Permanent pacemakers are the mainstay of treatment for irreversible cardiac pacing and conduction disorders of various origins. It is often used in patients with “symptomatic bradycardia”. Symptomatic bradycardia” refers to the slow ventricular rate that leads to insufficient blood supply to the brain, which may result in dizziness, vertigo, blackout, and syncope (transient loss of consciousness); insufficient blood supply to the whole body may result in fatigue, reduced endurance to physical activity, and congestive heart failure. Indications for pacemaker implantation Pacemaker implantation is suitable for the treatment of bradyarrhythmias accompanied by symptoms such as fainting, blackout, chest tightness, fatigue and cardiac insufficiency. Preoperative preparation for pacemaker implantation 1. Preoperative auxiliary examination: blood test, urine test, stool test, liver and kidney function, blood glucose, electrolyte and coagulation time, chest X-ray, cardiac ultrasound, dynamic electrocardiogram. 2.Preparation of medication: Stop using medication that activates blood circulation and removes blood stasis, such as heparin, aspirin, warfarin, etc., in order to prevent intraoperative hemorrhage and formation of hematoma in the subcutaneous capsule. 3.Pre-operative training bed urination and defecation, instruct the patient to master the breath-holding action, in order to cooperate with the venous puncture insertion of pacemaker catheter. 4, skin preparation preoperative skin preparation range should be larger, because the scheduled venous cannulation such as failure, often in its vicinity or even switch to the opposite side of the puncture, surgical site cleaning should be thorough. 6.Preoperative diet should be eaten less but not forbidden to eat and drink before the operation, in order to prevent the patient’s defecation, hypoglycemia or poor venous filling. 7, drug preparation preoperative routine antibiotic (such as penicillin) test, and good procaine test. Pacemaker implantation surgical procedure Pacemaker installation surgery is performed by a cardiologist, usually under local anesthesia. In this procedure, an electrode lead is inserted through a vein in the arm or under the clavicle, and under X-ray fluoroscopy, it is inserted into a predetermined pacing position in the heart chambers, secured and tested. Then a pacemaker connected to the electrode lead is buried in the chest, the skin is sutured, and the procedure is completed. (Local anesthesia → Insertion of a catheter into the puncture portal of the cephalic vein/subclavian vein below the clavicle → Delivery of the electrode lead into the heart → Determination of its position → Fixation of the electrode in a specific location within the heart chambers → Testing of performance. Subcutaneous implantation of the pacemaker → fabrication of the pacemaker capsule → attachment of the pacemaker → final suturing of the skin to close the incision). Advantages of pacemaker implantation Atrial synchronization is maintained and frequency adaptation is achieved by atrial tracking. Surgery takes 1-2 hours and the patient can be discharged from the hospital 7 days after surgery. Post-operative attention after pacemaker implantation 1, appropriate exercise, avoid overwork: avoid strenuous activities and heavy lifting of the upper limbs on the operated side within 3 months after the operation to prevent electrode displacement and bleeding of the capsule (it usually takes 3 months for the scar tissue around the electrode to be formed), and exercise appropriately according to the physical condition every day, such as taking a walk. In daily life, do not do large-scale exercise and excessive physical labor, activities to feel comfortable, not excessive fatigue limit. 2, regular life, emotional stability: patients are advised to develop good living habits, maintain a regular rhythm of life, adequate sleep and stable emotions, avoid overwork, pay attention to warmth, avoid getting cold, and take medication at regular intervals as prescribed by the doctor. 3.Please go to the specialized hospital to test the pacemaker function regularly, generally monthly follow-up within six months, and every six months thereafter. When the service life of the pacemaker is approaching, the follow-up period should be shortened and the pacemaker should be replaced when the battery is exhausted. 4, after the surgery, please avoid the following environment to prevent interference: ① to pay attention to the living environment, there is no magnetic interference, absolutely prohibit close to the strong magnetic field, electric field, general household electrical appliances will not affect, but pay attention to such as hairdryer do not frequent switch, contact with home appliances such as sense of abnormality should be careful to stay away. ② to prevent interference in the hospital environment: tell patients and their families, a variety of diagnostic and therapeutic equipment in the hospital, such as magnetic resonance, surgical knife, lithotripsy shockwave, electrocautery, etc. will be a certain interference with the pacemaker and the impact may lead to serious consequences, so the installation of pacemakers are prohibited from accepting the above checks and treatments, such as those who really need it, it is necessary to be under strict cardiac supervision, and maintain a certain distance from the pacemaker If it is really necessary, it should be done under strict cardiac monitoring and at a certain distance from the pacemaker. Therefore, when you visit the hospital due to illness, you should tell the medical staff in advance. ③Prevent the interference of family and working environment: pacemaker in the design although experts also consider the influence of some normal electrical appliances, such as household electrical tools, microwave ovens, low-power radio, etc., but still need to pay attention to in the maintenance of electrical appliances should be maintained in accordance with the original design, grounding is reliable, or else electromagnetic wave or microwave leakage of lethal interference to the pacemaker. In addition, radar, high-voltage electric fields, cell phones, have an effect on the pacemaker, so the pacemaker installer should avoid approaching such equipment.