeat when it is slow or irregular. You must consult with Dr. Karthigesan at scheduled intervals to ensure the device functions well.
A cardiac pacemaker with catheters.

Pacemaker Implantation: Before, During & Post Procedure Care

  • Avoid food and drink for a specified period before your procedure. You will be given an overnight fasting schedule, usually overnight.
  • Inform Dr. Karthigesan about your medication and anesthetic agent allergies, if any.
  • Discuss your existing heart valve disease, if any, since you may require an antibiotic procedure.
  • Avoid taking any blood thinners before your procedure.
  • An anesthetist will administer a sedative through an IV in your arm. This medication will help you relax and stay calm.
  • Dr Karthigesan will administer a local anaesthetic to numb the keyhole area.
  • Your doctor will insert one or multiple wires into a major vein near or beneath your collarbone. The wires are guided towards your heart with the help of x-ray images.
  • One end of the wires will be secured at a designated position in your heart. The other end will be attached to the pulse generator in your pacemaker.
  • You may be asked to stay in the hospital to monitor your condition after the implantation procedure.
  • Your doctor will program your pacemaker and customise it to your heart rhythm requirements.
  • He will advise you to avoid strenuous exercises and heavy lifting for at least a month after the procedure.
  • Make sure not to put pressure on the pacemaker area.
  • Inform all your doctors and dentists about your pacemaker implantation.
  • Always consult Dr. Karthigesan with any queries about using certain electrical equipment around your pacemaker.

Permanent Pacemaker Implantation: The Benefits

  • Pacemakers are life-saving devices that prevent your heart from stopping abruptly.
  • Designed to keep your heart beating without any disruptions, thereby improving your life quality.
  • Eliminates any symptoms of low heart rate, like breathlessness and syncope spells, resulting in more body stamina.
  • Helps reduce symptoms like giddiness, fatigue, and heart palpitations, which are usually caused by heart rhythm problems.
  • Helps prevent syncope spells caused by low heart rate.
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Permanent Pacemaker Implantation: Your Questions Answered

A slow heart rate occurs when the heart slows down or pauses, causing breathlessness, dizziness, tiredness, and fainting spells or syncope. Most often, you will not experience any warning signs before falling unconscious.

These low heart rates are mostly associated with age-related degenerative changes in the heart's electrical system. However, this condition can also affect small children with congenital defects in the heart’s electrical system.

A pacemaker implantation is only a minimally invasive procedure. Apart from avoiding strenuous physical activity and driving for a few weeks post-procedure, there are no other restrictions. You can be physically active and handle electronics without the fear of acquiring any side effects.
You should get your pacemaker checked at least once in six months. However, the latest pacemakers are Bluetooth-enabled or can be remotely monitored through a mobile app. This technology tracks the pacemaker’s functions and reduces your need to visit pacemaker clinics.

A pacemaker has three important parts:

  • The pulse generator- It is an electronic circuit enclosed in a small metal case attached to a mini computer and battery that generates electrical impulses to your heart.
  • The leads- They are insulated wires that connect the pulse generator with the heart chambers.
  • An electrode- This part is attached to the end of the lead and touches the wall of the heart.
Implantable Cardioverter Defibrillators or ICDs and pacemakers generate electrical signals to control your heart rhythm. The difference between both devices is that ICDs can also detect dangerous heart rhythms and immediately generate a shock to restore the normal rhythm. Pacemakers are not designed to do this function.
The life expectancy after pacemaker implantation depends on the following:
  • Your age.
  • Your general health condition.
The fewer the health complications, the longer the life expectancy. The person can also live a normal or near-normal life.
The pacemaker battery can last for up to 10 to 12 years. It can vay depending on the body’s utilization of the pacemaker to maintain your heart rhythm.
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