Some devices may need to be adjusted if your medical condition or lifestyle changes. Most adjustments are done using a device called a programmer. This is a specialized computer that communicates with the pacemaker or ICD using magnetic signals via a "wand" or loop placed over your chest where the device is implanted.
Your doctor will instruct you about the schedule of follow-up visits you should keep based on your condition and type of device. You may have an assessment using a monitor and telephone line or an internet connection on a periodic basis.
Most current ICDs and some pacemakers can now be followed remotely. This means the device can wirelessly transmit data to your doctor. If the original leads are working properly, in most cases, they will be left in place and reattached to the new device. Most device batteries will last at least 5 to 7 years, depending on use. After that time, the battery or pulse generator will need to be replaced. Depending on your condition, you may have a pacemaker with 1 to 3 flexible, insulated wires leads placed in one or more chambers of your heart.
These wires deliver the electrical pulses to adjust your heart rate. However, some newer pacemakers don't require leads. Pacemakers work only when needed.
If your heartbeat is too slow bradycardia , the pacemaker sends electrical signals to your heart to correct the beat. Some newer pacemakers also have sensors that detect body motion or breathing rate and signal the devices to increase heart rate during exercise, as needed. Complications related to pacemaker surgery or having a pacemaker are uncommon, but could include:.
Before your doctor decides if you need a pacemaker, you'll have several tests done to find the cause of your irregular heartbeat. Tests done before you get a pacemaker could include:. You'll likely be awake during the surgery to implant the pacemaker, which typically takes a few hours. A specialist will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax. Your chest is cleaned with special soap.
Most pacemaker implantations are done using local anesthesia to numb the area of the incisions. However, the amount of sedation needed for the procedure depends on your specific health conditions. You may be fully awake or lightly sedated, or you may be given general anesthesia fully asleep. One or more wires are inserted into a major vein under or near your collarbone and guided to your heart using X-ray images.
One end of each wire is secured at the appropriate position in your heart, while the other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone. A leadless pacemaker is smaller and typically requires a less invasive surgery to implant the device. The pulse generator and other pacemaker parts are contained in a single capsule. The doctor inserts a flexible sheath catheter in a vein in the groin and then guides the single component pacemaker through the catheter to the proper position in the heart.
You'll likely stay in the hospital for a day after having a pacemaker implanted. Your pacemaker will be programmed to fit your heart rhythm needs.
You'll need to arrange to have someone drive you home from the hospital. Your doctor might recommend that you avoid vigorous exercise or heavy lifting for about a month. Avoid putting pressure on the area where the pacemaker was implanted. If you have pain in that area, ask your doctor about taking medicines available without a prescription, such as acetaminophen Tylenol, others or ibuprofen Advil, Motrin IB, others.
It didn't answer any of my questions. I still don't know what to do next. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. Patient Education. Pacemaker Failure Pacemakers are reliable life-saving devices.
Some reasons you may have a pacemaker are to Help increase your heart rate if it is too slow Address problems with the electrical system within in the heart resulting in heart block Improve heart failure when there is evidence of both heart muscle damage and problems with the electrical system of the heart. Slow a fast, irregular heart rate that required medicine or procedures leading to a heart rate that is too slow Each of the above problems typically causes you to feel symptoms.
Signs and symptoms of pacemaker failure or malfunction include: Dizziness, lightheadedness Fainting or loss of consciousness Palpitations Hard time breathing Slow or fast heart rate, or a combination of both Constant twitching of muscles in the chest or abdomen Frequent hiccups A complete failure of a modern pacemaker is rare. Causes for a pacemaker failure include: Battery depletion Loose or broken wire between the pacemaker and the heart Electronic circuit failure resulting from a break in wire insulation or a fracture in the wire Electrolyte abnormality such as high potassium in the blood Electromagnetic interference from certain devices such as power generators, arc welders, and powerful magnets found in medical devices, heavy equipment, and motors A pacemaker lead getting pulled out of position A change in your condition that needs pacemaker reprogramming Common household devices, such as microwave ovens, TV remotes, heating pads, and electric blankets don't interfere with pacemakers.
Home care The following are general care guidelines: Don't push, pull, or twist the pulse generator unit placed under your skin. Follow-up care Follow up with your healthcare provider as advised. When to seek emergent care You may need to seek emergent care or call if you have any of the following: Trouble breathing Fainting or loss of consciousness Chest pain Frequent or persistent palpitations the sense that your heart is fluttering or beating fast or hard or irregularly Slower than usual heart rate compared to your normal Chest pain with weakness, dizziness, fainting, heavy sweating, nausea, or vomiting Extreme drowsiness, confusion It is important to keep in mind that these symptoms may be a result of a problem with your pacemaker.
When to seek medical advice Call your healthcare provider right away if any of the following occur: New symptoms of weakness, dizziness, lightheadedness Pain, redness, swelling, drainage from pacemaker implant site or other signs of infection Fever of Before the device corrects that episode, you could get dizzy, light headed, or pass out.
People who have serious or recurrent problems with heart rhythm disturbances may have restrictions and may have activities such as driving curtailed. Usually, when a pacemaker is placed and it is working well, the problem has been corrected and driving is allowed. For implantable defibrillators, the issue is not so simple. Some things are not recommended, like heavy weight lifting, because that could crack or damage a lead an electrical connection from the device to the heart.
Very extreme upper extremity motion over a long period of time could do the same thing. People who do a lot of exercise and have defibrillators could get a shock from their defibrillators when they don't need a shock because their heart is beating too fast, but it is not due to an abnormal or life-threatening problem.
In electrophysiology we treat heart rhythm problems, such as when the heart becomes irregular, when it gets fast or when it gets slow. There are various ways to treat heart rhythm problems. If the heart rhythm gets very slow and it is not treatable with changes in medications then a pacemaker is needed.
What a pacemaker does is keep the heart beating at the proper rate and from beating too slow. It also will only activate if it is needed, it is not shocking people all the time. An implanted defibrillator is a bigger device.
It is there to prevent death from a cardiac arrest. The device shocks the heart if it needs to be shocked, because of a life-threatening rhythm disturbance from the lower chambers of the heart. It can correct this rhythm. Because it has a pacemaker built into it, a defibrillator also has the capability of stimulating the heart like a pacemaker, to help stop fast rhythms, at times, and to prevent the heart from getting too slow.
These devices are highly reliable. The device often has to be programmed to the patient's needs, the medical condition and the situation. Cost is an issue. Some people must have a device implanted at any cost, as they most certainly would not survive without that device. In those cases, devices are placed without question. There are other situations where a device implantation may not be completely clear, necessary, or allowed by the present billing structure.
Currently a high quality of battery — a lithium battery — that wears out slowly is used. There is a point before the battery fails when we have several months to decide what to do.
The battery's energy supply does wear out, and it can vary depending on the kind of device--some devices will last maybe five years, maybe ten years, and some people get more life out of it and some get less, depending on the situation and how much they use it. What we do when the battery reaches its end of life is we open up the pocket where the device is located, which is under the skin, and we unscrew the leads.
Then we plug in a new device and close up the skin. We put in a brand new device, often a higher quality, more technologically advanced device.
A pacemaker implant can be done under local anesthesia, but most patients prefer to have sedation, so we use conscious sedation, where the patient can respond to us. We do not generally place a tube down the throat for most people unless we use general anesthesia. For defibrillator implants we have to use larger amounts of conscious sedation because we need to test the device.
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