Definition & Overview
The insertion of a new or replacement pacemaker is a minimally invasive procedure performed under local anaesthesia. It can be performed using the transvenous technique where the electrode is inserted through one of the veins of the heart.
A pacemaker is an important and life-saving device that is placed either in the chest or abdomen to correct abnormal heart rhythms. It uses an electrode that makes use of electrical impulses to stimulate the heart to beat at a normal rate.
Pacemakers are used to treat arrhythmias. An arrhythmia is a heart disorder characterised by either too slow (bradycardia) or too fast (tachycardia) heartbeats. These are caused by the heart’s poor electrical conduction system. An electrode is useful in such cases as it is designed to reestablish the heart’s normal rhythm.
The device has a pulse generator that holds the battery and a tiny chip (tiny computer). This stores the programme that “teaches” the heart to beat normally. It also has leads or wires that send generated impulses to the heart muscle to make it contract. They also record the electrical activity of the heart.
A pacemaker’s battery life can last for years. When the battery wears out, the device is taken out and replaced.
The installation of a permanent pacemaker (either new or replacement) is done in an operating room or cardiac catheterisation lab.
Who Should Undergo and Expected Results?
The insertion of a permanent pacemaker is indicated for patients diagnosed with arrhythmias. The procedure to replace the pacemaker, on the other hand, is indicated if the installed pacemaker is not functioning properly or when its battery has worn out.
The replacement or installation of a new pacemaker allows for an improved quality of life of patients suffering from unstable heartbeats. By normalising the heart rhythm, pacemakers can treat symptoms including fainting, lightheadedness, and fatigue. This device corrects irregularities the moment they happen by sending electric impulses to the heart muscle. This continues as long as the pacemaker detects a pacing problem. Most pacemakers in use today are designed to automatically adjust the heart rate based on the patient’s level of physical activity. As such, they can allow patients to resume a more active lifestyle.
How is the Procedure Performed?
Before the procedure is performed, the patient is administered with antibiotics via IV to reduce the risk of postoperative infections. The area where the pacemaker is inserted is then cleaned and injected with local anaesthetic. The anaesthesia numbs the area and prevents patients from feeling pain during the procedure.
The incision is then made in the collarbone, which allows doctors to avoid most of the vital organs near the heart and provides an easy access to the heart muscle.
The surgeon then inserts the pacemaker leads into the large subclavian vein in the shoulder. The three leads are put together and guided toward the target heart muscle into the right atrium.
The pacing generator is placed right below the skin beneath the collarbone. On some occasions, pacemaker leads are placed or inserted through a surgical incision in the chest wall using an invasive procedure called thoracotomy. With this technique, the pacing generator is placed right in the abdominal area.
As soon as the pacing generator is in place, the threaded leads are connected to the battery. When this is done, the surgeon sews up the wound.
A fluoroscopic examination is also carried out to properly guide the leads to the target area and avoid puncturing or injuring nearby organs.
Surgeons use either a single-chamber or dual-chamber pacer depending on the severity of the arrhythmia.
Possible Risks and Complications
The installation of a pacemaker is almost always a safe procedure. Generally, patients only develop a mild reaction to local anaesthetics.
Others experience skin burns due to the prolonged use of fluoroscopes, which happens when surgeons took time in installing the leads into the right place.
Other risks and possible complications include the following:
- Haematoma, or the swelling of clotted blood within nearby tissues
- Phlebitis, or the inflammation of the walls of the veins
- Local infection
- Puncture or injury to heart arteries
- Haemothorax, or the presence of blood in the pleural cavity
- Pneumothorax, or the presence of air or gas in the space between the chest wall and the lungs
- Catheter-related thrombosis
- Pulmonary embolism
- Air embolism
- Puncture or damage to the atrial wall, which may lead to pericardial tamponade or pressure around the heart due to the presence of excess fluid in the pericardial cavity
- Lost guide wire
- Anaphylaxis, or the acute reaction to some tools and drugs used during the procedure including the medicines inserted through IV
Chylothorax, a type of pleural effusion (presence of excess amount of fluid in the pleural cavity)
Zhan C, Baine WB, Sedrakyan A, Steiner C. Cardiac device implantation in the United States from 1997 through 2004: a population-based analysis. J Gen Intern Med. 2008 Jan. 23 Suppl 1:13-9.
Bernstein AD, Daubert JC, Fletcher RD, et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol. 2002. 25:260.
## What is Insertion of New or Replacement of Permanent Pacemaker with Transvenous Electrodes?
Insertion of a new or replacement permanent pacemaker with transvenous electrodes is a medical procedure to regulate abnormal heart rhythms. A pacemaker is a small, battery-powered device that delivers electrical impulses to the heart, helping it maintain a regular beat. Transvenous electrodes are thin wires that are threaded through a vein and connected to the heart tissue.
* **Improved Heartbeat Regulation:** Pacemakers can correct slow or irregular heart rhythms, reducing symptoms such as fatigue, dizziness, and shortness of breath.
* **Reduced Risk of Heart Failure:** By regulating the heartbeat, pacemakers prevent the heart from overworking, which can reduce the risk of heart failure.
* **Better Quality of Life:** Improved heartbeat regulation can significantly enhance daily function, allowing individuals to engage in activities that were previously difficult or impossible.
* **Prolonged Survival:** Pacemakers can improve the prognosis for individuals with serious heart arrhythmias, prolonging life expectancy.
## Who is Eligible for a Pacemaker?
Patients with certain heart conditions, such as:
* **Bradycardia:** Slow heart rate (less than 60 beats per minute)
* **Heart Block:** Interruption in the electrical signals between the heart’s upper and lower chambers
* **Sick Sinus Syndrome:** Disorder of the heart’s natural pacemaker, the sinus node
* **Pacemaker Malfunction:** Failure or malfunction of an existing pacemaker
The procedure typically takes 1-2 hours and is performed under local anesthesia. The surgeon:
* Makes an incision in the chest or abdomen
* Creates a small pocket beneath the skin for the pacemaker
* Inserts the transvenous electrodes into a vein and advances them to the heart
* Connects the electrodes to the pacemaker
## Expected Results:**
* **Immediate Improvement:** Most patients experience immediate improvement in their heart rhythm after the procedure.
* **Gradual Recovery:** Complete recovery from the procedure may take several weeks, as the incision heals and the body adjusts to the pacemaker.
* **Routine Follow-Ups:** Regular check-ups are necessary to monitor the pacemaker’s function and ensure optimal performance.
* **Long-Term Success:** Pacemakers can last for several years before the battery needs to be replaced.
* Insertion of New Pacemaker
* Replacement of Permanent Pacemaker
* Transvenous Electrodes
* Heart Arrhythmias
* Heart Block
* Sick Sinus Syndrome
* Pacemaker Malfunction
* Local Anesthesia
* Battery Replacement
* Heartbeat Regulation
* Reduced Risk of Heart Failure
* Improved Quality of Life
* Prolonged Survival