Do you know about “artificial pacemaker implantation”?
Lin Chuangming, Yin Kechun, Department of Cardiovascular Medicine, Fangcun Branch, Guangdong Chinese Medicine Hospital
An artificial pacemaker is composed of a pulse generator and an electrode wire connected to it, which can stimulate the heart with a certain form of artificial pulse current to produce rhythmic contraction of the heart. The pulse generator is flat and round, very small, about 40 mm x 50 mm x 6 mm, and weighing about 30 grams. It is actually a microcomputer powered by a high-performance battery. The pacemaker is usually embedded under the skin in the upper chest, its lead reaches the heart through a vein, and the electrodes at the tip of the lead are fixed to the inner side of the heart muscle. When the pacemaker works, electrical impulses from the pulse generator are transmitted to the myocardium via the wires and electrodes, and the myocardium senses the electrical impulses to produce a contraction. At the same time, the pacemaker electrodes collect the heart’s activity and store it in a chip inside the pulse generator for analysis. The mode of operation of a common pacemaker can be represented by three word codes: The first word code indicates which heart chamber is stimulated by the pacemaker: A = atrium, V = ventricle, D = atrium and ventricle biventricular. The second character code indicates which cavity the pacemaker is able to sense its own excitation, A = atrium, V = ventricle, D = both atrium and ventricle, and O = no sensing function. The third character code indicates in which way the pacemaker reacts after sensing the heart’s own excitation, T=triggered response, I=inhibited response, D (or T/I) = both triggered and inhibited response, O=no response. The fourth character code indicates the performance of program control, P=Pathing, M=Multiple program control, O=No program control and frequency adaptive performance, R=Frequency adaptive function, the fifth character code indicates the working mode of anti-tachyarrhythmia, R=Pacing, S=Stroke, D=Pacing+Stroke, O=No antiarrhythmia function. Yin Kechun, Cardiovascular Disease Specialist, Guangdong Provincial Hospital of Traditional Chinese Medicine
If your heart rate is too slow or abnormal, and you experience symptoms such as fainting, dizziness, fatigue, shortness of breath, palpitations, and loss of consciousness, you need a pacemaker to help your heart to beat normally. A pacemaker senses your heartbeat and sends pulses only when needed, and waits for the heart to beat on its own when not needed. Some pacemakers can also sense the patient’s activity, such as climbing stairs or exercising, to speed up the heart rate to suit the body’s needs. Once the pacemaker is implanted in the body, its settings can be changed. The pacemaker settings are adjusted by the physician using a programmable controller.
The electrical impulses from the pacemaker are usually too weak to be felt by most people. If you feel them, please tell your doctor and he can adjust the settings to make you more comfortable. Pacemakers generally last 5-10 years, depending on the type of battery, the frequency of the pulses and the patient’s own heart rhythm, and if you need the help of a pacemaker frequently, the battery will last a relatively short time. The battery does not suddenly stop working during the period of battery depletion. Most of the time, the battery gradually runs out of power over a period of several months and can be replaced if you make regular follow-up visits to the hospital to check the battery. Pacemaker batteries cannot be replaced alone and require a new surgery to replace the pacemaker. Replacing the pacemaker is a very simple procedure that allows you to get out of bed for 3 days after surgery and be discharged from the hospital in a week.
Pacemakers have been implanted in millions of people worldwide. Pacemaker implantation is a minimally invasive procedure with short time, minimal trauma and quick recovery. To prevent electrode displacement, patients need to lie flat or semi-prone for 2-3 days after surgery, with no bed activities or right-sided lying, and appropriate restrictions on the activities of the operated upper limbs. It is recommended to turn gently and not to cough violently or breathe deeply to avoid electrode displacement. After surgery, attention should also be paid to the prevention of wound bleeding and infection, and observation of the wound for blood oozing and redness and swelling. The stitches can usually be removed 7-10 days after surgery.
You will need to rest for a few days or weeks after the surgery. The wound will gradually heal and you will gradually get better. At first you may feel the presence of the pacemaker and slowly you will not pay much attention to it. When you go home after the procedure, you need to do what you can to keep the wound clean and dry. If you notice redness, warmth, swelling, significant pain or the beginning of discharge, please inform your doctor immediately. Usually the pacemaker is not fixed to the endocardium until 3 months after implantation. In order to avoid dislocation of the pacemaker lead, you should sleep in a flat or left-sided position for 1 month after surgery; for 3 months after surgery, you should avoid strenuous activities of the upper limb on the side where the pacemaker is installed and avoid raising your arm high, but light activities such as washing and eating are fine for daily activities. It is forbidden to rub or massage the pacemaker site with force and to avoid collision of the pacemaker with sharp objects. Three months after the pacemaker is installed, you can swim, run, dance, go on trips, etc., if your physical strength allows. At all times, you should avoid activities that involve violent vibrations, such as horseback riding and bumper cars.
After the pacemaker implantation, you will be given a pacemaker identification card, which lets everyone know that you have a pacemaker implanted. It contains important information such as the type of pacemaker you have. Keep this card with you at all times, as it will provide critical information to paramedics at any time, especially if you need emergency assistance. After the pacemaker is implanted, you should get used to taking your pulse every morning and recording it, and if there are any major abnormalities, you should seek medical attention. You should contact your physician to follow up on your pacemaker at 1 month, 3 months, 6 months, and 1 year after surgery, and every 6 months or 1 year thereafter. After 6-7 years of pacemaker use, the pacemaker should be followed up every 6 months or 3 months, and the decision to replace the pacemaker should be made on the advice of the physician.
Since the pacemaker is a delicate electronic device, its performance can be affected by strong magnetic fields or currents, which can affect its normal function, and in some cases it is necessary to be vigilant and not to take it lightly. Electromagnetic interference can be caused by: electrical equipment that is in poor working condition or not properly grounded; electrical equipment that can generate large amounts of energy, such as industrial generators arc welders or resistance welding machines; magnets, large heaters and radio broadcast transmitters can also cause electromagnetic interference; medical equipment, including magnetic resonance, radiation therapy and transcutaneous electrical nerve stimulation; metal detectors used in shopping malls and airports detectors and security systems. In general, common household appliances such as TV sets, video players, VCRs, video cameras, microwave ovens, washing machines, refrigerators, vacuum cleaners, irons and shavers do not affect the function of pacemakers; however, radios, TV sets and magnetized cups with magnetic properties should be used at a distance of 15 cm or more from pacemakers as far as possible. Other common household power tools and non-professional RF transmission devices, etc., generally do not interfere with the function of the pacemaker if they are operated properly. If interference occurs, simply move away from or turn off these appliances quickly. For metal detectors and security systems used in shopping malls and airports, patients with pacemakers should pass through such entrance and exit security devices with a normal gait and avoid staying in this area. Many people now use cell phones. Although test data show that the interaction between cell phones and pacemakers is temporary, the distance between the handheld cell phone and the pacemaker should be kept at least 15 cm, and the cell phone should be placed on the opposite side of the implanted pacemaker after use, not in a breast pocket or pinned to a belt 15 cm away from the pacemaker, because the cell phone is on The mobile phone can also transmit signals when it is on standby. Contact your physician if you feel otherwise after being in close proximity to a source of electromagnetic interference. At airports, show your pacemaker identification card to security and you will not have to walk through a metal detector. Before undergoing any medical or dental treatments and examinations, tell your doctor that you have a pacemaker. Do not perform any transheat therapy, even if your pacemaker is turned off, it can cause damage to the tissue around the implanted electrodes and cause permanent damage to the pacemaker.
Although you are fitted with a pacemaker, you may also need to use anti-arrhythmic drugs at the same time to treat other arrhythmias (such as a rapid heart rate). Do not stop taking your anti-arrhythmic medication without your doctor’s advice.