According to some data, the number of pacemakers implanted in China each year accounts for only 10% of the patients who should be implanted, and the ratio is much lower than that of developed countries such as Europe and the United States, which means that 90% of the “right patients” still refuse to install pacemakers. Pacemaker surgery Figuratively speaking, a pacemaker is a generator plus a wire. The pacemaker is usually implanted under the skin in the upper chest and its wires reach the heart through a vein, with the electrodes at the top of the wires fixed to the inner side of the heart muscle. The pacemaker stimulates the heart muscle to make the heart beat and maintain a normal heartbeat, which can cure slow arrhythmias. Pacemaker implantation is a common procedure today and takes about one hour. The procedure is performed under local anesthesia, usually through a transverse incision in the upper chest just below the clavicle, and the pacemaker electrode lead is inserted into the heart through a subclavian vein. The surgeon fixes the front end of the pacemaker electrode in a specific part of the heart cavity as indicated by a television fluoroscope (an X-ray monitoring device). A small pulse generator (i.e., pacemaker) is then connected to the electrode lead, the pacemaker is placed under the skin inside the incision, and the skin is finally sutured to close the incision. When is a pacemaker required? The main indications for pacemakers are sick sinus node syndrome and atrioventricular block. In most cases, pacemakers are intended for people whose heart rate is too slow to cause discomfort. Pacemakers should be implanted when the heart stops for more than 3 seconds or when the heart rate frequently falls below 40 beats, especially in patients who experience blackouts and sudden fainting. This is the primary and initial therapeutic category of pacemakers. In addition, pacemakers can treat and prevent many diseases. For example, a heart attack can cause the heart muscle to fail to contract forcefully. The reduced contraction of the heart causes the heart to under-pump, resulting in various symptoms such as dizziness, chest tightness, and weakness. For example, in cases of congestive heart failure and severe hypertrophic obstructive cardiomyopathy where medication has failed, multiple pacing electrodes can be installed in various parts of the heart to synchronize multiple electrical stimulation commands to help the heart muscle contract. Meanwhile, some diseases can trigger cardiac arrest or fatal malignant ventricular arrhythmias (e.g., rapid ventricular tachycardia, ventricular fibrillation), and pacemakers with defibrillator function can be installed, which can restore the regular beating of the heart. In addition to this, pacemakers are also indispensable or the only treatment in the comprehensive treatment of certain heart diseases (carotid sinus hypersensitivity syndrome, vasovagal syncope, idiopathic Q-T prolongation syndrome, prevention of rapid atrial arrhythmias, etc.). If you are easily fatigued, have weakness, are lethargic all day long, feel uncomfortable with your heartbeat or have dizziness, blackness or even fainting, you may have a slow heartbeat and should see a cardiologist promptly. Slow heartbeat is usually treated with medication and pacemaker therapy. There are no specific medications for chronic tachycardia. Numerous clinical studies have confirmed that pacemaker implantation is the most effective way to treat slow heartbeat. Cardiac pacing technology has been used for more than half a century and has saved the lives of numerous patients with slow heartbeats. A slow heartbeat can be caused by a lesion in the heart’s command unit (medically known as the sinus node) and/or an obstruction in the conduction of the heartbeat’s commands. Our whole body depends on the contraction of the heart to pump oxygen and nutrients. A slow heartbeat causes low pumping function or a transient stop, which results in a series of symptoms of oxygen deprivation, such as dizziness, vertigo, darkness, syncope, memory loss, fatigue, weakness, activity endurance The symptoms include dizziness, dizziness, black haze, syncope, memory loss, fatigue, weakness, activity endurance, chest tightness, panic, shortness of breath, etc. In severe cases, fainting or death may occur. If these symptoms are transient, or if they are not very obvious, but the examination has revealed a significant cardiac arrest and atrioventricular block, or a fast and slow heartbeat, most patients need pacemaker therapy. In addition, if the patient has to take certain medications that slow down the heart rate and his or her own heartbeat is slow, then a pacemaker may also be needed to protect the heart. Treatment of advanced refractory chronic heart failure With the rapid development of medical technology, pacing technology is changing rapidly and pacing therapy is no longer limited to patients with slow heartbeats. Some pacemakers can also treat refractory chronic heart failure by improving heart function through biventricular synchronous pacing. Biventricular synchronized pacing (abbreviated as CRT) can treat heart failure by restoring the synchronized beating of the right and left ventricles. The prevalence of chronic heart failure in adults in China is about 0.9%, and it is estimated that there are about 5 million patients with heart failure nationwide. Drug therapy has made great progress in recent years and is the basic treatment for heart failure, but there are still poor or ineffective patients, while heart transplant donors are limited and costly. Pacing therapy is developing rapidly and is an effective complementary tool for the treatment of advanced chronic heart failure. CRT-type pacemakers are mainly aimed at patients with chronic heart failure in which the left ventricle is greater than 55, the cardiac output is less than 35%, and the left and right ventricular contractions are not synchronized, allowing the left and right ventricular contractions to be unsynchronized and improving a series of problems with worse cardiac function and less effective blood ejection. Treatment of rapid malignant ventricular arrhythmias Pacemaker technology can save the patient’s life in time in case of severe slow heart rate, and CRT-type pacemakers are an effective treatment for severe refractory chronic heart failure. However, for many heart diseases such as coronary myocardial infarction and dilated cardiomyopathy, patients are not only exposed to the problem of heart failure but also to the risk of sudden onset of rapid ventricular malignant arrhythmias (sustained ventricular tachycardia, ventricular fibrillation), and about 30% of patients with chronic heart failure die from sudden death due to malignant ventricular arrhythmias. Patients with coronary angina pectoris, myocardial infarction, cardiomyopathy, refractory heart failure, and other patients at high risk for malignant tachyarrhythmias, such as ventricular tachycardia or ventricular fibrillation, as well as those with a family history of hereditary malignant arrhythmias and sudden cardiac death, need to be fitted with special pacemakers with resuscitation and defibrillation (ICDs for short) to prevent sudden cardiac death. If better conditions are available, installation of a CRTD is recommended to address both the treatment of heart failure and the prevention of malignant arrhythmias. Pacemaker installers should stay away from strong magnetic fields In daily life, most home appliances, such as electric shavers, TV sets, vacuum cleaners, ovens, etc., do not interfere with the work of pacemakers, and patients can travel safely in cars and airplanes, etc. However, patients should stay away from strong electromagnetic fields, such as radar stations, high-voltage transformers, welding machines, electromagnetic machines, etc. They should not use the side of the ear where the pacemaker is placed to receive cell phones, and should not undergo MRI examinations. At the same time, patients with pacemakers mostly suffer from coronary heart disease, hypertension and other diseases, so the treatment of the original disease should not be neglected after the pacemaker is installed. In fact, patients with pacemakers can also suffer from angina pectoris, myocardial infarction and heart failure. Therefore, it is important not to be paralyzed and to take medication for the primary disease as prescribed by the doctor. It is important to remember that patients with pacemakers should carry an emergency card with their name, age, contact address, date and type of pacemaker installed, etc., after discharge from the hospital, so that the doctor can be informed of the pacemaker’s condition in case of an emergency. Fatal myths Myth 1: The procedure to install a pacemaker is dangerous The implantation of a pacemaker is already a very mature procedure that takes about one hour. The procedure requires very little local anesthesia, which means that the patient will be awake and can relax and undergo the procedure. A transverse incision is usually made in the upper chest just below the clavicle, and after separating the fatty tissue, the pacemaker is buried between the fatty tissue and the deep fascia. The pacemaker is connected to an electrode lead, which is inserted into the patient’s heart and secured to the endocardium by a vein selected in advance by the surgeon. The pacemaker lead is inserted into the heart through a subclavian vein. The process is quite simple. The pacemakers commonly used in clinical practice are small, light, thin, long-lived and multifunctional, only the size of a matchbox, weighing between 25 and 50 grams, using low-energy integrated circuits to generate and control the electrical pulse distribution, and using lithium batteries as the power source, sealed together in a titanium alloy casing, with a life expectancy of 6-7 years. Current artificial pacemakers monitor the patient’s own heart rate and rhythm, and when their own electrical impulses are too slow or even not issued, the pacemaker can automatically issue impulses to stimulate the heart and thus restore the patient’s heartbeat. The power of the pacemaker to mimic the natural heart impulses is extremely weak, but is sufficient to pace the heart, so the pacemaker can help restore the patient’s normal heart rate and rhythm. Studies have shown that 76% of patients who have a pacemaker no longer experience any discomfort and are able to return to their former vibrant lives. Myth #2: A faster or slower heartbeat is not a big deal A survey was conducted and found that 66% of patients did not recognize the importance of treating their arrhythmias. “As doctors, we often tell our patients to have a pacemaker and he says I never do, it’s not that serious.” Second, there is another segment of the population that doesn’t know what the benefits of having a pacemaker are. They would say, “Why should I have one, I can live without one, a doctor asked me to have one two years ago, I didn’t, and I’m still alive today!” Also, there is the relationship with doctors, not all doctors are doctors who do pacing electrophysiology. Some doctors don’t know much about pacemakers, for example, some surgeons are not familiar with these treatments. Some patients may need a 24-hour ambulatory electrocardiogram, but the hospital does not have such equipment, so some patients may be missed. Other doctors do not know enough about which diseases should be treated with pacemakers or ICDs, such as sudden cardiac death, heart failure, etc. Myth 3: Taking medication will cure heart disease Most often pacemakers are intended for people whose heartbeat is too slow to cause discomfort. Pacemakers should be implanted when the heart stops for more than 3 seconds or when the heart rate frequently falls below 40 beats, especially in patients who experience blackness before the eyes or sudden fainting. This is the primary and initial therapeutic category of pacemakers. The efficacy of pharmacological treatment in this group of patients is not exact and in the long run the installation of a pacemaker is the only effective solution. In addition to slow heartbeats, pacemakers can also treat and prevent many diseases, such as heart attacks that prevent the heart muscle from contracting vigorously and cause the heart to under-pump, resulting in various symptoms such as dizziness, chest tightness, and weakness. For example, in cases of congestive heart failure and severe hypertrophic obstructive cardiomyopathy, multiple pacing electrodes can be installed in various parts of the heart to generate multiple electrical stimulation commands simultaneously to help the heart muscle contract. Some diseases can trigger cardiac arrest or fatal malignant ventricular arrhythmias (e.g., rapid ventricular tachycardia, ventricular fibrillation), and pacemakers with defibrillator function can also be installed, which can restore the heart to beat regularly. In addition, pacemakers are an indispensable treatment in the comprehensive treatment of certain cardiac conditions.