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Pacemakers represent one of the earliest and most successful nonpharmacological therapy for arrhythmias. Millions of pacemakers have been implanted since the very first pacemaker was implanted. Drugs are no longer used except in the very acute setting before implantation of a temporary or permanent pacemaker.
A cardiac pacemaker is a device that is used to regulate the heart rate.
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If you have been found to have a heartbeat that is too slow, a pacemaker can
be implanted in the body to take over the function. This small electronic
device automatically monitors and regulates the heartbeat, by transmitting
electrical impulses to stimulate the heart when it is beating too slowly. A
pacemaker consists of a pacing lead and a pulse generator. Single chamber
pacemakers have only a single lead while dual chamber pacemakers have two leads
with one lead in the atrium and the other in the ventricle. Dual chamber
pacemakers are more physiological but more expensive. The indications of pacing are now well established. The most important indication of pacing however remains complete heart block and the sick sinus syndrome which account for 95% of the indication for pacemakers implanted in Singapore. During the last pacemaker survey in 2005 in Singapore, the implant rate was 91 per million. With our ageing population, we can expect that the need for pacemaker implantation in Singapore will rapidly increase.
Single
chamber pacemakers are pacing systems that use one
lead in either the right atrium or the right ventricle of your heart.
A
single lead in the right atrium is commonly used in conditions where the normal
pacemaker of the heart is not working adequately, such as in the case of sick
sinus syndrome. Atrial pacing is used when the sinus node is sending out
signals that are too slow or irregular. However, to use this method of pacing,
the rest of the heart's normal conduction system must be functioning normally.
More
commonly, the single lead is placed in the right ventricle to help correct a
slow or irregular heart beat. This is most often the case when the electrical
flow is slowed or blocked in the region of the atrio-ventricular (A-V) node and
the normal impulses from the atria cannot reach the ventricle. This would
result in too slow a heart beat. The pacemaker system would keep the heart
beating at a steady rate
Dual chamber pacemakers
are pacemaker systems that use a lead in the right atrium as well as the right
ventricle (figure 6). This type of pacing most closely mimics the heart's
normal conduction pattern by pacing sequentially from atria to ventricle thus
maximizing the heart's pumping ability. By having a lead in both the atria and
ventricle the pulse generator is able to continuously regulate the heart's
electrical activity in both chambers. These are the most commonly used
pacemakers at the present time.
Commonly asked questions about pacemakers
Will I need to make any lifestyle changes after my pacemaker is implanted?
There are no significant lifestyle changes that
you will need to make as a result of having a pacemaker implanted. Most
patients resume their normal activities soon after implantation. Specific
issues or concerns should be addressed with your pacemaker physician or nurse.
How often will I need to have my pacemaker checked?
Your pacemaker system will need to be evaluated
by your pacemaker physician, nurse, or your local cardiologist's office at
least twice yearly. A special computer called a programmer
is used to perform a comprehensive evaluation of your pacemaker system. The
programmer has a wand (like a computer
mouse) that is used to communicate with the pacemaker. The wand is placed on
your chest directly over the pulse generator and a radio wave signal is used to
send and receive information from the pulse generator. Changes in the pacemaker
settings can be done via this method as well. A complete assessment of the
pacemaker's sensing and pacing functions, battery life, and diagnostic
information is obtained, which enables your pacemaker physician/nurse to fine
tune your care.
How is the battery changed?
The battery that is used to power your pulse
generator is tightly sealed within the metal shell of the device. Therefore,
when the battery's energy is depleted a whole new pulse generator must be
implanted. The skin over the pulse generator site is numbed up with local
anesthetic. You may also receive a light sedative through a intravenous line to
help you relax. A new incision is made in the skin and the pacemaker pocket is
opened. The pulse generator is removed and lead(s) disconnected. At this time
the lead(s) are hooked to a special analyzer that evaluates the lead(s) for any
evidence of potential malfunction. A new pulse generator is then attached to
the lead(s) and the system is reimplanted in the same pocket. The incision is
sutured (sewn) together and a small dressing applied. Most patients can go home
the same day as their procedure.
Can I use a microwave?
Microwave ovens will not interfere with the
proper functioning of your pacemaker. You can use a microwave oven without
concern.
Can I use a cell phone?
It is possible that a cellular phone might
interfere with the normal functioning of your pacemaker. The interaction is
temporary, however, and will only affect the pacemaker during the time that
your cellular phone is close to your pacemaker. To avoid this potential
interference, it is recommended that you hold the cellular phone on the
opposite side of your body away from the pacemaker. You should also not store
your cellular phone in your breast pocket.You should always try to maintain a
distance of at least 6 inches between your cellular phone and your pacemaker
system.
Do I have to take any precautions at the airport?
If you were to walk through the metal detector at
the airport, it will not harm you nor your pacemaker. However, because the
pacemaker is encased in a metal shell, it is possible that the pacemaker may
set off the security alarm. To avoid this problem, it is generally recommended
that you show your pacemaker identification card to the security agent and
inform him/her that you have an implanted pacemaker system. They should let you
pass around the metal detector. If the airport security wants to scan you with
the "hand wand", they can everywhere except over the device.
This information also pertains to any metal detector such as at a courthouse or
federal building.
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