Bradycardia threatens health There are many cases of cardiogenic syncope being misdiagnosed as stroke. In order to confirm the diagnosis of stroke, the receiving physician will first examine the brain CT, and in most cases of middle-aged and elderly people, there are often old or lacunar infarct foci in the brain that are asymptomatic, but through CT examination, these foci will “show up” and become imaging evidence for the physician to confirm the diagnosis of stroke and treat the patient accordingly. In some cases, it is only on further examination that the physician discovers the presence of a slow arrhythmia during follow-up treatment, making it clear that the real cause of the syncope is a slow heartbeat that is causing a lack of blood supply to the brain. Slow arrhythmias, also known as bradycardia, can pose a serious threat to the patient’s health if they are not diagnosed and treated in a timely manner. First, irregular heartbeat can form thrombus in the atrial wall, which can be dislodged by the irregular heartbeat and enter the brain with the blood flow, blocking the cerebral blood vessels and causing a stroke. Secondly, patients who have had syncope due to bradycardia tend to syncope again, and frequent syncope can easily cause serious trauma. For patients who go out alone or engage in high-risk occupations, once they syncope, the accidental injury caused may even be life-threatening. If bradycardia is not treated for a long time, the myocardial ischemic state can be gradually aggravated, and the heart function is further affected. At the same time, due to the insufficient blood supply capacity of the heart, other body organs may be caused by insufficient blood supply and diseases, such as insufficient blood supply to the brain, which can lead to Alzheimer’s disease. There are many such cases, and they even have behavioral abnormalities such as open defecation, which disappear once the bradycardia is controlled. The main treatment for bradycardia is the installation of a pacemaker. The pacemaker is actually the size of a matchbox, weighing between 25 and 50 grams, and the shell is made of cast titanium. During the surgery, the surgeon makes a 4-6 cm incision in the upper chest of the patient, separates the fatty tissue and buries the pacemaker between the fatty tissue and the deep fascia. The pacemaker is connected to a metal lead, which is fed into the patient’s heart by a vein selected in advance. In this way, the pacemaker stimulates the heart with a certain form of artificial pulsed current, which causes the heart to contract effectively and pump blood to supply the body’s needs, thereby increasing the heart rate and pulse and relieving or eliminating the patient’s symptoms. With the increasing maturity of cardiac pacing technology, the acceptance of pacemakers by patients today is greatly increased, and a few physicians will do their best to recommend them to their patients in order to increase the implantation volume. However, we believe that pacemakers are expensive, invasive, and inappropriate pacing may be harmful, so strict indications are essential. In general, asymptomatic bradycardia does not necessarily need to be installed, but only bradycardia that presents with a decrease in cardiac blood output and leads to ischemia in the brain and other organs. For example, patients with atrial fibrillation combined with long intervals is a relatively common clinical phenomenon, but many patients are fitted with pacemakers early. In fact, as long as they are asymptomatic, these patients often may not need pacing therapy. Most of these long intervals are due to occult conduction of the AV node, and in some cases the bradycardia disappears after ablation of AF, so patients should be cautious and take advice before installing a pacemaker. Pacemakers are not the more expensive the better. Pacemakers are becoming more and more versatile, and the price difference is so great that it is always difficult for patients to make a decision when choosing one. Some younger patients with good financial conditions tend to choose expensive pacemakers with good features, while older patients with poor family conditions usually choose cheaper ones. In fact, when choosing a pacemaker, one should consider the patient’s condition and financial situation, weigh the pros and cons, and choose the most suitable pacemaker for the patient. The most basic requirement of a pacemaker is its safety and reliability. As for the various functions it sets, although useful, the more functions it sets, the higher its price, and the difference in price may be tens of thousands of dollars. For example, although pacemakers with frequency response function can intelligently simulate the heartbeat value according to the human activity, i.e., it is fast when it is fast and slow when it is slow, most patients belong to intermittent bradycardia, and for them, spending more than 10,000 yuan to increase this function is superfluous. Only patients with persistent bradycardia or those whose heart rate is found to be decompensated after examination are required to have it installed. In conclusion, different patients have different clinical conditions such as heart rate status, cardiac function, and whether they are combined with other tachyarrhythmias, etc. The development of modern pacemakers provides clinicians and patients with more options. After implantation, the patient’s condition may change over time, so it is important to pay attention to follow-up. The main purpose of the follow-up visit is to check if there are any complications, if the pacing system is working properly, if the electrodes are well positioned, if they are not displaced or broken, and if the battery is about to be depleted. In principle, the two ends are tight and the middle is loose. Usually, the shelf life of single-chamber pacemakers is 8 years and that of dual-chamber pacemakers is about 6 years, so the follow-up interval should be shortened to once every half month about a year before the expiration date, so that the pacemaker can be replaced in time before the battery is exhausted. At the follow-up visit, in addition to a physical examination, an electrocardiogram is performed and pacemaker parameters are recorded. If necessary, an ambulatory electrocardiogram, echocardiogram and chest X-ray are also performed. The doctor will also set the programmed parameters and turn on the corresponding auxiliary functions according to the condition. Many patients have never adjusted the relevant parameters for five or six years since the pacemaker was installed, which is like buying a TV set and never adjusting it. The quality of the follow-up physicians also has a direct impact on the effectiveness of the follow-up. For example, in some hospitals, the pacing clinic is run by a physician from the electrocardiogram department, in others by an engineer from the pacemaker company, and in a considerable number of hospitals, no special pacing clinic has been established. This results in some patients being missed after pacemaker implantation, or not being able to observe the clinical situation and pacing parameter settings in a uniform manner despite the follow-up visits. The reason why our hospital sends specialized cardiologists to the clinic is that we consider the various situations that can be encountered during the follow-up, and that clinical experience and familiarity with the use of pacemakers are essential.