Zhucheng Hospital of Traditional Chinese Medicine has been performing pacemaker implantation for many years and has implanted pacemakers in many patients. Some of the patients are unsure and fearful of pacemaker implantation. I have learned more deeply about the tremendous role of pacemaker application through my study in higher level hospitals, and I would like to tell you some of the information that patients or colleagues need to know and may want to know.
I. Preoperative
Without going into the indications for pacemaker implantation, the outpatient doctor will certainly tell you: “To have a pacemaker, no drug can treat it”. The pacemaker is a flat piece of about 20 ml, which feels like a larger watch (not round, of course), and is usually implanted under the skin on the left or right side, just below the clavicle. The electrode lead (hereinafter referred to as electrode), which is attached to the pacemaker at one end, enters the heart through a blood vessel at the other end and is anchored to the right atrium and/or right ventricle.
Before understanding the classification, it is useful to talk about the working relationship between the atria and the ventricles to help understand why there are single-chamber and dual-chamber pacemakers; as you know, the main function of the heart is to pump blood to supply the whole body. Simply put, the atrium squeezes out blood to the ventricle, and then the ventricle closes the interatrial channel while contracting, so that blood is pumped to the arteries, where it flows throughout the body and returns to the veins, where it is oxygenated in the lungs and then flows into the atrium. …… A cycle is completed. Therefore, the process of atrial “extrusion” will affect the final amount of blood pumped out of the ventricle, and the atria first “squeeze”, the ventricle after the “pump” sequence is very important (imagine if the coordination is not good, the atria contracted at the same time will cause what). (imagine what would happen if the atria and ventricles contracted at the same time). Of course, compared to the atrial “squeeze” compared to the ventricular “pump”, the role of life support is much smaller, the image is that the ventricular “pump” to live, with the atrial The image is that the ventricular “pump” can only live, but with the atrial “pump” can live better.
1. Ordinary pacemakers: single-chamber and dual-chamber. Single-chamber is only one electrode, mostly connected to the right ventricle, so the main role is to maintain the effective “pump” of the ventricle, playing the main role of the pacemaker to maintain life. They are mainly used in patients with persistent atrial fibrillation.
2. Dual-chamber pacemakers: Two electrodes, one connected to the right ventricle and one to the right atrium, are used to coordinate the atrioventricular contraction – ‘squeezing’ and ‘pumping’ – so as to enables a closer approximation of the normal heart beat sequence. Suitable for patients with non-persistent atrial fibrillation.
Special features of pacemakers.
The most used: the frequency adaptation function (R): mainly used in patients with sinus bradycardia, who cannot adjust their own heart rate to match the amount of activity at the time during physical activity. Pacemakers with the R function detect the activity level and adjust the pacing frequency to match it, thus further approximating the normal heart rhythm. Both single- and dual-chamber pacemakers are available with an R function.
Pacemakers are also classified as internal implantable cardioverter-defibrillators (ICDs) and so-called “triple-chamber pacemakers” (CRTs), as well as CRTDs (triple-chamber pacemaker + ICD). The population for which they are indicated will be described in a future issue of the Apricot Grove newsletter.
After admission, the doctor will usually tell you the general conditions of the implanted pacemaker before implantation, such as single and double chambers, whether it is with R, etc. Remember, although you spend money on the implant, it is not the same as buying groceries, and what you know about this aspect of the cure is far from enough to choose a pacemaker autonomously, nor is it necessary to do so, adding to your worries. So trusting your doctor will make the operation much smoother.
Second, intraoperative
Generally, local anesthesia is used, unless the patient is a child who cannot control himself or a mentally impaired person who is under general anesthesia. During the operation, the patient can clearly tell the surgeon that you are uncomfortable, “pain”, “can’t hold it”, etc., but it is better not to move unless you get the surgeon’s consent, after all, the operation area is sterile, and in some operations such as puncture, your sudden movements will hurt yourself. You will not feel any pain during the operation.
You will feel a mild tingling, swelling and a sense of pressure from the surgeon. The total operation time (for a normal pacemaker) is not too long. The wound will be dressed with pressure to stop the bleeding at the end of the operation.
III. Before discharge from the hospital after surgery
You will be given prophylactic antibiotics when you return to the ward. You may have wound discomfort that night and may take painkillers and sleeping pills.
You will be told to lie flat for 24 hours, in fact the main purpose is to keep the upper body immobile for 24 hours, the main purpose is to prevent the electrode from dislocating from the heart, after all, it has just been “hooked”. The legs can be moved (you must move them to avoid the formation of blood clots in the lower limbs).
Usually the doctor will change your medication and release the compression bandage on the second day. The stitches will be removed seven days after surgery.
Fourth, after discharge
You will be told not to move the shoulder joint on the side of the pacemaker for 3 months, also to avoid dislocation of the electrode. After 3 months, you can use that side of the arm to lift up and other movements. You can even do breaststroke. Also, after 3 months you should come to the hospital to have your pacemaker programmed and have the parameters adjusted to ensure that it works more effectively.
After 3 months, don’t forget to ask your ward for your pacemaker’s guarantee card, which contains information about the type of pacemaker implanted, the guarantee period, the name of the implanted operator, etc. You can come to the program once every 1-2 years after a smooth chemistry, and you’ll be fine. After a few years have passed and there is still one year to go before the guarantee year, you will be worried, will it run out of power? Well, don’t be overly nervous first, generally the pacemaker can still be used normally for at least 3 months after it shows no power during the programmed control (it is recommended to replace it), and you won’t feel any discomfort during these 3 months, so arrange a good time to come to the hospital to replace it as soon as possible. If you don’t pay attention to this, after 3 months the pacemaker will really run out of power and will try to ensure your safety in the most energy-efficient mode, at this time the dual-chamber pacing may become single-chamber and the pacing frequency will become fixed instead of the previous programmed frequency, and you may feel uncomfortable. At this point, you should get a replacement immediately.
If you don’t feel it yet, the pacemaker will eventually run out of power and fail, and you may pay the price for your carelessness – your heart rate will return to the pacemaker-less state. Therefore, it is recommended that you should shorten the programming interval when you have one year left before the guarantee period, e.g. once every six months, and once every 3-6 months after the guarantee period when there is still power.
The life expectancy of a pacemaker is related to many factors, such as the pacing voltage, the number of functions turned on and the number of pacing sessions. However, even if it is not paced, it will still consume power because the pacemaker is still working with sensing and other functions. Finally, don’t think that a dead battery means replacing a battery, after all, it doesn’t apply to a radio. Most of the electrodes can be used for about 20 years, so most patients do not need to reinsert the electrodes when replacing them. The difference is that it costs less money for the electrodes, and you don’t have to lie flat for 24 hours at that time. Of course, the electrodes will be tested intraoperatively to see if they can continue to be used.