An implantable cardiac pacemaker is a small, battery-operated medical device that’s placed under the skin to help control abnormal heart rhythms. When the heart’s natural pacemaker malfunctions, a pacemaker delivers electrical pulses to coordinate heartbeats. Modern pacemakers can detect and adjust to different heart rates throughout the day and deliver therapy only when needed.
How a Pacemaker Works?
Implantable Cardiac Pacemaker is consists of a small pulse generator, which houses the battery and electronic circuitry, as well as thin insulated wires called leads that connect directly to the heart. The leads are placed through a vein into the chambers of the heart that require pacing. They detect the heart’s electrical signals and also deliver the small electrical impulses from the generator to prompt the heart muscle to contract when needed.
The pacemaker constantly monitors heart activity through the leads. If it senses the heartbeat is too slow or irregular, it automatically sends out electrical pulses to restore a normal rhythm. This overdrive pacing raises the heart rate until it gets back into the target safe range. The pacemaker can be programmed from outside of the body by a clinician to deliver therapy according to individual patient needs.
Types of Pacemakers
There are different types of pacemakers depending on how many heart chambers they can pace and sense:
- Single chamber pacemakers are used for slow heart rates only. They deliver impulses to just one chamber of the heart -either the atria or ventricles.
- Dual chamber pacemakers are more advanced models that can both sense and pace both upper (atrial) and lower (ventricular) chambers of the heart. They coordinate contractions between the two and more closely mimic the heart's natural rhythm.
- Biventricular pacemakers or cardiac resynchronization therapy (CRT) pacemakers are used for more severe heart failure. In addition to pacing both chambers, they also pace the left ventricle in a particular way to improve synchronization of contractions.
Indications for Pacemaker Implantation
Some of the most common reasons a pacemaker may be implanted include:
- Sinus node dysfunction: The natural pacemaker of the heart (sinus node) is damaged and unable to maintain a regular rhythm.
- Atrioventricular block: There is a delay or block in electrical signals traveling between the upper and lower chambers of the heart.
- Bradycardia: The heart beats too slowly, less than 60 beats per minute while resting.
- Congestive heart failure: The heart's lower chambers don't contract efficiently in synchrony due to underlying damage. CRT pacemakers help in such cases.
Implant Procedure
The pacemaker implantation procedure itself takes about an hour and is performed under local anesthesia. During the procedure:
- An incision is made usually below the collarbone or in the upper chest.
- Leads are then inserted through a vein and guided into position in the heart under fluoroscopy.
- The pacemaker generator is placed under the skin in a pocket created by the surgeon near the incision.
- Leads are connected to the generator and tested for proper function.
- Incisions are closed with dissolvable or removable stitches.
The patient typically stays overnight in the hospital to monitor their recovery. Most people can return to their normal daily activities within 2-4 weeks after the procedure.
Programming and Follow Up Care
During follow up visits, the pacemaker's function and settings can be noninvasively checked using a programmer placed over the generator pocket. This allows clinicians to ensure optimal performance and reprogram the device as a patient's condition changes over time. Patients are followed up indefinitely throughout the device's lifespan to monitor performance and check battery status remotely in most cases nowadays. Replacement surgery is needed when the battery runs low, usually 5-10 years after implantation depending on the model. With advances in technology, pacemakers offer a powerful therapeutic option to support quality of life for patients with symptomatic bradycardia or abnormal heart rhythms.
In an implantable cardiac pacemaker is an important and life-extending treatment for abnormal heart rhythms due to natural or injury-related pacemaker dysfunction. Modern devices offer highly tailored therapy through advanced programming capabilities and remote monitoring features. With proper medical management, pacemakers allow patients to lead active lives for many years.
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Ravina Pandya, Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. (https://www.linkedin.com/in/ravina-pandya-1a3984191)
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