04/11/2024
A pacemaker is a surgically implanted device that copies the electrical pulses that control heartbeats. Pacemaker surgery may be performed as an outpatient or inpatient treatment, depending on your health and the reason for the heartbeat issue. A pacemaker is used to repair an abnormally slow heartbeat either permanently or temporarily, such as after open-heart surgery. Implanting a pacemaker is considered a less invasive technique. This blog describes pacemaker implantation surgery, including its purpose, risks, and contraindications. It also discusses what to expect before, during, and following the procedure.
What Is Pacemaker Surgery?
Pacemaker surgery involves placing a pacemaker device.
A pacemaker consists of a pulse generator with a battery and circuitry, as well as one to three small electrical wires that are implanted in the heart chambers. The pacemaker produces electrical pulses that stimulate a heartbeat and are timed to ensure a proper cardiac rhythm. Pacemaker surgery is used to address a variety of cardiac rhythm issues. While it is most commonly performed on adults with heart problems, it can be used on children with congenital heart abnormalities. Most pacemakers are put in under local anaesthesia, however, you may also receive intravenous (IVF) medication to help you relax.
Types of Pacemaker Surgery?
Pacemakers are classified according to the type of arrhythmia they treat. They're broadly classified as follows:
- Single-chamber pacemakers send electrical impulses to a single chamber of the heart. They are most commonly used to insert the right ventricle in persons who have chronic atrial fibrillation & require pacing to maintain a normal heartbeat.
- Dua-chamber pacemakers are used when the rate of chamber contractions is improper. The device corrects this by sending synchronised pulses to the right atrium & ventricle (lower chamber).
- Biventricular pacemakers, commonly known as cardiac resynchronization treatment, are used to treat heart failure. They work to ensure synchronous contraction of the right and left ventricles, allowing them to pump together and improving cardiac function.
There are also combination devices known as automatic implanted cardioverter-defibrillators (AICDs), which include both a pacemaker and a defibrillator. AICDs not only regulate heart rhythm but also provide a jolt of electricity to rectify ventricular tachycardia or ventricular fibrillation.
Risk of Pacemaker Surgery
Pacemaker surgery, like other types of surgery and anaesthesia, has its own set of dangers and concerns. Although the surgery is considered low risk, approximately 3% of pacemaker recipients will experience some type of problem, which can range from mild and manageable to potentially life-threatening.
Risks and complications of pacemaker implantation surgery include:
- Electrode lead dislodgment
- Phlebitis (venous inflammation)
- Hemothorax (accumulation of blood between the chest wall and lungs)
- Pneumothorax (collapsed lung)
- Post-operative infection
- Cardiac perforation and tamponade
A serious thromboembolic occurrence in which a blood clot forms and causes a stroke, heart attack, pulmonary embolism, or deep vein thrombosis (DVT).
According to a 2019 study published in the Journal of Clinical Medicine, the two most prevalent problems were pneumothorax and lead dislodgment, with rates of 3.87% and 8.39%, respectively . Severe consequences, such as stroke, occur in less than 2% of instances and are typically seen in persons with pre-existing risk factors.
How to Prepare
Pacemaker implementation is a common surgery, but it requires preparation. Once a pacemaker has been recommended, you will meet with a cardiologist or general surgeon to go over the procedure, how to prepare and what to expect.
Location: Pacemaker surgery is performed in a hospital's operating room cardiac catheterization lab, or a specialised surgical centre. The room will be outfitted with an ECG machine, a mechanical ventilator, and a "crash cart" in case of a cardiac emergency. It will also include a fluoroscope, which uses X-rays to create live images of the heart to aid in the placement of pacemaker leads.
What to Wear: If you are having surgery as an outpatient, you should select clothes that are easy to get into and out of. You will be asked to put on a hospital gown and remove any hairpieces, eyewear, dentures, hearing aids, and tongue or lip piercings. If your surgery involves an overnight hospital stay for observation, bring only what you need: toiletries, daily medications, a comfy robe & slippers, your cell phone and charger, and an additional pair of socks and underwear. Leave the important things at home.
What is Required for Hospital Surgery
Food and Drink: You must stop eating at midnight the night before your procedure. On the day before the operation, you are permitted to drink a few sips of water while taking your morning pills, if applicable. Nothing should be eaten orally within four hours of the operation, including water, chewing gum, or sweets. The majority of pacemaker procedures are performed in the morning to accommodate the extended fasting time.
Medications: Before having pacemaker surgery, you should avoid taking medications that cause bleeding. Some may need to be discontinued a day or two before surgery, while others may be avoided for a week or more before and after. They include:
- Anticoagulants (blood thinners) like Coumadin (warfarin)
- Antiplatelet medications, such as Plavix (clopidogrel)
- NSAIDs include aspirin, Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and Mobic (meloxicam).
To minimise issues and interactions, tell your doctor about any medications you are taking, whether they are prescription, over-the-counter, nutritional, herbal, or recreational.
What is required: To register for hospital admissions, you will need to provide your driver's licence or another kind of official ID. You'll also be asked for your insurance card. Although most facilities will bill for their services, some may want to pay in advance for copay or coinsurance costs. Call early to confirm that the facility accepts your insurance and that all medical professionals, including the anesthesiologist, are within the network. If a down payment is asked, inquire as to which payment methods the office takes. You will also need to bring someone who can drive you home. Even if only local anaesthesia is used, your arm will be in a sling for 24 to 48 hours following the treatment. This, along with the aftereffects of IV sedation, makes driving risky.
Summary
Pacemaker implantation is a minimally invasive operation that involves implanting a pacemaker device, which may help cure a variety of diseases that cause irregular heartbeats. A pacemaker can help relieve symptoms such as palpitations, shortness of breath, and difficulty exercising. The pacemaker is introduced under local anaesthesia. You may also receive a medication that makes you sleepy. The surgeon will make a small incision in your chest near your shoulder to insert one or more leads into your heart. Depending on your condition and overall health, you may be able to return home the same day, or you may be admitted to the hospital overnight for observation.
Frequently Asked Questions
Q1: What is the usual recovery time?
A: After a few weeks, many people can get back to their normal activities. It is also critical that you follow any doctor's advice regarding changes in your lifestyle or medications.
Q2: What do you need to do after pacemaker surgery?
A: Following pacemaker surgery, you must have frequent device checkups to monitor your heart health, the pacemaker's settings, and battery life. Most pacemakers endure 5 to 15 years. With regular device inspections, your healthcare professional will be able to inform you when your pacemaker's battery needs to be changed. You'll be handed a pacemaker identification card. You should keep it with you at all times. It's a good idea to leave a copy or a picture with a family member.