In medical practice, we increasingly encounter patients for whom a pacemaker is a vital necessity. The device helps to cope with heartbeat disorders, which previously would have led to disability and early death of the patient.

Cardiac dysfunction inevitably leads to loss of functionality of other internal organs, including the central nervous system, due to lack of oxygen. The pathological condition can develop when the pulse rate is too slow (bradycardia), arrhythmia complicated by tachycardia, and organ blockade, in which the conduction of electrical impulses fails.

The need for a pacemaker and indications for installation arise in the following diseases:

• Sick sinoatrial node syndrome, in which the heart rate drops to 40 or below. It also includes sinus block, bradycardia and bradyarrhythmia (attacks of decreased rhythm followed by episodes of tachycardia).
• Atrioventricular block (atrioventricular conduction disorder) 2-3 degrees.
• Pathologies of the carotid sinus - a sharp drop in heart rate due to irritation of the site of expansion of the internal carotid artery. It can be provoked by active movement of the head or compression of the neck by clothing. Manifested by severe dizziness and fainting.
• The need for drug therapy (for example, Amidaron) to normalize the contractile function of the heart during various blockades and arrhythmias.
• Other types of bradycardia, which are accompanied by convulsions and/or loss of consciousness due to a short-term complete stop of the electrical system of the heart (asystole).
• Paroxysmal ventricular tachycardia.

• Atrial fibrillation.
• Regular cases of extrasystoles with a high probability of transition to ventricular fibrillation, left ventricular failure, often resulting from a heart attack.

Installation of a pacemaker is indicated in cases where life-threatening conditions cannot be treated with medication.

What types of pacemakers are there?

To have an understanding of the installation method and types of devices, you need to understand what a pacemaker is and what the principle of its operation is.

A pacemaker (pacemaker), also called an artificial pacemaker, is a device that maintains or imposes a normal heart rate, suppresses other sources of impulse excitation, and monitors the patient's own pulse.

EX structure

Modern models of artificial pacemakers resemble mini-computers: they consist of electrodes, a complex microcircuit and a battery that allows them to work on average for about 10 years. New pacemakers are designed to last longer – up to 12-15 years.

Using a microcircuit, the device recognizes the electrical potential of the myocardium - in other words, a cardiogram. Electrodes with a sensitive head are implanted into the thickness of the heart muscle, transmitting information about impulses and returning electrical charges that normalize the beat rhythm.

The dimensions of the device vary depending on the model and functions, and the average weight is about 50 g. The pacemaker is configured by a computer programmer within the medical institution where the operation to implement it was carried out.

Classification

Pacemakers are divided by purpose and number of electrodes. By purpose they are classified into:

• Pacemakers (pacemakers), which are used for bradycardia to ensure a normal frequency of blood emissions.
• Cardioverter-defibrillators, which, in addition to the function of a pacemaker during rare contractions of the heart, are capable of recognizing the state of fibrillation and restoring the normal frequency of beats using a strong electrical discharge of 12-35 J or special stimulation schemes.

According to the number of electrodes, ECS are divided into:

• Single-chamber. The stimulator electrode is located in the left ventricle and initiates contraction of other cavities. It is rarely used, since if the atrial and ventricular rhythms coincide, the blood circulation of the heart is disrupted. Useless for supraventricular arrhythmias.
• Two-chamber. Equipped with two electrodes, which are placed in the ventricle and atrium. They control and coordinate the rhythm of cavity contractions well.
• Three-chamber. They are the most optimal and physiological. Three electrodes are located in the two ventricles and the right atrium, respectively. Such models are actively used for dyssynchrony of contractions of the left and right ventricles.

Pacing is also classified by duration. EX is installed for the following types of exposure:

• Permanent. Epicardial implantation is performed only on an open heart using special devices.

• Temporary. It is used before installing a permanent pacemaker, in case of drug overdose or transient heart rhythm disturbance. To stabilize the patient's condition if resuscitation is necessary, external or endocardial cardiac pacing is used. Placing electrodes on the sternum is less effective than passing them through a central venous catheter directly into the atrium or ventricle.
• Diagnostic. Transesophageal stimulation is used to eliminate attacks of atrial arrhythmias, as well as to check the functionality of the heart if paroxysmal tachycardia, sinus node pathology, atrioventricular conduction disorder, or coronary artery disease are suspected.

The ability to select an external rhythm allows you to use a pacemaker as a replacement for bicycle ergometry and treadmill test when diagnosing the causes of angina pectoris.

Labeling of pacemakers

For short designation, three-letter (ICHD) and five-letter (NBG) codes are used. The marking indicates the number of electrodes and the presence of additional functions. The letters of the code sequentially indicate:

1. Localization of implanted electrodes (A – atrial, V – ventricular, D – both cavities).
2. Detectable camera.
3. Response to a received impulse (stimulation – I, suppression – T, both functions – D, no response – O).
4. Adaptation to the patient’s body requirements for contraction frequency (load). Rate-adaptive pacemakers are labeled with the letter R.
5. Presence and parameters of other functions in tachycardias.

Contraindications

There are no absolute contraindications for implantation of a heart pacemaker, either based on age or vital signs. The decision is made by surgeons and cardiologists regarding each clinical case. Surgery may be recommended even for patients who are already in the intensive care unit due to a heart attack. This is possible if the cessation of blood supply to a section of the heart muscle is accompanied by complete atrioventricular block or severe arrhythmia.

The date of intervention can be postponed due to several clinical circumstances (indications), if the patient does not need immediate installation of a pacemaker. These include:

• Fever or symptoms of infectious diseases.
• Exacerbation of chronic pathologies of internal organs (asthma, gastrointestinal ulcers).
• Mental disorders that exclude normal contact with the patient and reduce the likelihood of successful rehabilitation.

Preparation and tests before intervention

The list of necessary diagnostic procedures varies depending on the urgency of the operation and the standards of a particular clinic. Standard preoperative cardiac tests and studies are usually performed:

Preparation for surgery includes consultation with the following doctors:

• Arrhythmologist.
• Otolaryngologist and dentist (they exclude or treat foci of infection).
• Other specialists in case of chronic diseases of the kidneys, central nervous system, endocrine system.

A few days before the intervention, doctors may require you to stop therapy with NSAIDs and anticoagulants. In parallel with this, it is necessary to lighten the diet, and on the day of the procedure, starting from midnight, do not eat or drink anything.

How is implantation performed?

The cardiac stimulator is installed with local anesthesia of the sternum, less often - under general anesthesia. The entire procedure lasts 1-2 hours and includes the following steps:

1. After all diagnostic procedures, the patient is taken to the operating room. Local anesthesia is applied to the sternum above the left clavicle.
2. An incision is made into the skin and vein under the collarbone. The electrodes are passed through the vessel to the cavities of the heart. The progress of the detectors is monitored using x-rays.
3. When they reach the desired chambers, the surgeon looks for the best place to stimulate by checking the heartbeat parameters on the ECG. Upon completion of the search, the electrodes are fixed in the wall of the organ with “antennae” or a corkscrew-like fastening.
4. After installing the detectors in the subcutaneous tissue, a bed is prepared for the pacemaker housing. After placing the device, doctors connect electrodes to it, stitch the wound and apply a sterile dressing. A noticeable scar later remains at the site of the suture.

After the operation, the arrhythmologist programs the pacemaker, setting the modes for recording the cardiogram, stimulating the heart muscle, parameters for analyzing the load and choosing the degree of stimulation activity. Also in the settings you can set an emergency mode, which operates when the battery charge is low.

For 6-10 days, the patient is observed in the hospital, receiving therapy with analgesics, anticoagulants and antibacterial drugs.

How long does the stimulator last?

The pacemaker is installed forever, but the duration of uninterrupted operation of one pulse source does not exceed ten years. The service life of the ECS is on average 8-10 years: it is determined by the battery capacity. After complete discharge or failure of the stimulator due to non-compliance with safety standards or manufacturing defects, the device must be replaced. Often the electrodes last longer than the electric pulse generators, so during a repeat operation they can only install a new titanium case with a microcircuit and battery.

The warranty covers the first 3-5 years of operation of the device.

What is the cost of the operation?

If it is necessary to implant a heart pacemaker, the cost of the operation can be paid according to a quota, that is, the patient can do it free of charge, excluding the cost of travel, stay in a medical facility and accommodation during preparation for the procedure and rehabilitation. Due to the high demand for ECS, scheduled installations are carried out on a rolling basis.

The price of electrical stimulators varies depending on the manufacturer and configuration of the device. Single-chamber pacemakers will cost the patient 10-70 thousand rubles, two-chamber pacemakers - 80-200, three-chamber pacemakers - up to 450. The cost of the electrodes, as well as the costs of the implantation itself, are often calculated separately.

Complications

Side effects after surgery that may worsen the patient's condition are uncommon. According to statistics, complications are observed in 6.2% of elderly patients (over 65 years of age) and 4.5% of people under this age. The probability of fatal consequences is orders of magnitude lower than these values. When installing an pacemaker, there is a risk:

• Infectious infections - suppuration of the incision, fistula formation, sepsis.
• Displacements of detector electrodes.
• Intracardiac bleeding.
• Stimulation of extracardiac muscles, diaphragm.
• Loss of the analyzing function of the pacemaker, leading to stimulation failures.
• Swelling of the upper limb.
• Pneumothorax.
• Block up large vessels.
• Detector fracture.
• Early end of battery life.

Most of these complications can be avoided with proper implantation of the device, the use of quality equipment and adequate postoperative care. To protect yourself, you should pay attention to patient reviews of heart pacemakers from a particular manufacturer, as well as about operations performed by a particular doctor.

Lifestyle after surgery

Life with a pacemaker is full and differs from the reality of a healthy person only in a number of aspects. By following the recommendations, the patient can work, do household chores, and even get involved in sports.

In this case, it is necessary to observe safety precautions:

• Visit a cardiac surgeon and arrhythmologist once a quarter for 1 year after implantation of the stimulator, once every six months during the second year and annually thereafter.
• Monitor your health status (well-being, blood pressure, pulse rate).
• Give up bad habits (alcohol, nicotine), establish a balance between work and rest.
• Avoid certain diagnostic methods (ultrasound of the sternum, MRI) and physical therapy (exposure to magnetic fields and heat).
• Consult a cardiologist before minimally invasive interventions (electrocoagulation, operations with electric scalpel incisions, crushing stones in internal organs).
• Do not stay near high-voltage power sources for long periods of time.
• Avoid blows to the sternum and falls.
• When using a mobile phone and sources of electromagnetic radiation (including household ones), it is advisable to place it on the other side of the body relative to the device, at a distance of more than 25-30 cm from it.

The patient needs to carry with him a document confirming the installation of the pacemaker: this will avoid detector checks that are dangerous for the operation of the device.

The patient’s ability to work is determined by a medical commission, taking into account the presence or absence of complications (IHD, CHF). A patient may be given a disability group if work at a specific workplace can cause serious harm to him or the device (contact with electric welding equipment, steel-smelting machines).

The presence of a pacemaker is not an absolute contraindication for pregnancy. But the patient must be observed by a cardiologist throughout the entire pregnancy and follow all the doctor’s recommendations on nutrition and exercise. Childbirth takes place only by caesarean section, the operation is scheduled.

Physical activity should be moderate, without straining the sternum. During the rehabilitation period (up to 3 months), sports are prohibited along with any intense exercise of the upper body.

Martial arts are prohibited for life due to the risk of impacts to the area of ​​the device, extreme sports, football, rugby, basketball, hockey, shooting, bodybuilding with weights on the pectoral muscles.

Baths and saunas are allowed only after consultation with a doctor in the absence of complications, after the end of rehabilitation. Visits should be infrequent and gentle.

Forecast

The use of pacemakers in medicine has significantly increased the life expectancy of patients with arrhythmia, heart block and sinus node weakness. For bradyarrhythmias and supraventricular tachycardias, the effectiveness of device installation reaches 100%. With atrial and ventricular fibrillation, pacemaker helps 80-99 patients out of 100.

Knowing not only your own indications for installing a pacemaker, but also what it is, what advantages and disadvantages the operation to implant it carries, you can make the right decision with greater confidence. ECS allows you to eliminate the unpleasant symptoms of cardiac pathologies and stop life-threatening conditions in a timely manner.

Pacemakers. Lifestyle after pacemaker implantation. Where to install a pacemaker?

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Lifestyle of a patient with a pacemaker

The attending physician introduces the patient to the basic restrictions and rules of living with a pacemaker.
Many clinics where implantation is performed also issue special brochures and leaflets that contain the most important information. In practice, the patient gradually gets used to it and lives a normal life. The risk of serious complications from any exposure to a modern pacemaker is extremely small. The devices are equipped with multi-stage protection, and even the magnetic field, which disrupted the mode in older models, is more of a theoretical danger these days. In most cases, negligence can lead to material costs - repeated surgery, replacement of the device or a short course of treatment.

Does a pacemaker affect the course of pregnancy and is it possible to give birth with it?

In general, women with an implanted pacemaker should do the following:

• Before implanting the device, it is better to notify doctors that the patient would like to have children in the future. This may affect the choice of device model.
• Before conceiving a child, it is better to consult with your attending cardiologist, who will check the condition of the device and conduct the necessary examinations. In some cases, it may be necessary to first replace the batteries or the entire device ( to avoid doing this during pregnancy).
• To monitor the course of pregnancy, you should choose a competent specialist who will agree to manage such a complex patient. In practice, many doctors simply do not want to take risks and refer patients to other specialists.
• If any unusual symptoms occur ( not only from the heart) it is better to immediately contact your doctor, as complications can be very diverse.
• Before giving birth, you should undergo additional examinations, and a cardiologist is often invited to the birth itself to help monitor the patient’s condition.

A special difficulty arises when the patient needs to have a permanent pacemaker installed during pregnancy. In these cases, the body is implanted higher ( so that it does not move as the fetus grows). During the operation itself, the abdomen must be covered with a special lead blanket, since the position of the electrodes is usually monitored using x-rays.

However, even with all these features and precautions, the risk to the mother and baby is very small. In the vast majority of cases, proper attention from specialists ensures a normal pregnancy and childbirth.

What physical activity is allowed for patients with a pacemaker ( sports, household stress, sex, etc.)?

However, extremely heavy exercise is not recommended for patients. Together they affect not only the heart, but also increase blood pressure and in rare cases the pacemaker may not be able to cope with the problem that has developed. Because of this, such patients are not allowed to engage in many sports professionally.

Regarding physical activity, patients with a pacemaker should adhere to the following recommendations:

• allowed to practice most sports at amateur level ( no stress on wear);
• Contact sports are prohibited ( martial arts, fencing, etc.), since there is a high risk of getting a blow to the area where the pacemaker is implanted;
• You should play football, volleyball, basketball and similar games with caution, as a blow to the danger zone can be caused by contact with a player or the ball;
• Active exercises on horizontal bars, uneven bars, and artistic gymnastics are prohibited, as they involve a sharp change in body position, and the electrodes in the heart can become dislodged;
• swimming allowed;
• Any household loads are allowed ( including sex, but without pressing on the area where the device is implanted).

Is a disability group given after implantation of a pacemaker?

The following factors will be relevant at the commission meeting:

• initial diagnosis;
• type of pacemaker;
• type and volume of medical services provided;
• the patient's degree of dependence on the pacemaker;
• the presence of other acute and chronic diseases;
• education and working conditions;
• social status ( having a family, living conditions);
• age, etc.

Taken together, the commission assesses whether a person retains their ability to work after having a pacemaker installed, and to what extent. From a medical point of view, a patient with an artificial pacemaker is equal to a patient with coronary heart disease and should receive a disability group. Therefore, there are legal prerequisites for this. However, if there are no factors in the workplace that could pose a hazard to the operation of the device, and the patient is not completely dependent on the pacemaker, a disability group is usually not given.

In any case, the first step for patients after surgery should be a consultation with the attending physician on this issue ( Usually doctors themselves do not offer to undergo a commission). The doctor can tell you where to go next, how realistic it is to assign a disability group and what documents may be needed. He must also provide a relevant medical report.

One of the options for the commission’s decision may be to assign a temporary disability group. The patient could lose his ability to work only in the postoperative period, or he would be given time ( up to several years) to obtain other education and retraining. In any case, this issue is resolved with the involvement of not only doctors, but also other specialists ( lawyers, medical and social experts, etc.).

Where and who can work with a pacemaker?

The following jobs and professions may pose a risk to patients with implanted pacemakers:

• Law enforcement and military forces. Police officers and military personnel must have good physical training. In addition, their training and work involve physical contact, during which they can receive a blow to the area of ​​the implanted body.
• Welder and some construction specialties. Working on a construction site can involve not only severe physical exertion, but also the use of powerful tools. For example, a welding machine creates a fairly powerful electromagnetic field that can affect the operation of a pacemaker. Working with a jackhammer due to strong vibration sometimes leads to displacement of the electrodes.
• Manufacturing engineers. Factories typically use high-power electrical equipment, magnets, and other equipment that pose a hazard to the patient with a pacemaker. A safety specialist can determine the presence of dangerous physical factors.
• Electricians and electricians. Working with electrical equipment, one way or another, is associated with the danger of electric shock. Weak discharges that would not cause harm to a healthy person can disrupt the functioning of the pacemaker and put the patient's life in danger.
• Power plant workers. At power plants, despite all types of protection, there is a chance of being exposed to powerful electromagnetic radiation. They are located around equipment and high voltage power lines.
• Miners. Mine diving itself, although associated with certain changes in the physical parameters of the environment, does not pose a serious threat to patients with a pacemaker. However, high-power equipment commonly used in mining operations can be a source of electromagnetic fields.
• Some doctors. A number of doctors ( especially in the field of diagnostics) is often located near powerful electrical equipment.

Is it possible to massage patients with a pacemaker?

The following massage techniques pose some risk:

• direct massage of the area where the pacemaker is attached;
• deep massage of the torso muscles ( stomach, chest, back);
• a number of manual therapy techniques that require strong turns of the body;
• massage associated with the use of hot lotions and heating the body.

Is it possible to fly on an airplane with a pacemaker?

Is it possible to go through a metal detector in stores, at the airport and at customs?

The main places where metal detectors can be found are:

• Large shops and supermarkets. Devices operating on the principle of metal detectors are sometimes installed at the exits of stores. There they are called upon to prevent petty thefts. However, such devices are safe for patients with pacemakers. They are configured to search for other metals, and do not react to the body of the device in any way.
• Airports. Metal detectors are installed at the airport for security purposes, and all passengers ( as well as employees) to enter the so-called “sterile zone” they pass through the frame of a fairly powerful metal detector. Such devices pose the greatest danger to patients with pacemakers. Airport workers know about this, and the patient does not have to go through the frame if he presents a special patient passport. This document is issued after the implantation of a pacemaker. In such cases, security personnel are required to replace going through a metal detector with a thorough physical search or other methods that are safe for the passenger. International airports in other countries may require an international pacemaker identification card. This should be taken care of in advance, before the start of the trip.
• Customs control zones at the borders. Customs offices also sometimes install metal detectors through which luggage or passengers pass through. People with a pacemaker should notify employees of the implanted device and provide appropriate documentation.

How do you know if a pacemaker is prohibited?

Is it possible to visit a bathhouse or sauna, sunbathe on the beach or in a solarium?

An exception may be patients in whom cardiac damage occurs against the background of systemic diseases. For them, visiting the bathhouse is dangerous due to possible complications, but not from the pacemaker, but due to the presence of a systemic disease.

Tanning on the beach is also not a contraindication, since most of the sun's rays are absorbed by the skin, and the pacemaker is implanted much deeper. However, infrared rays can heat metal because they penetrate quite deeply. That is why patients with a pacemaker are not recommended to visit solariums or infrared saunas.

Can a mobile phone affect the operation of a pacemaker?

Is it possible to exercise at home with an implanted pacemaker?

There are certain restrictions on physical activity in the first months after implantation. This is due to normal fixation of the housing and electrodes, as well as normal healing of the postoperative wound. When exercising on the simulator, you should avoid sudden movements and any pressure on the area where the body is implanted. More detailed instructions can be obtained from your doctor after surgery.

Does alcohol affect the functioning of a pacemaker?

Alcoholic drinks in the presence of a pacemaker pose a danger for the following reasons:

• a large amount of alcohol affects the conduction of impulses by the heart muscle and can provoke arrhythmia;
• alcohol leads to vasodilation, which changes blood pressure, and this, in turn, affects the functioning of the heart;
• Long-term consumption of alcohol, even in small doses, can eventually affect the size of the heart muscle ( hypertrophy of certain sections).

Do microwaves, refrigerators, and other household appliances affect the performance of a pacemaker?

When using household appliances, patients with a pacemaker should pay attention to the following points:

• You should not lean against switched-on electrical appliances with the area of ​​skin under which the pacemaker is attached;
• turned on hand-held devices cannot be brought closer than 10 cm to the implantation site;
• Do not touch the TV screen while the TV is on ( especially old models with kinescope);
• Do not touch the metal casing of switched on electrical appliances ( washing machine, microwave oven, heaters, etc.), since sometimes they get electric shock;
• you need to check the grounding of household appliances and install modern sockets to prevent accidental electric shocks.

Does laser affect ( laser radiation) for the operation of a pacemaker?

Can I use a pacemaker and a hearing aid at the same time?

What medications and drugs should not be taken by patients with a pacemaker?

In some cases, patients are prescribed to take aspirin or other medications for a long time after implantation. These drugs reduce the risk of blood clots and reduce the likelihood of complications. Independent refusal to take them or changing the dose is not recommended. It is better to consult on this matter with the attending cardiologist, who is not only familiar with the principle of operation of the pacemaker, but also knows the patient’s diagnosis in detail and can take into account the general condition of the body.

Do patients with a pacemaker need a specific diet and diet?

In most cases, the diet in cardiac patients is aimed at “unloading” the heart and reducing the risk of atherosclerosis. It is recommended to monitor salt intake, the amount of potassium and sodium, and the content of “harmful” lipids in food. The exact diet for any disease can be checked with your doctor. Also, during a consultation with a nutritionist, you can create a detailed menu taking into account the patient’s tastes and medical recommendations.

Patients with most heart diseases should adhere to the following recommendations:

• reduce salt intake during the day ( including as part of other dishes);
• reduce consumption of fatty foods;
• exclude concentrated animal fats;
• give preference to fish and seafood;
• try not to overeat during the day;
• eat fresh fruits and vegetables more often;
• reduce consumption of coffee and energy drinks;
• try to avoid fatty dairy products.

In addition, cases where cardiac damage has developed against the background of other pathologies should be taken into account. This is possible, for example, with a number of autoimmune diseases, diabetes, problems with the thyroid gland. These patients may need a more restrictive diet.

Should doctors be warned about a pacemaker during dental treatment and other medical procedures?

The presence of a pacemaker may make adjustments to therapeutic and diagnostic procedures for the following reasons:

• Use of certain medications. If you have a pacemaker, the use of certain medications during procedures may be limited. This is due to their effect on the functioning of the heart. To correctly prescribe treatment and to avoid complications, you need to warn your doctor about the implanted pacemaker before choosing the drug and dose.
• Exposure to electromagnetic field. Physiotherapeutic treatment and a number of diagnostic studies are based on the influence of a strong electromagnetic field. For patients with a pacemaker, such procedures are contraindicated. The physician should be advised to consider alternative treatment or diagnostic approaches.
• Exposure to ultrasonic waves. Ultrasound waves are used for ultrasound, crushing kidney or gallstones, and some other procedures. These manipulations are not a categorical contraindication for patients with a pacemaker, but doctors should be warned in advance. Then they will be more attentive during the procedure and the examination or treatment will not affect the operation of the device.
• Exposure to electric current. For a number of surgical interventions, doctors use special scalpels with electrocoagulators. This is convenient because it avoids

In some patients, in the long-term period after sympathectomy, it becomes necessary to install a pacemaker.

A pacemaker is a device that records the rhythm of the heart and generates electrical impulses that are sent to the heart and cause its normal contractions. Surgeries to implant pacemakers are indicated for pathologies accompanied by insufficiently frequent contractions that cannot fully ensure normal blood circulation and vital functions of the human body.

Previously, cardiac surgeons used devices that did not respond to the heart’s own rhythm and operated with a pulse generation frequency specified during their implantation. This significantly limited the possibilities of their use and did not always ensure the achievement of the required therapeutic effect. Thanks to the development of the medical technology industry, devices can now be used that resemble the coordinated operation of a minicomputer and synchronize the normal contraction of the atria and ventricles.

Let's tell you how a pacemaker works, because not everyone knows what it is.

Implantation of a pacemaker may be indicated for any bradycardia or bradyarrhythmias that pose a threat to the health or life of the patient. The reasons for their development can be the following conditions and diseases:

• or rest, accompanied by a decrease in rhythm;
• constant or intermittent bradycardia in heart failure;
• disturbances of atrioventricular conduction (AV block of the first type of II and III degrees, AV block of the first degree with a developed block of one of the branches of the His bundle);
• (SA blockade, sinus bradycardia).

The conditions described above can be caused by both congenital and acquired diseases of the cardiovascular system, including infectious lesions, scar tissue formed after suffering, processes caused by aging, and unknown factors.

How does a pacemaker work?

The pacemaker consists of the following components:

• battery to supply the device with electrical energy, which is designed for many years of uninterrupted operation of the device (after its resources are exhausted, the pacemaker must be replaced);
• chip, transforming battery energy into impulses for stimulation and controlling their power and duration;
• connector block for connecting the pacemaker body with electrodes;
• electrodes, which are flexible and durable spiral conductors that are fixed in the chambers of the heart, transmit impulses emitted by the device to the heart and carry data on heart activity to the microcircuit; at the end of the electrode there is a metal head that securely fixes it to the wall of the heart;
• programmer, which is a special device for monitoring and regulating the settings of a pacemaker; if necessary, the doctor can change the settings for the correct rhythm of contractions; also thanks to this device, the doctor can view information recorded in chronological order about registered atrial and ventricular rhythm disturbances (ventricular fibrillation, ventricular and supraventricular tachycardia).

The pacemaker microcircuit and battery are combined into a pulse generator and are housed in a sealed titanium case, and the connector block is located at the top of the device and is enclosed in a transparent plastic block.

Types of pacemakers

Currently, single-chamber, double-chamber and triple-chamber pacemakers can be used for cardiac pacing. The type of device required for each clinical case is determined by the doctor individually, based on the data of diagnostic studies.

Single chamber pacemaker has only one active electrode, which stimulates only one ventricle. The main disadvantage of this type of device is the stimulation of only one of the chambers of the heart. At the same time, the atria continue to function in their own rhythm, and when the contractions of the ventricle and atrium coincide, a disturbance in blood flow is observed: blood from the ventricle is thrown into the atrium and blood-bearing vessels.

Dual chamber pacemaker has two electrodes. They are implanted into the atrium and right ventricle - this ensures stimulation of both parts of blood pumping, coordinated work of the atrium and ventricle, and proper blood flow through the heart.

Three-chamber pacemakers(cardiac synchronizing) are capable of stimulating three chambers of the heart in a certain sequence: the right and left ventricles and the right atrium. Such latest generation pacemakers ensure normal heart function and physiological intracardiac hemodynamics. These cardiac synchronizing devices can be used to eliminate desynchrony of the heart chambers in severe forms of bradyarrhythmia or bradycardia.

Some models of pacemakers are equipped with touch sensors. Such devices are called frequency-adaptive, and their components include a sensor that detects changes in the activity of the nervous system, respiratory rate and body temperature. Pacemakers of this type are used for cardiac pacing in cases of rigid sinus rhythm, which is caused by a significant depletion of cardiac reserves.

There are also models of pacemakers that are equipped with a cardioverter defibrillator, which, when fibrillation or dangerous arrhythmias occur, begins to perform automatic defibrillation. After exposure of the chambers of the heart to a high-voltage discharge, ventricular fibrillation or tachycardia is stopped, and the heart continues to contract according to the rhythm specified when the device was implanted.

How does a pacemaker work?

The device's microcircuit constantly analyzes the pulses generated by the heart, conducts the pulses generated by the pacemaker to the heart wall and controls their synchronization. The electrode, which is a conductor, transmits the impulse generated by the device to the heart chamber and carries information about the activity of the heart itself back to the microcircuit. At the end of each conductor-electrode there is a metal head, which brings the electrode into contact with one or another part of the heart, “reads” information about the electrical activity of the heart and sends impulses only when they are needed.

When the heart contracts very rarely or completely absent, the pacemaker goes into constant stimulation mode and sends impulses to the heart at the frequency that was set when the device was implanted. When the heart operates spontaneously, the pacemaker begins to work in standby mode and functions only in the absence of independent heart contractions.

Pacemaker models with a built-in cardioverter defibrillator are programmed to automatically turn on cardioversion and defibrillation and begin to generate a high voltage pulse when the device receives data on ventricular fibrillation or life-threatening tachycardia.

How is a pacemaker installed?

The operation to implant a pacemaker is minimally invasive and can be performed in an operating room equipped with an X-ray machine to monitor all the actions of the cardiac surgeon. Local anesthesia is used for pain relief.

1. The doctor punctures the subclavian vein and secures an introducer in it, through which an electrode (or electrodes) is advanced into the lumen of the superior vena cava.
2. Next, under the control of X-ray equipment, the electrode moves into the right atrium or right ventricle and is fixed on the wall of the heart chamber. If the implanted pacemaker is two- or three-chamber, then the implantation of other electrodes is performed in the same way.
3. After fixing the electrodes, the doctor performs several tests to measure the threshold of excitability, to which the heart responds with contractions.
4. After obtaining a good ECG graph obtained from the installed electrodes of the device, the electrodes are permanently fixed, and a “pocket” is made under the skin in the subclavian region or under the pectoral muscle for implantation of the pacemaker housing.
5. After inserting the device into the “pocket” and connecting the electrodes to it, the tissue is sutured.

In total, this method of surgery for implanting a pacemaker takes no more than 2 hours. If necessary, other implantation methods can be used.

Rehabilitation

For some time after implantation of the pacemaker, the patient experiences slight discomfort and pain at the site where the device is installed. Also, a hematoma may form at the site of insertion of the device. Some patients may experience an increase in body temperature. All these unpleasant sensations can be eliminated either independently or with the help of symptomatic therapy.

As a rule, patients after pacemaker implantation are prescribed a prophylactic course of antibiotics. If necessary, the doctor makes adjustments to the regimen of previously prescribed antihypertensive drugs (they are either canceled or their dosage is reduced).

Some patients in the first days after surgery feel slight “twitching” at the site of implantation of the device, which is caused by electrical impulses generated by the pacemaker. Within a few days, all these negative sensations disappear completely or are eliminated by reprogramming the device.

Already on the first day after surgery, most patients can get out of bed, and after a week they return to their usual rhythm of life. You are allowed to start work after 2 weeks.

Three months after the operation, the patient must undergo a follow-up examination. A subsequent visit to the doctor should take place after six months, and then, if there are no complaints, the patient can undergo follow-up examinations once or twice a year.

An early visit to the doctor should take place if the following complaints appear:

• decreased heart rate;
• signs of inflammation in the area of ​​device implantation: redness, swelling, pain;
• the appearance of new attacks of dizziness or fainting.

Life after having a pacemaker installed

A patient with a pacemaker must follow a number of recommendations:

1. Avoid contact with strong electromagnetic sources: high-voltage transmission lines, television towers, metal detectors, repeaters.
2. In medical institutions (including when visiting a dentist), present documents confirming the presence of a pacemaker, since some therapeutic and diagnostic procedures may be contraindicated (MRI, ultrasound with moving the sensor along the device body, magnetic therapy, electrotherapy, lithotripsy, monopolar coagulation). If necessary, MRI can be replaced by computed tomography or x-rays. There are also models of pacemakers that are not sensitive to the effects of an MRI installation.
3. To avoid displacement of the device and disruption of its operation, observe a number of restrictions in everyday life: dose the types of loads that involve the pectoral muscles, contact voltage sources only with the hand opposite the place where the device is implanted, avoid impacts in the area where the pacemaker is located, place the mobile phone at a distance of at least 20-30 cm from the place of implantation of the device, place the audio player on the opposite side, keep various electrical appliances with motors (electric drill, lawn mower, hammer drill, electric razor, hair dryer, etc.) away from the pacemaker.
4. Working with industrial or office equipment does not interfere with the functioning of the pacemaker. It must be in good working order and grounded.
5. Avoid contact with equipment that may cause electrical noise: welding machines, electric steel furnaces, electric saws, dielectric heaters, distributors or ignition wires of an automobile engine.
6. Monitor your heart rate frequently (during exercise and at rest).
7. Measure blood pressure periodically (especially if it has been observed before).
8. If blood pressure rises to 160/90, angina attacks appear and signs of circulatory problems (shortness of breath, edema), take medications recommended by your doctor.
9. Regularly engage in exercise therapy to train the heart (the permissible level of loads and the rate of their increase are indicated by the doctor).
10. Fight excess weight.

Having a pacemaker installed is no longer something special. The operation is performed under local anesthesia. An incision is made parallel to the collarbone, and pacemaker electrodes are inserted into the heart muscle. The process is displayed on the monitor screen.

As soon as the electrodes are connected to the heart, the pacemaker immediately starts working and the heart rhythm returns to normal. The device turns on when impulse conduction is disrupted and stabilizes heart contractions.

Pacemaker installation

Electronic devices that generate sinus node pulses are of the following types:

1. Single-chamber, the simplest. Stimulates a separate organ of the cardiac ligament: chamber, ventricle or atrium.
2. The action of two-chamber ones is aimed at both cardiac chambers, the ventricle and the atrium.
3. Three-chamber pacemakers are used in cases of severe heart failure that causes arrhythmia and ventricular fibrillation.

Indications for surgery to install a pacemaker:

Preparing for heart surgery is the same as preparing for any type of surgery. The patient donates blood and urine. They do tests (general and specific), special studies are carried out: chest radiography, cardiography. In case of chronic diseases, additional examinations are prescribed.

Bradyarrhythmias with complications (MAS syndrome) are considered contraindications to surgery, but there are no absolute contraindications.

Factors that increase the risk of postoperative complications:

• diseases of the hematopoietic system;
• the need to constantly take certain medications;
• presence of bad habits;
• obesity.

Installation of a pacemaker takes about 2-2.5 hours. You will have to spend 24 to 48 hours in the hospital ward. At first, constant monitoring of heart function and blood pressure is necessary.

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Rehabilitation period

At first, the patient may feel pain in the area of ​​the suture and the heart area. Painful sensations are relieved with anesthetics prescribed by the doctor. Independent choice of medications is prohibited.

Each patient is given detailed instructions on how to behave during the rehabilitation period and is warned about complications. The body's reactions to the installation of the device are individual, and it is impossible to give general advice. Mandatory recommendations:

• do not drive a car for 2 weeks;
• avoid physical activity for at least 1.5 months.

The sutures are removed within a week as the scar heals.

It is possible that the following symptoms appeared within a week after the operation:

• painful sensations that are not relieved by prescribed anesthetics;
• shortness of breath, cough;
• general swelling, redness of the scar, discharge from the incision;
• signs of infection: fever and fever,

Then you need to seek medical help. These symptoms indicate the onset of complications.

After the operation, you can lead a normal life, without forgetting about some restrictions. It is necessary to avoid contact with television transmitters, radar installations and radio transmitters of various types, and try not to be exposed to high-voltage currents. You cannot be examined with tomographs or include physical procedures into therapeutic measures.

At airports and in many stores there are warnings about the dangers of passing through magnetic frames for people with a pacemaker. If there is no such warning, you need to approach the persons responsible for the inspection and inform them of the presence of the device. You must have your device owner's card with you. You should always be aware of the presence of a pacemaker when seeking medical help.

A mobile phone or other device that projects radiation should not be carried in a pocket that comes into contact with the heart area. The duration of operation of the devices ranges from 7 to 15 years. When the device reaches the end of its service life, it must be urgently replaced. Having a pacemaker increases life expectancy and improves its quality. But you need to remember: this device is placed on a new heart.

This is a device that regulates heart rate and helps maintain it at a level necessary for a normal and fulfilling life.

Pacemakers are called artificial heart drivers. These are devices designed for patients with abnormal heart rhythm to stabilize it. They are used in cases of serious rhythm disturbances, for example, with blockade, rare pulse, weakness of the sinus node, in case of long pauses between heartbeats, etc.

Installation of a pacemaker is indicated for all types of bradycardia that threaten human life. In this case, the heart rate is less than 60 beats per minute.

Under normal conditions, a normal, healthy heart rhythm depends on electrical impulses originating in the sinus node of the heart's conduction system. If the process of impulse formation is disrupted, a disturbance in the frequency of contractions of the heart muscle occurs. In this case, this small device - a pacemaker - can help.

What are they?

A pacemaker is an electronic device consisting of a special circuit through which impulses are generated. It also contains electrode wires and a battery that keeps the device in operating mode. The device can be single-chamber, two-chamber or three-chamber.

Single chamber– designed to stimulate one cardiac chamber, atrium or ventricle;

Double chamber– perceive and stimulate both cardiac chambers, as well as the atrium and ventricle;

Three-chamber– are installed in patients with heart failure, as well as for the treatment of ventricular tachycardia, ventricular fibrillation and all types of arrhythmias that are life-threatening for the patient.

How is a pacemaker installed?

The device is installed by a doctor using local anesthesia. Through a small incision made parallel to the collarbone. Bypassing the subclavian vein, the pacemaker electrodes are inserted into the corresponding areas of the heart muscle. The entire process is carried out under radiographic control.

The electrodes are then connected to the heart and to the pacemaker. Now the device is placed in a certain area located in the projection of the pectoralis major muscle. Immediately after installation, the stimulator sets the rhythm, transmitting appropriate impulses to the heart, and it begins to contract correctly, maintaining an even and sufficient rhythm.

The device is connected to the heart muscle using the feedback principle. It controls its electrical activity and stimulates the heart only when needed.

But in the case of asystole, when the heart does not beat at all or its rhythm is extremely rare, the device begins to work in constant stimulation mode, sending impulses at a certain frequency set by the doctor. If intrinsic cardiac activity occurs, the stimulator goes into standby mode and turns on again when necessary.

Postoperative period

Before leaving the hospital, the device will be programmed according to the program and to calculate stimulation needs. After returning home, you must adhere to certain rules that will help you recover successfully and quickly after surgery.

After about a couple of weeks, after your health has recovered, you can gradually return to your normal daily life. But for another 1-2 months you should avoid intense physical activity, especially in the upper body. Do not lift weights exceeding 5 kg. Remember that the sutures may come apart due to stress (they will be removed about a week after the pacemaker installation procedure).

During the recovery period, be careful not to make excessive or sudden movements of the shoulder or arm on the side where the pacemaker is installed, so as not to accidentally dislodge the wires.

You cannot drive a car for 1-2 weeks after the operation. Also, during this period, you should not mow lawns or shovel snow. Until your doctor gives permission, transfer these responsibilities to other family members.

If you suddenly feel unwell while doing normal light housework, such as washing the dishes, put it aside and rest. Don't forget that the stimulator is not a new heart. He only directs its rhythm. And if before the operation the heart was weak, then after installing the device, it did not become stronger. The pulse simply leveled out and became more even and measured.

Normal life after surgery

Most often, patients are interested in whether they can use a mobile phone with a stimulator. Of course, in the modern world it is difficult to live without modern means of communication.

However, some restrictions must still be observed. For example, talk on your cell phone as little as possible. Do not wear it on your chest, neck or breast pocket. It's better to keep your phone in your purse or briefcase.

TV, computer, office equipment, washing machine and most household appliances do not affect the operation of the pacemaker. But it is undesirable to be near a microwave oven, as it can affect the installed device.

When going to the dentist, be sure to inform him that you have a pacemaker.

Before traveling, consult with your healthcare provider about how to safely pass through airport detectors. If life-threatening situations occur, seek medical attention immediately. Be healthy!