As we grow older, the function of the heart may deteriorate, resulting in a decrease in the number of heartbeats; if the condition persists, there may be a risk of heart failure in severe cases. To treat slow heartbeat, a pacemaker is one of the effective treatments. However, many patients have doubts about rashly installing a “machine” in their bodies, and even worry about the risk of infection. In a recent interview with a reporter from “Sky Post”, cardiologist Tse De-hsin dismantled the 6 myths about pacemaker installation and relieved patients’ doubts.
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1. Who needs a pacemaker?
The target is mainly patients with slow heartbeat. Generally speaking, the heartbeat of a normal person should not be less than 60 beats per minute, but if the heartbeat continues to be lower than 40 beats per minute, the heart may not function normally. One of the main causes of slow heartbeat is related to the degeneration of the heart’s sinus node as the patient grows older. The sinoatrial node is the control tower of the heart. It can send signals to the ventricles through the atrioventricular node, causing the atria and ventricles to contract in coordination, thereby controlling the heart rate.
If there is a problem with the sinoatrial node or the atrioventricular node, there is a chance that the signal sent to the ventricles will be weakened, which will reduce the heart rate. People with slow heartbeat may experience symptoms such as fatigue, easy fatigue, and short-term dizziness. In severe cases, heart failure and sudden death may even occur.
This kind of heart problem caused by heart block is difficult to be adjusted by drugs. Therefore, doctors generally recommend that patients install a pacemaker. too slow.
2. What types of pacemakers are there?
Cardiac pacemakers mainly coordinate the heartbeat by sending out currents. They are composed of two parts: the electrode lead and the pacemaker. Functionally, they can generally be divided into single-wire (single-chamber) and double-wire (double-chamber), which are as follows:
One-liner:
A pacemaker has only one wire implanted in the right ventricle, so it is also called a single-chamber pacemaker, which is suitable for patients with atrial fibrillation or intermittent slow heartbeat.
Double line:
A pacemaker has two wires connecting the right atrium and right ventricle, so it is also called a dual-chamber pacemaker, which can effectively help maintain the coordinated contraction of the atrium and ventricle, and can treat patients with heart block or slow heartbeat.
Dr. Xie pointed out that purely in terms of cost-effectiveness, the cost of a single-line pacemaker is less than that of a double-line pacemaker. Some patients with atrial fibrillation or intermittent bradycardia only need to install a single-line pacemaker. However, a single-line pacemaker can only ensure that the patient’s heartbeat will not be too slow, but it cannot coordinate the beating of the atrium and the ventricle at the same time. There will be a situation where the atrium and the ventricle beat separately, which may make the patient’s physical function worse in disguise, or induce dizziness and other symptoms.
In addition, since the patient’s heart condition may continue to deteriorate with age, it is impossible to predict whether the single-line pacemaker will still be sufficient to support the patient’s heart condition.
Wireless Pacemakers:
At present, some wireless cardiac pacemakers are very small in size, and the pacemaker is placed into the right ventricle from the patient’s thigh through a minimally invasive surgery. And because these pacemakers are directly implanted, there is relatively little risk of infection. However, these pacemakers only have a single-line function. If the patient only has atrial fibrillation, and it is only intermittent, and does not need to rely on atrioventricular coordinated contraction, you can consider choosing this type of wireless pacemaker to reduce the chance of venous embolism.
It should be noted that once a wireless pacemaker is implanted in the heart, it cannot be removed, and the battery will be exhausted in about 8 years, so young patients may have the opportunity to implant 3 or more wireless pacemakers in the heart , and its cardiac function may be negatively affected as a result.
The battery of a wired pacemaker can generally be used for 10 years or more, and it only needs to replace the pacemaker implanted under the patient’s collarbone, and the wire does not need to be replaced if the function is normal.
In conclusion, Dr. Xie pointed out that medical technology does not mean that the newer the better, but that it is necessary to find the most suitable pacemaker according to the condition of the patient. Therefore, patients should discuss with their doctors more and do not blindly pursue new models.
3. How is a pacemaker installed?
The entire operation is performed in a minimally invasive manner. The doctor will perform local anesthesia on the patient’s clavicle, and open a wound about 2-3 cm long, about the size of a 1 yuan coin, and then guide the wire through the vein to the atrium or ventricle .
At this time, the doctor will test the pacing energy of the wires, and at the same time ask the patient to cough, breathe vigorously, etc., to ensure that the wires in the patient’s body can be adjusted to the most stable position. When everything is checked, the two wires will be connected to the pacemaker, and then the pacemaker will be implanted in the patient’s collarbone, and finally the wound will be stitched. The whole operation takes about 1 hour, and patients are usually discharged from the hospital the next day after the operation.
4. Are there risks with having a pacemaker?
At present, the installation of cardiac pacemakers is performed by minimally invasive surgery, which has greatly reduced the risk compared with traditional surgery. Due to the smaller wound, the recovery speed is also faster. As for the risk of wound bleeding, inflammation, infection, and pneumothorax caused by minimally invasive surgery, the risk of wound bleeding, inflammation, infection, and pneumothorax is even lower than 1%. It is also very rare for wires to loosen after surgery.
5. PostoperativemultipleWhat is the point of diagnosis?
After the patient is installed with a pacemaker, he needs regular follow-up visits every 3 months. The doctor will also check the battery status of the pacemaker during follow-up visits. When the battery is found to be running out of power, the follow-up visits will be made more frequently to closely check the power of the pacemaker, and arrange to replace the battery when necessary.
As far as battery replacement is concerned, wired pacemakers are relatively simple. Patients only need to undergo local anesthesia, perform minimally invasive surgery to replace the pacemaker fixed under the collarbone, and reconnect it to the electrode leads.
6. How does the patient pay attention to in life after surgery?
Patients can usually be discharged from the hospital the day after the operation, but it is not recommended to take a bath the day after the operation to avoid wound inflammation. For the first month after surgery, avoid raising your hands above your head and lifting heavy objects, or do some impactful activities, and you can live a normal life for the rest.
In addition, any instrument with a magnetic field may affect the function of the pacemaker. It is recommended that patients keep a distance of 15 cm from these instruments. As for whether the patient can use the phone, since the pacemaker is usually placed on the left clavicle, it is best to put the phone next to the right ear, and try to avoid putting the phone in the chest pocket.
Patients also need to carry a certificate card that lists the pacemaker information. If the patient needs to undergo any additional medical examinations such as MRI, he must let the doctor know that he has a pacemaker in his body. Currently, pacemakers are generally allowed to do so. Magnetic resonance, but you need to adjust the machine in advance, and some old models that are not compatible with magnetic resonance cannot perform magnetic resonance examination. Generally, after the pacemaker stabilizes in the body, the patient can return to normal life.
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Written by: Wu Zifeng
2023-05-22 00:03:56
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