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A pacemaker is a device that monitors that beat of the heart and records any erratic movement. When an abnormality in the heartbeat is detected, the pacemaker sends small electrical impulses to the heart muscle to regularise the heart rate. It also helps to stimulate the lower chambers of the heart, known as ventricles. A pacemaker is best suited for patients that have problems such as arrhythmia, fainting spells and congestive heart failure.

The main objective of a pacemaker is to control the irregular heartbeat. The doctor implants a pacemaker in the heart of a patient to treat a slow heartbeat after a heart attack, heart surgery or a drug overdose. Moreover, a permanent pacemaker is also aimed to rectify a prolonged irregular heartbeat or to treat heart failure.

A pacemaker imitates the natural activity of the electrical system of the heart and essentially includes two components:

· Pulse Generator: It is a tiny metal container, which hosts the battery and the electrical circuitry that controls the electrical pulse rate of the heart.

· Leads: Also known as electrodes, these are insulated wires that are situated in the chamber(s) of the heart and transfer the electrical pulses to regulate the uneven heart rate.

With recent advancements, leadless pacemakers are also available for implantation. That said, pacemakers only send out electrical impulses when an irregular heartbeat is detected. The pacemaker sends electrical signals to the heart to correct the beat when the heart starts beating slowly. Moreover, with medical advancements in this field, pacemakers now come with a sensory motion detector that function based on the body motion and breathing rate of the person and accordingly sends signals.

Types of Permanent Pacemakers

Generally, pacemakers are of the below three types:

· Single-chamber pacemakers that transfer electrical impulses to the right ventricle of the heart

· Dual-chamber pacemakers that transfer electrical impulses to the right ventricle and atrium of the heart

· Biventricular help to regulate the abnormal beats by stimulating the lower chambers of the heart

The Procedure of a Permanent Pacemaker Implantation

To prepare the patient for the pacemaker implantation, the doctor gives specific medications through an intravenous line. Moreover, the patient is given local anaesthesia but remains awake throughout the procedure. Once, the patient is sedated, the incision area is sanitized and then the surgeon inserts one or more flexible, insulated wires into a vein situated under or near the collarbone.

These wire/wires are directed to the heart with the help of X-ray images that are displayed on a monitor. One end of the insulated wire/wires is connected to the pulse generator that is implanted under the collarbone skin.

Once the pacemaker is placed, the doctor determines a minimum heart rate and sets the pacemaker accordingly. If the heart rate drops below the specified rate, the pacemaker automatically generates

an electrical impulse, which passes through the lead onto the heart muscle. This, in turn, contracts the heart muscle and creates a heartbeat.

After a Permanent Pacemaker Implantation

Once the pacemaker is permanently implanted in the heart of the patient, the doctor keeps the patient under observation for a day or more as per the condition. If there are no complications and the patient is stabilised, he/she is discharged. However, a family or a friend should accompany the patient back home.

The battery life, the working and the overall heart health can be monitored by the doctor remotely. After the surgery, it is generally recommended to avoid any activities that can cause an exertion to the heart muscle. Moreover, any pressure at the site of the implantation should be avoided. In case, there is any discomfort, pain or other troubling symptoms, medical attention must be sought immediately.

To ensure the pacemaker plantation is successful, the doctor will advise the patient to follow a few precautions such as:

· Using the cell phone from a minimum distance of 6 inches from the pacemaker

· Avoiding activities that involve lingering or leaning against a metal detector

· Maintain a safe distance, not less than 2 feet, from any power-generating objects such as welding machines, high-voltage transformers, generators, etc.

Moreover, in case the patient undergoes any other surgery, test or imaging exam in the future while the pacemaker is in place, the concerned doctor should be duly informed beforehand.

Risks of a Permanent Pacemaker Implantation

A pacemaker implantation surgery is considered a very safe surgical procedure and has minimal risks. Some of the risks associated with rare cases include:

· Infection at the pacemaker implantation site

· The allergic reaction of the special dye or anaesthesia used during the procedure

· Chances of swelling, bruising or bleeding at the site of the incision

· Injury to the nearby blood vessels and tissues

· Collapsed lungs

Results of a Permanent Pacemaker Implantation

The pacemaker helps to regulate the heart rate of the patient and ensure a healthy heart. It is a close-to-natural imitation of the heart’s electrical activity. However, a patient with a pacemaker might need to follow some specific precautions to ensure there are no complications and the pacemaker continues to function effectively.

The patient must discuss all fears, lifestyle modifications, precautions, medications, safety measures, etc. with the doctor after the surgery. That said, a pacemaker is not a hindrance in life, instead it effectively improves the quality of life of the patient. In some cases, the patients can take a few days to adjust to the pacemaker. But as days pass by, the body starts to naturally adopt the new machine. Hence, the patient can easily carry on with everyday life without thinking about it.

Overall, a pacemaker improves the heart condition and rectifies issues that occur due to slow heartbeat such as fatigue, fainting, lightheadedness, etc. But to maintain the heart-health, it is important to get the condition of the pacemaker checked every three to six months. Further, if there are any symptoms such as swollen legs, fainting, unexplainable weight gain, etc. – the patient must inform the doctor. Also, typically pacemakers have a battery life of 15 years and need to be replaced via a small and simple procedure.

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