Rehabilitation after installation of a pacemaker. Postoperative period and possible complications. Diagnostics before installation

If you have been diagnosed with heart problems that could be fatal, do not despair. Modern medicine Today, you may be offered to install an assistant to resume normal cardiac activity.

For many patients, living with an implant may seem like a challenge, but this little device will give you the chance to new life. You will be able to go to work, play sports, walk with your children as before - everything that you did before and that brought you positive emotions.

Qualified cardiologists will tell you how to behave correctly after surgery. In the article you will learn all the intricacies of choosing and installing a device, as well as side effects and how to eliminate them.

Unfortunately, over time, a person does not become younger. Every year, various diseases appear and appear after a certain period of time. With each passing year, each person begins to notice the appearance of certain complaints: there is a stomach ache, there is a “shot” in the knee, there is a “jammed” back.

But the most common thing that causes anxiety in the patient is probably the appearance of pain in the heart, or the feeling of its normal functioning. At the same time, sometimes, any special methods no research required. People themselves note these disturbances and characterize them as “interruptions in the heart,” perhaps this is where the expression “heart is acting up” came from.

Currently, thanks to the development of medicine, it has become possible to study the mechanisms of these disorders and appropriate treatment. One of the options for correcting these disorders and the possibility of restoring lost function is the installation of an electrical pacemaker (pacemaker).

The modern device is a complex device in a sealed housing made of a special inert medical titanium alloy with small dimensions. The case itself contains a battery and a microprocessor unit.

Modern stimulators are guided by the heart’s own electrical activity; when contractions slow down, are disrupted, or a pause occurs, within a programmed time, the stimulator begins to generate an electrical discharge to stimulate myocardial contractions.

And if there is a normal rhythm of impulses, the pacemaker does not generate these impulses. These are so-called “on-demand” stimulants. Currently, there are several types of pacemakers. There are single-chamber, two-chamber, three-chamber.

A pacemaker is a small device, about the size of a half dollar, placed under the skin near your heart to help control your heartbeat. The pacemaker is introduced as part of what is often referred to as "cardiac resynchronization therapy."

People may need a pacemaker for a number of reasons - mainly one group of conditions called arrhythmia, in which the heart's rhythm is abnormal.

• Normal aging of the heart can disrupt your heartbeat, causing it to beat too slowly.
• Injury to the heart muscle resulting from heart attack, is another common cause of irregular heartbeat.
• Some medications may also affect your heart rate.
• For some, hereditary diseases- Cause of irregular heart rhythm.

Regardless of the root cause of the irregular heart rhythm, a pacemaker will help you fix it.

Today, there are such types of pacemakers as single-chamber, two-chamber and three-chamber.

1. Single chamber pacemaker

Single-chamber pacemakers appeared first, initially pacing at a given frequency, but models soon appeared that sense the heart's own activity and operate as needed. A single-chamber pacemaker is equipped with one electrode installed in one chamber of the heart (ventricle).

2. Dual chamber pacemaker

The next generation pacemaker is a dual-chamber pacemaker. The peculiarity of this model is the presence of two electrodes, which ensures synchronous contraction of the ventricles and atria and, as a result, stimulation becomes physiological, significantly increasing the patient’s functional capabilities.

The electrodes of a dual-chamber pacemaker are installed in the ventricle and atrium. An example of such effective devices can be Medtronic pacemakers, and these are the models that the Cardiodom clinic uses.

The Medtronic pacemaker is a reliable device that can provide the highest quality of life to the patient for many years. The most latest developments ECS operating in dual-chamber mode are able to detect the presence of atrial fibrillation and flutter in a patient and automatically switch to another, safe (single-chamber) stimulation mode - the so-called “switch mode”.

Thus, the possibility of maintaining supraventricular tachycardia is excluded.

3. Three chamber pacemaker

These EX models are among the most modern and high-tech. Unlike a two-chamber pacemaker, there are already three electrodes that stimulate contractions of the three parts of the heart in a certain sequence.

A pacemaker or cardioverter-defibrillator of this type can be installed in a patient with the most dangerous form of arrhythmia (ventricular tachycardia and ventricular fibrillation) or to prevent sudden cardiac death.

Thus, today there are different types of pacemakers, which allows you to choose the best option in each specific case. By installing a pacemaker with appropriate characteristics, we can confidently say that the quality and life expectancy of the patient will increase significantly. You can read more detailed information in the section “Main types of pacemakers.”

Electrodes used in ECS are of two types - models with active and models with passive fixation. Active fixation involves attaching an electrode inside the heart using a special attachment that resembles a bottle opener. Passive fixation is carried out using special antennae at the end of the electrode.

Indications for surgery to install a pacemaker are the following conditions:

• bradycardia with clinical manifestations (pulse less than 40 beats/min);
• bradycardia accompanied by Morgagni-Adam-Stokes syndrome (MAS);
• severe disturbances of myocardial contractile function during physical activity;
• a combination of increased and decreased heart contractions;
• insufficient increase in heart rate under load and sufficient contraction of the myocardium at rest (chronotropic competence);
• carotid sinus syndrome;
• atrial fibrillation (pacemakers are indicated for atrial fibrillation);
• A-B blockade 2-3 degrees;
• incomplete blockade;
• weakness syndrome sinus node(SSSU).

A pacemaker can be installed permanently, but a temporary pacemaker can also be used. Indications for the use of this device are varied, for example, an external pacemaker can be installed in diagnostic or for preventive purposes, as well as in preparation for surgery to install a permanent pacemaker.

In addition, the use of a temporary pacemaker is advisable in cases where it is necessary to correct any condition - paroxysmal tachyaarthymia, bradycardia due to CVS or acute heart attack.

An external pacemaker consists of oversized electrodes applied to the heart area on the anterior surface chest and between the left shoulder blade and the spine in the projection of the heart.

For those who need a pacemaker, there are practically no contraindications; the only contraindication to installing a pacemaker may be the unreasonableness of the operation. Studies have shown that the longer the arrhythmia lasts, the more difficult it is to restore normal sinus rhythm hearts.

The use of a pacemaker for arrhythmia guarantees constant maintenance of such a rhythm - new generation devices recognize paroxysms and instantly stop them, preventing disorders from developing. Thus, a pacemaker for arrhythmia can be confidently called the most effective remedy.

The need for cardiac surgery can be emergency, when the patient’s life is impossible without an operation to install a pacemaker, or planned, when his heart can work independently for several months even with rhythm disturbances.

IN the latter case The operation is carried out as planned, and before performing it it is advisable to conduct a full examination of the patient.

The list of required tests may vary in different clinics. Basically the following must be done:

• ECG, including daily monitoring of ECG and blood pressure according to Holter, which allows you to register even very rare but significant rhythm disturbances over a period of one to three days,
• EchoCG (ultrasound of the heart),
• Blood test for thyroid hormones,
• Examination by a cardiologist or arrhythmologist,
• Clinical tests blood - general, biochemical, blood test for coagulation,
• Blood test for HIV, syphilis and hepatitis B and C,
• General urine test, stool test for worm eggs,
• FGDS for exclusion peptic ulcer stomach - if it is present, treatment by a gastroenterologist or therapist is mandatory, since after surgery, medications are prescribed that thin the blood, but have a destructive effect on the gastric mucosa, which can lead to gastric bleeding,
• Consultation with an ENT doctor and dentist (to exclude foci chronic infection, which can have a negative effect on the heart, when identified, lesions should be promptly sanitized and treated),
• Consultations with specialized specialists if there are chronic diseases (neurologist, endocrinologist, nephrologist, etc.),
• In some cases, an MRI of the brain may be needed if the patient has had a stroke.

How to place a pacemaker

Now let's talk about how a pacemaker is installed. If you watch a video of how a pacemaker is installed, you will notice that a cardiac surgeon performs it under X-ray control, and total time The procedure varies depending on the type of implanted device:

• a single-chamber pacemaker will require half an hour;
• for a two-chamber pacemaker – 1 hour;
• A three-chamber pacemaker requires 2.5 hours to install.

Typically, surgery to install a pacemaker occurs under local anesthesia.

The operation to implant an pacemaker consists of the following steps:

1. Preparing for surgery. This includes processing surgical field and local anesthesia. An anesthetic drug (novocaine, trimecaine, lidocaine) is injected into the skin and underlying tissues.
2. Installation of electrodes. The surgeon makes a small incision in the subclavian region. Next, the electrodes under X-ray control are inserted sequentially through the subclavian vein into the desired cardiac chamber.
3. Implantation of the pacemaker housing. The device body is implanted under the collarbone, and it can be installed subcutaneously or deepened under pectoral muscle.

In our country, the device is more often implanted in right-handed people on the left, and in left-handed people on the right, which makes it easier for them to use the device.

4. The electrodes are connected to the already implanted device.
5. Device programming. It is produced individually to suit the patient’s needs, taking into account the clinical situation and the capabilities of the device (which also determine the cost of the pacemaker). In modern devices, the doctor can set the basic heart rate, both for the state of physical activity and for rest.

Essentially, this is all the basic information about how a pacemaker is installed.

The operation to install a pacemaker can last from forty minutes to three and a half hours, depending on the type of device. In general, any of the stimulators consists of an electronic circuit - a pulse generator and conductor electrodes.

The power source for the device is a battery, designed for an average of 7-8 years of continuous operation. To avoid rejection of the foreign body by the body, the circuit is placed in a titanium case.

The invasive intervention is performed by a cardiac surgeon under the control of X-ray equipment. The presence of an anesthesiologist is also mandatory, despite the fact that in most cases local anesthesia is used.

Direct implantation includes the following steps:

• tissue incision in the collarbone area;
• sequential insertion of electrodes through the subclavian vein into the corresponding parts of the heart;
• placing the stimulator body in the prepared bed;
• connecting electrodes to the body;
• individual setting of the device operating mode.

In order not to create discomfort in the patient’s daily life, modern devices are programmed in the “on demand” mode.

This means that the device delivers impulses until the heart begins to contract on its own in the desired rhythm, after which the device turns off - the next time it turns on when the organ stops sending a signal in a timely manner.

It is worth knowing that complications after installing a pacemaker occur in no more than 3-5% of cases, so you should not be afraid of this operation.

Early postoperative complications:

• leakage pleural cavity(pneumothorax);
• thromboembolism;
• bleeding;
• violation of insulation, displacement, fracture of the electrode;
• infection of the surgical wound area.

Long-term complications:

• ECS syndrome – shortness of breath, dizziness, decreased blood pressure, episodic loss of consciousness;
• pacemaker-induced tachycardia;
• premature failures in the ECS.

Surgery to insert a pacemaker should be performed by an experienced surgeon under X-ray guidance, which avoids most of the complications that arise at an early stage. And in the future, the patient must undergo regular examinations and be registered with a dispensary.

If there are complaints about deterioration in health, the patient should immediately consult with the attending physician.

A pacemaker is a small electrical device that, once implanted in the body, is designed to artificially create electrical impulses and ensure regular heartbeats. In essence, this device is a customizable pacemaker, which, in the process of its operation, “imposes” the correct beat on the heart.

Installing a pacemaker is a rather serious and responsible step that requires good reasons. The process itself is invasive. The unjustification of implantation is the only contraindication to its implementation.

The decision to undergo surgery is made on a strictly individual basis, depending on the clinical picture of the underlying disease, concomitant diagnoses, age, gender, and lifestyle of the patient. However, there are a number of diagnoses, the formulation of which is an absolute indication for pacemaker implantation.

These include:

• bradycardia with severe symptoms - a decrease in heart rate to less than 50 beats per minute;
• complete heart block - discrepancy between the rhythms of the atria and ventricles;
• severe heart failure;
• some forms of cardiomyopathies, in which the resulting structural changes significantly affect the contractile activity of the heart.

Artificial pacemakers can be:

• single-chamber, regulating the functioning of only one part of the heart - the atrium or ventricle;
• two-chamber, perceiving and stimulating simultaneously two chambers of the organ;
• three-chamber, having a special device for the treatment of heart failure.

The development of science and technology has divided all pacemakers into frequency-adaptive ones, which automatically increase the frequency of generated impulses with increasing physical activity, and non-frequency pacemakers, which work in accordance with specified indicators.

Requirements modern life forced to equip each of the devices, especially imported ones, with many additional parameters and functions that allow the device to be maximally adapted to each patient.

A modern pacemaker is not just a heart simulator, it is a high-tech device that allows for multi-stage safety for the patient. The developers provide protection from interference, such as external electromagnetic or mechanical influence, protection from tachysystolic rhythm disturbances, etc.

Even in cases where the pacemaker battery cannot be replaced, which could cause death, key vital functions are identified and maintained in emergency mode. Programming is carried out in the proximity of a special programmer head and the device, which eliminates failures, reconfiguration or accidental interference with the operation of the device.

The main danger that patients are interested in is the failure of the pacemaker and, as a result, immediate death. However, despite this possibility, the probability of failure is negligible. More precisely, a few hundredths of a percent.

Another thing is that the presence of an electronic device, albeit a high-tech one, requires a special attitude towards it, towards your rhythm of life and living conditions, and special attention during pregnancy. Another dangerous consequence of using a heart muscle stimulator can be pacemaker syndrome.

Then implantation leads to a number of reasons that cause dizziness, nagging pain in the chest, malaise, or even pain in the jaws.

The operation of the stimulator changes the ECG picture. Artificial impulses lead to the fact that the ECG cannot reflect the real and objective situation and condition of the patient’s heart. In this regard, there are risks of untimely detection of such dangerous disease, like coronary heart disease.

A patient can receive a disability group due to a pacemaker, but the decision to assign a specific group is made collectively and requires a thorough analysis of the loss of performance. Modern pacemakers allow patients to feel good during pregnancy.

Pregnancy proceeds as usual, the only thing is delivery by caesarean section, and special attention to the use of power tools and appliances. Pregnancy will be under the supervision of a physician who will rule out dangerous or harmful factors that could lead to serious consequences.

Basic laws of life with a pacemaker

Implantation of a pacemaker conventionally divides the patient’s life into “before” and “after”. The new rules after surgery include a number of requirements and restrictions, compliance with which should become the daily norm. Reviews from people who have been living with a pacemaker for several years generally indicate an increase in the quality of life after its installation.

Strict adherence to the instructions will avoid complications, side effects, painlessly and quickly adapt to new living conditions. Life with a pacemaker is divided into three stages, each of which has its own requirements:

1. First week after surgery

During this period the patient is in the hospital. Under the close supervision of the attending physician and medical personnel the sutures are healing.

It is important to keep the surgical wound clean and dry. The cardiologist takes regular measurements of heart rate.

With absence negative factors, on the fifth day after implantation it is already possible to take a light shower, and a week later the patient is discharged from the hospital.

2. The first three months with the device

A person with a pacemaker is placed on a dispensary register. The first scheduled examination is carried out after three months. However, you should immediately consult a doctor if the patient feels unwell, dizziness, tachycardia, swelling or pain in the area where the device is installed, unreasonable attacks of hiccups occur, or any sound signals from the device are heard.

During this period, it is recommended to listen especially carefully to your body. The mode of life and work should be as gentle as possible. Lifting loads heavier than five kilograms is prohibited. Even light work should be done with the hand opposite the pacemaker area.

3. The remaining period before replacing batteries

Six months later, a follow-up examination of the patient is scheduled again; from this point on, the frequency of visits to the cardiologist is normally once every six months. Skipping scheduled procedures is prohibited. Even if the date of the examination coincides with the period of the business trip, you must find out in advance about the possibility of undergoing a scheduled consultation at local clinics.

If there are no warning factors, your doctor may gradually lift some restrictions. However, among them there are those that are permanent, regardless of the time after implantation of the pacemaker and the patient’s well-being.

Before leaving the hospital, the pacemaker will be programmed according to your pacing needs. When you return home, follow these steps to ensure a normal recovery:

1. Ask your doctor when it is safe to shower, swim, or expose the surgical site to water;
2. Once you feel normal, you can return to daily activities. This may take about two weeks;
3. For 4-6 weeks, avoid physical activity, especially those associated with top part bodies;
4. Avoid excessive arm/shoulder movement on the pacemaker side for two weeks. This will help prevent the wires from moving;
5. Do not drive for one week after surgery;
6. The stitches will be removed within one week;
7. Procedures to avoid after pacemaker insertion:

• Heat therapy (often used in physical therapy);
• High voltage or radar technology (e.g. arc welding, high-voltage wires, radar installations or smelting furnaces);
• Radio and television transmitters;

A hard ridge may form on the skin along the incision, which usually resolves as the wound heals.

Replacement of a pacemaker may be indicated for emergency reasons (suppuration of the pacemaker bed, critical charge or breakdown installed device), and as planned - in the event that the ECS test reveals that the battery is depleted.

It is worth noting that pacemaker replacement is always performed under local anesthesia, even if the installation was performed under general anesthesia. The operation to replace a pacemaker takes a minimum amount of time, and after it the patient recovers as quickly as possible.

When a pacemaker is replaced, the operation is often also the least expensive. How much does it cost to install a pacemaker? How much will a pacemaker cost for atrial fibrillation, and how to choose the right model? You will find answers to these and other questions about pacemaker implantation below.

For those who need to install a pacemaker, cost plays a significant role. Of course, it is optimal to install the best pacemaker at an affordable price, and this option is quite possible. Where is a pacemaker installed inexpensively and with high quality? Of course, at the CardioDom clinic! What factors shape the total cost?

Installing a pacemaker in Moscow may not cost much at all - it depends, first of all, on what kind of pacemaker you plan to buy, as well as on the pricing policy of the clinic where the preparation for the operation, the operation itself, and the rehabilitation period will take place.

The Cardiodom Clinic offers to buy a pacemaker at the best price, and you can also count on the highest quality of medical care!

Depending on which generation of pacemaker you choose, the price may vary significantly. So, there are models of several categories:

1. category.

IN in this case implantation of a pacemaker will be quite expensive, but we are talking about the best pacemakers that exist today.

These are imported models, the quality of workmanship is the best, many devices are characterized by the presence of a second sensor, a wide range of settings, the presence of a sleep mode, Holter monitoring, etc.

Thus, implantation of a pacemaker in this category means ensuring quality of life and health due to High Quality device. At the same time, it is worth remembering that by purchasing a pacemaker of this category, you get increased energy consumption of the device and, as a result, a shorter service life.

In addition, regardless of whether you are going to install a pacemaker in Moscow or in another city, its price will always be high.

2. category.

Buying pacemakers in this category is the best option in terms of cost and quality of the devices.

In this case, installing a pacemaker in Moscow will be much cheaper, although, of course, models in this category are somewhat inferior to models of the first category in terms of functionality, but are not inferior in reliability!

3. category. Outdated models. They are quite reliable, but they are inferior to models of the first two categories in functionality, appearance, comfort of use. The main advantage of this category is the minimum price.

1. Electrical devices

Although pacemakers are equipped with protection against interference from other electrical devices, strong electric fields should still be avoided. The use of almost all household appliances is allowed: TV, radio, refrigerator, tape recorder, microwave oven, computer, electric razor, hair dryer, washing machine.

To avoid interference, you should not approach the pacemaker implantation site closer than 10 cm to an electrical appliance, lean against the front wall of the microwave (and generally avoid it) or the screen of a working TV. You should stay away from welding equipment, electric steelmaking furnaces, and high-voltage power lines.

It is not advisable to go through control turnstiles in shops, airports, and museums. In this case, upon discharge from the hospital, the patient is given a device passport and an owner’s card, which must be presented during the search, after which it can be replaced by a personal search.

The KS is also not afraid of most office equipment. It is advisable to develop the habit of grasping appliance plugs and other voltage sources with the hand further away from the pacemaker.

2. Mobile phone

Long conversations on it are undesirable, and you need to hold the receiver 30 cm or more from the CS. When talking, hold the tube to the ear on the opposite side of the implantation site. Do not carry the handset in your breast pocket or around your neck.

3. Sport

It is prohibited to engage in contact and traumatic sports, that is, team games, martial arts, since any blow to abdominal cavity or chest may damage the device. For the same reason, shooting with a gun is not recommended.

With a pacemaker, you can return to walking, swimming, and other exercise that allows you to constant control well-being and allow you to comply with safety rules.

The area of ​​the body where the pacemaker was implanted should not be exposed to direct sunlight. It should be kept covered with some kind of cloth at all times. Also, avoid swimming in cold water. It is especially important for car enthusiasts to remember that they should not touch live wires while repairing a car or replacing a battery.

Validity period and how long they last with the device

On average, the lifespan of a pacemaker is determined by the capacity of the battery, designed for 7-10 years of operation. When the battery life is approaching, the device will give a signal during the next scheduled examination.

After this, you should replace the battery with a new one. Therefore, the question of how long people can live with a pacemaker also depends on the regularity of visiting the doctor. There is an opinion that, being a foreign body, the CS can harm a person. This is not at all true, despite the fact that often there is no alternative to installing it.

In order to continue completely full life You have to put up with only minor restrictions that are worth it. In addition, it can be installed completely free of charge.

You can often hear the question of how long people can live with a pacemaker, especially from those for whom such surgery is recommended. Medical practice shows that people with an implanted pacemaker, provided they follow all the doctor’s recommendations, live no less than other people. In other words, having a pacemaker can only prolong life, not make it shorter.

There is a misconception that sports and life with a pacemaker are incompatible concepts. This is not entirely true. There are a number of sports activities and physical exercises that, six months after installation of the device, are not only not contraindicated, but are also extremely beneficial for the cardiovascular system, namely:

• measured swimming without diving,
• hiking and race walking,
• gymnastics and yoga,
• golf,
• tennis.

The main rule in training should be moderation - you cannot overexert yourself and do something through force. Diving, rifle and shotgun shooting, powerlifting, as well as all contact sports during which the patient may receive a blow to the area of ​​the installed pacemaker are prohibited.

The number of workouts, their duration and feasibility should be agreed with the treating cardiologist.

A pacemaker is a device that reacts extremely sensitively to changes in the environment. magnetic field. This circumstance must be taken into account in life “after” implantation. Reviews indicate that among the electrical appliances that surround a person in everyday life, the most dangerous are a microwave oven, a TV, and a power tool (hammer, drill, jigsaw).

It is not recommended to approach these devices while they are running. As for the mobile phone, it also belongs to the risk group. Completely abandon this “good” in modern world It's unlikely to succeed. But you will have to minimize its use, as well as carry it not in your pocket, but in a bag or purse.

A heart pacemaker is an absolute excuse to avoid a metal detector test. However, in order to avoid awkward situations, you should have with you the passport of the owner of the pacemaker, which is issued upon discharge from the hospital.

Caution should also be exercised when passing medical examinations according to concomitant diagnoses. Some types of tests are prohibited for people with a pacemaker. Despite the fact that the fact of implantation is usually indicated in the patient’s medical record, it should be reminded of it when visiting any doctor.

In addition, the installation of the implant should be reported to all those who most often surround the patient, be it relatives or labor collective. This will make it possible to react promptly and correctly in the event of emergency situations in the work of the pacemaker.

Despite numerous positive reviews When thinking about living with a pacemaker, you should remember that an artificial pacemaker is by no means a new heart or a cure for diseases. This is just an opportunity to live, observing the safety rules.

Further lifestyle with a pacemaker can be characterized by the following components:

• Visiting a cardiac surgeon once every three months during the first year, once every six months in the second year and once a year thereafter,
• Counting your pulse, measuring blood pressure and assessing your well-being at rest and during exercise, recording the data obtained in your own diary,
• Contraindications after pacemaker installation include alcohol abuse, prolonged and exhausting physical activity, non-compliance with work and rest schedules,
• It is not forbidden to engage in light physical exercise, since it is not only possible, but also necessary to train the heart muscle through exercise, if the patient does not have severe heart failure,
• The presence of an pacemaker is not a contraindication for pregnancy, but the patient must be monitored by a cardiac surgeon throughout the pregnancy, and delivery must be carried out by cesarean section as planned,
• The working capacity of patients is determined taking into account the nature of the work performed, the presence of concomitant ischemic heart disease, chronic heart failure, and the issue of loss of ability to work is decided collectively with the involvement of a cardiac surgeon, cardiologist, arrhythmologist, neurologist and other specialists,
• A patient with an pacemaker may be assigned a disability group if the working conditions are determined by a clinical expert commission to be severe or that could cause harm to the stimulator (for example, working with electric welding or electric steel-smelting machines, other sources of electromagnetic radiation).

Except general recommendations, the patient must always have a pacemaker passport (card) with him, and from the moment of surgery it is one of the patient’s main documents, because in case of emergency care The doctor should be aware of the type of pacemaker and the reason why it was placed.

Despite the fact that the stimulator is equipped with a built-in system of protection against electromagnetic radiation, which interferes with its electrical activity, the patient is recommended to be at a distance of at least 15-30 cm from radiation sources - TV, cell phone, hair dryer, electric razor and other electrical appliances. It is better to talk on the phone using the hand on the opposite side to the stimulator.

MRI is also strictly contraindicated for persons with pacemaker, since such a strong magnetic field can damage the stimulator microcircuit. If necessary, MRI can be replaced by computed tomography or radiography (there is no source of magnetic radiation). For the same reason, physiotherapeutic treatment methods are strictly prohibited.

Pacemakers. What it is? Classification of pacemakers. Technical characteristics and care of the device

Thank you

What kind of device is a pacemaker and why is it needed?

In what cases is a patient given a pacemaker?

Most often, a pacemaker is implanted for the following problems:

• Bradycardia. Bradycardia is a decrease in heart rate that can occur for various reasons. It should be noted that in this case all parts of the heart muscle contract in the correct order. It’s just that the impulse that stimulates contraction is produced less frequently. Because of this, blood in general is pumped worse throughout the body. If the cause of bradycardia cannot be identified and eliminated, the patient will be implanted with a pacemaker, which will constantly maintain the heart rate within normal limits.
• Asystole. Asystole is the absence of heartbeats for a certain period of time. If an electrocardiographic study ( ECG) detected episodes of asystole lasting 3 seconds or more, this is an indication for the installation of a pacemaker.
• Low heart rate ( Heart rate) under load. An important study in cardiology is taking an ECG during physical activity. Normally, in response to exercise, the heart rate increases. If this does not happen, it is believed that the heart is not able to meet the body's increasing demands for oxygen, and it is better for the patient to have a pacemaker installed.
• Atrioventricular block. Atrioventricular block is the complete or partial blocking of impulses in the node between the atria and ventricles. As a result, the chambers of the heart lose their rhythmic contractions, and the volume of pumped blood decreases. Not all atrioventricular blocks are an indication for the installation of a pacemaker. The decision in each individual case is made by the attending physician.

Use of pacemakers at different ages ( in children, adolescents, etc.)

Parents of children with an implanted pacemaker need to pay attention to following features:

• Full bathing of the child is possible only after the postoperative scar has completely healed. Before this, only wiping or washing is possible without getting water into the area where the body is implanted.
• A small child needs to be constantly monitored as the body may lift the skin slightly. Children, out of curiosity, often begin to move the device under the skin, which can cause malfunctions.
• The presence of a pacemaker in a child precludes participation in contact sports. The possibility of visiting various sections should be discussed with your doctor. In any case, section leaders and coaches must be informed about the child’s presence of a pacemaker.
• An implanted device is not a contraindication for attending kindergarten or school. However, caregivers and teachers should be aware of this and keep an eye on the child.
• Also, the presence of a pacemaker is not an absolute contraindication for routine vaccination. However, it is better not to vaccinate for the first time after implantation of the device. This is not due to the presence of a pacemaker, but to the surgical intervention itself, after which the body must recover. If necessary, children are given an individual vaccination schedule.
• The psycho-emotional education of a child is also a very important task. Many children begin to develop complexes as they grow older. It is important to teach the child all precautions and develop good habits. After this, the children are explained that they can live a full life and are no different from other children.

Currently, new, more compact models of pacemakers are being developed, which will greatly facilitate operations in childhood.

What are the pros and cons of having a permanent pacemaker?

Pros and cons of a permanent pacemaker

How to choose the best pacemaker?

In general, when choosing a pacemaker, pay attention to the following features of the device:

• device type ( single-chamber, double-chamber, etc.);
• electrode configurations;
• electrode fixation mechanism;
• type of insulating material;
• site of housing implantation;
• battery capacity;
• cost of the device, etc.

Types and types of pacemakers

Most often, pacemakers are classified according to the area of ​​stimulation. In this case, the patient himself cannot choose the device, and the attending physician helps him in this. The most convenient devices are those with a long service life ( good battery) and the possibility of contactless adjustment of the operating mode. In most clinics that implant pacemakers, the patient can familiarize themselves with the differences between the various models and consult with a specialist.

Classification of pacemakers

Based on the principle of use, pacemakers can be divided into the following categories:

• Temporary. Temporary pacemakers are commonly used in intensive care units. The electrodes are applied to the heart, but the body of the device is not implanted. Thus, the rhythm is maintained for a relatively short time until doctors fix the problem.
• Permanent. Permanent pacemakers are implanted on long term (5 – 10 years or more). They, in turn, have their own classification.
• Other types of cardiac stimulation. Other types include, for example, transesophageal pacemakers, in which the electrode is inserted into the esophagus for a while, rather than being supplied to the heart muscle through the vessels. External pacing through the chest wall is also possible. In terms of mechanism, such devices are close to defibrillators and are rarely used in practice.

Based on the number of electrodes, models of permanent pacemakers are classified as follows:

• Single-chamber. They have one electrode in one chamber of the heart, where rhythm disturbances are observed.
• Two-chamber. Two electrodes are applied to two areas of the heart muscle ( usually in two chambers of the heart). These devices provide more efficient blood pumping.
• Three-chamber. Three electrodes are connected to the heart, capable of completely regulating the rhythm of contractions. These models are usually equipped big amount additional functions.
• Four-chamber. Models with four electrodes are rarely used and only for special indications.

Temporary and permanent pacemakers

Differences between temporary and permanent pacemakers

Single chamber

Single chamber pacemakers are sometimes used in patients with persistent atrial fibrillation. This type can also be implanted for sick sinus syndrome ( SSSU). The best option would be a frequency-adapted model that is capable of adjusting the frequency itself. A fixed frequency imposes serious restrictions on physical activity and creates certain risks of complications.

Double chamber

A dual-chamber pacemaker is indicated for the following disorders:

• bradycardia with Morgagni-Adams-Stokes syndrome;
• incomplete atrioventricular block ( 2 or 3 degrees);
• lack of adequate heart response to physical activity;
• carotid sinus syndrome;
• sick sinus syndrome ( not always);
• some other disorders of the rhythm and conduction function of the myocardium.

Three-chamber

Three-chamber pacemakers are considered the most functional options for patients. Modern models not only have frequency adaptation, but also a number of special sensors that respond to changes in vital signs. So the device can regulate the heart rate depending on body temperature, breathing rate or natural nervous regulation ( for example, in a state of psycho-emotional arousal). In addition, the three-chamber pacemaker can be equipped with a cardioverter-defibrillator. The wide range of features of three-chamber models increases their cost compared to dual-chamber or single-chamber pacemakers.

Four-chamber

Cardioverter-defibrillator ( resynchronization therapy)

Typically, cardioverter defibrillators need to be replaced more frequently because their batteries drain faster. Their average service life is 5 – 7 years. Precautions in daily life are almost the same as those for patients with a conventional pacemaker. It should also be noted that a person with an implanted defibrillator does not “get shocked.” Even at the moment of discharge, you can touch it, and the other person will feel practically nothing.

Transesophageal

The use of a transesophageal pacemaker has the following advantages:

• the procedure is non-invasive, that is, unlike other internal or external pacemakers, surgery is not required;
• the risk of complications is minimal, since the procedure is not traumatic and does not take much time;
• the effectiveness of myocardial stimulation with proper placement of the electrode probe into the esophagus is almost the same as with other methods of cardiac stimulation;
• the procedure can be used both to eliminate acute rhythm disorders and for diagnostic purposes;
• after the procedure, the natural heart rhythm quickly returns to normal;
• The cost of transesophageal pacing is lower than conventional pacing.

Epicardial

The epicardial pacemaker has the following advantages:

• The device is installed through a small incision in the intercostal space, that is, trauma during the operation is minimized.
• The body is attached inside the chest, and not under the skin, and is therefore less susceptible to mechanical stress ( displacement, impacts, etc.).
• The absence of electrodes supplied through the vessels reduces the risk of blood clots and maintains adequate blood flow.
• The device is convenient to use in pediatric cardiology, since in young children the diameter of the vessels is smaller, and the introduction of electrodes of conventional pacemakers can block their lumen.

Wireless pacemaker

So far, implantation of wireless models has been approved only for certain types of conduction disorders ( for example, some patients with atrial fibrillation). In addition, it is still very difficult to find clinics that perform such operations. However, as this technology develops, wireless pacemakers will gradually replace outdated models.

What is a rate adaptive pacemaker?

External ( temporary) pacemakers

External cardiac pacing has the following features:

• requires special equipment;
• cannot be carried out for a long time;
• the heart muscles contract together with the muscles of the torso ( chest wall) between the electrodes;
• associated with quite severe pain;
• It is advisable to give the patient sedatives or painkillers before the procedure;
• has less efficiency ( in restoring heart rhythm);
• As a rule, it is performed outside the hospital when there is an urgent need.

A more common version of an external pacemaker is a temporary device, which, in principle, does not differ much from the implanted one in its mechanism of action. Electrodes are also placed in the heart ( through the central veins), stimulating certain areas of the heart muscle. However, the external pacemaker housing is not implanted under the skin, but remains outside.

A patient with such a device is in the intensive care unit. The heart rate is regulated artificially until normal heart function is restored. For example, after a heart attack, the heart muscle is damaged due to temporary interruptions in blood circulation coronary vessels (vessels of the heart). Until the damage is repaired, serious rhythm disturbances may occur. The patient is fitted with an external pacemaker, which will eliminate this symptom. As blood circulation is restored, muscle function returns to normal, and the need for artificial stimulation disappears. If the damage is not repaired, the external pacemaker is simply replaced with a permanently implanted device.

There are risks associated with using an external pacemaker. Remains in the skin constantly open wound, through which the electrode in the heart is connected to the body outside. Through this route, the infection can enter directly into the blood, which can lead to very serious complications. In addition, there is a high risk of accidental displacement of the electrodes. This is why patients with temporary external pacemakers are in the intensive care unit, where the catheter insertion site is monitored daily and the heart is monitored using an ECG.

Technical parameters, characteristics and care of pacemakers

Any model of implantable pacemaker has standard operating modes, which may be disrupted under certain conditions.
If necessary, the operating mode of the device can be changed. In modern devices this is done remotely using special equipment.

When setting a specific pacemaker mode highest value have the following technical characteristics:

• Pulse generation frequency. Models without frequency adaptation work in a rhythm set by doctors during installation. This is an important characteristic, since the speed of pumping blood throughout the body depends on the heart rate. It should not be too high so as not to put extra stress on the heart muscle, but, at the same time, it should cover the body’s needs. Frequency adaptive models change frequency as needed, but also within predetermined limits.
• The strength of the generated impulse. For effective stimulation of the heart muscle and its full contraction, the optimal strength of the generated impulse must be selected. It is largely individual and depends on the sensitivity of muscle cells ( excitability). A pulse that is too weak will cause the pacemaker to not stabilize the heart. In some patients, changes in the structure of the heart muscle may occur as the underlying disease progresses. Because of this, susceptibility to impulses decreases, and you have to contact a specialist who will reprogram the device and increase the strength of the delivered discharges.
• Frequency adaptation. With frequency adaptation, the pacemaker is equipped with special detectors that record the work of the heart and the needs of the body. Models with this feature are much more convenient to use. The pacemaker can, for example, turn on only when necessary, which saves battery power and increases the service life of the device.
• Possibility of cardioversion. Some models are equipped with a built-in defibrillator that can start the heart automatically in case of cardiac arrest or stabilize the rhythm in case of severe failures.

The principle of operation of pacemakers

The heart is a hollow muscular organ that pumps blood throughout the body. Thanks to the sequential contraction of muscles in the walls of four sections ( cameras) the heart and the well-coordinated operation of the valves, the blood flow is constantly directed to the necessary vessels. Correct muscle contraction is ensured by the so-called conduction system. These are special cells in the walls of the heart that are capable of quickly spreading an electrical impulse. There are also a number of cells responsible for producing this impulse.

Normally, the work of the heart is reduced to the following phenomena:

• The bioelectric impulse occurs in special nodes - the sinoatrial and atrioventricular.
• The impulse propagates through the bundles and fibers of the conduction system located in the walls of the heart.
• Under the influence of an impulse, sections of the heart muscle contract successively, driving blood from one chamber to another.
• After contraction, the so-called repolarization phase begins. Muscle cells relax, and the chamber fills with blood again.
• The reverse flow of blood is prevented by valves located at the border of the transition from one cavity to another.

The principle of operation of an electrical pacemaker of any model is as follows. The device produces electrical impulses with a given frequency and a certain strength, which suppress the natural bioelectrical activity of the heart. These impulses control the contraction of the heart muscle, causing it to work properly. Thus, the heart functions normally in various pathologies. A pacemaker is simply irreplaceable for people who have problems with the generation and propagation of impulses naturally.

What are the operating modes of a pacemaker?

At the moment, there is a special mode encoding, which is used mainly by specialists in this field. It consists of three, four or five letters ( depending on the device model and the system adopted in the country).

The mode code contains the following information:

• the chamber or chambers of the heart that the machine stimulates;
• the chamber or chambers of the heart that the machine detects;
• presence of frequency adaptation;
• muscle response to an incoming impulse;
• parameters of the cardioverter-defibrillator ( if provided).

Service life of pacemakers ( how often should you change the battery)

The lifespan of a pacemaker depends on the following factors:

• Device type. The type of device and its operating mode largely determine the rate of battery depletion. If after surgery the pacemaker is constantly running, the battery will discharge evenly and relatively quickly. “Smart” devices turn on only when necessary, since they themselves monitor the rhythm of the heart. Thus, in sleep mode the battery is almost not discharged, and the overall service life of the device is greatly increased. In addition, some pacemakers "record" the heart's rhythm and store it. This also increases energy costs and can overall shorten the life of the appliance.
• Battery Type. Different models of pacemakers use different power sources. Each type of battery has its own design life, “energy reserve”, determined by its design and technical characteristics. Of course, models with more powerful batteries will last longer.
• Patient's diagnosis. The patient's illness also has a certain impact on the service life of the pacemaker. If multiple chambers of the heart need to be stimulated, the machine will work harder and the battery will drain faster. If there is no need for continuous stimulation, and problems arise only occasionally, energy consumption occurs more slowly.
• Complications. Emergency pacemaker replacement can be caused by various complications. Sometimes they appear in the first days or weeks after implantation, and sometimes after several years. Quite often, an inflammatory process develops in the subcutaneous bed where the device body is installed. In severe cases, this forces doctors to urgently remove or replace the pacemaker, although its service life has not actually expired. The cause of this complication may be infection during surgery or displacement of the body under the skin.
• Unforeseen disruptions. Some external factors may affect the functioning of the pacemaker ( for example, a strong magnetic field). In rare cases, this leads to serious malfunctions and the device has to be replaced or configured again.
• Some critical conditions. As a result of injuries or exacerbation of various diseases, the patient may need emergency medical care. If the pacemaker complicates access during surgery or interferes with assistance, it will be removed ( of course, taking all precautions).

Is a repeat operation necessary to replace the battery? battery) pacemaker?

Do the electrodes need to be replaced over time?

Is it possible to program and reprogram a pacemaker at home?

Checking and reprogramming the pacemaker is not done at home for the following reasons:

• Special equipment. In principle, the equipment for checking and adjusting pacemakers is not too voluminous and can be delivered to the patient’s home. However, it will still not be possible to transport the entire set of devices for all possible cases. The hospital will also have equipment to check the position of the electrodes if necessary ( X-ray, echocardiograph, etc.) or other additional parameters.
• Lack of specialists. Not all clinics and cardiology departments have specialists and equipment for checking and adjusting pacemakers. Home visit ( even if it is theoretically possible) is done extremely rarely, since it does not allow covering a large number of patients.
• Risk of complications. In principle, checking and reprogramming are not dangerous manipulations. However, in rare cases, the device or the patient’s heart may respond inadequately to external influences ( for example, checking the battery charge is done using a special magnet). Rhythm disturbances in this case would theoretically endanger the patient’s life if this happened at home. The hospital always has doctors and equipment to provide first aid and reduce the risk of any complications.

Does the pacemaker make any noise while it is working?

Medicine does not stand still; new medicines and devices are constantly appearing that can extend human life. Heart disease remained incurable for several decades. But now cardiologists have the opportunity not only to “look” into the heart, to see how it works inside, but to make it work. The heart pacemaker became a real salvation; doctors and patients always received only positive feedback.

The device seems to give people a “second chance” to live a full life again. The operation is not considered complicated; it takes only a few minutes. But do not forget that at first, for the first time after the operation, you need to listen to your condition and not overwork. To avoid problems in the future, you must follow the recommendations of doctors.

Basic information

An artificial heart pacemaker is a special electronic device. It has a built-in microcircuit that allows you to detect any changes in the functioning of the heart muscle. Thanks to the device, correction is made if necessary.

The device consists of the main elements:

1. Titanium case.
2. Connector block.
3. Electrodes.
4. Programmer.

• batteries
• microcircuits

The purpose of batteries is to produce the energy needed to create electrical impulses.

Microcircuits make it possible not only to obtain, but also to monitor electrodynamics.

The connection block is used to connect the electrodes and the housing. Electrodes are placed in the heart muscle, which allows information about the heart to be read. Bearers electric charges help to contract the heart muscle correctly.

The programmer or computer is in medical institution, in which the operation to install the device was carried out. Its role is to set or change pacemaker settings if necessary.

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Installation of the device

Many people are interested in how the device installation process occurs. The operation is considered simple. The patient is prepared in advance, the necessary examinations are carried out. The process does not take long.

The essence of the procedure:

• into the subcutaneous fatty tissue introduce a special device
• place the electrodes in the most different areas heart muscle

The operation is performed under local anesthesia. The following is done:

1. The patient makes an incision in the collarbone area.
2. Electrodes are inserted through a thin vein.
3. The device is connected to the heart.

Important! Despite the fact that the procedure is simple, all work on installing a pacemaker is carried out using special X-ray equipment.

After installing the device, people's lives change, new requirements appear, and some restrictions arise. But you can get used to everything. We must remember that the heart remains the same and must be protected.

The first days after installing the device

In the first days you need to adhere to the following:

• monitor the postoperative wound to keep it clean and dry
• if the person’s condition is good, there are no complications, then on the fifth day you can safely take a shower
• Do not lift weights in the first week
• give up heavy physical work in the house, for example, snow removal

Most people return to work within a week after surgery.

We must remember! No matter how well you feel after installing a pacemaker, you must listen to your body. If you feel tired, you need to put things aside and rest a little.

Life a month after the device was installed

After a month, a person who has undergone surgery is allowed. But there can be no talk of heavy physical activity. Swimming, playing tennis and golf are allowed. Walking is especially useful.

You should visit your doctor regularly. The first appointment after surgery is three months after discharge. The second appointment should be after six months, and then a visit to the doctor should be at least once every six months.

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If you experience anxiety or discomfort, you should consult a doctor immediately.

How to live on after having a pacemaker installed. Recommendations

Despite the fact that the device is equipped with special built-in protection against the influence and interference of other electrical devices, you still need to avoid powerful electric fields. Do not be afraid of household appliances such as: microwave oven, tape recorder, vacuum cleaner, refrigerator, computer and the like.

It must be remembered that in order to prevent interference, the devices must be located at a distance of no closer than a decimeter from the area where the cardiac device is installed.

There are a number of rules that must be followed in everyday life:

1. Do not touch the area where the cardiac device is installed to the operating TV.
2. Do not lean against the front wall of the microwave oven.
3. Do not stay near high-voltage power lines.
4. Do not stand near welding equipment.
5. Stay away from electric steel furnaces.

Remember not to go through security controls, both at airports and in stores. To avoid trouble, you should always have your cardiac device owner’s card and passport with you. The card can always be obtained at the hospital.

If an examination is prescribed such as: radiation therapy, diathermy, magnetic resonance diagnostics, external defibrillation, then first of all you need to inform the doctors that you have a pacemaker installed.

Fluorography and x-rays are not contraindicated. Sometimes radiography is prescribed if there is the slightest suspicion of electrode failure.

Important! You should not sunbathe in the open rays of the sun. In hot weather, you should always wear cotton clothing on your body.

The battery in the device is designed to last for a decade. When the expiration date is approaching, the device will sound a signal. The signal will be recorded during a routine examination. The battery will be replaced immediately. Therefore, it is important to visit your doctor on time and regularly.

Normally, the heart contracts rhythmically, obeying the impulses of its own pacemaker. But sometimes the natural pacemaker stops working properly, the pulse slows down, and the blood supply to the brain and other vital organs is threatened.

In such cases, cardiologists implant an artificial pacemaker into the patient - electrocardiostimulator (pacemaker), commonly called pacemaker.

Indications for installation and types of pacemaker

Installation of a pacemaker may be recommended for patients with a slow pulse, especially if such rhythm disturbances are accompanied by dizziness, lightheadedness or fainting. Pacemakers may be frequency-adaptive which allow your heart rate to increase during exercise, or without frequency adaptation.

Three-chamber pacemakers, in addition to performing the function of a pacemaker, can be indispensable for the treatment of heart failure, allowing the ventricles to contract synchronously and increase the force of contractions. These pacemakers are also called resynchronizers.

And some pacemakers with cardioverter function can suppress life-threatening cardiac arrhythmias - ventricular tachycardia and ventricular fibrillation. Similar cardioverter-defibrillators used to prevent sudden cardiac death.

It should be noted that indications for pacemaker installation are determined only by a doctor, cardiologist-arrhythmologist. Only he can correctly set the readings and select the optimal pacemaker, resynchronizer or cardioverter for each specific case.

Indications

• Sick sinus syndrome.
• Arrhythmias with a decrease or increase in heart rate.
• Intracardiac blockades.
• Sinoatrial blockade.
• Long QT syndrome.
• Ventricular tachycardias.
• Ventricular fibrillation.

Types of pacemakers

There are implantable cardioverter defibrillators and standard pacemakers. The former set the correct rhythm and eliminate arrhythmia, while the latter affect exclusively the heart rhythm. The use of electrical pacemakers is advisable for bradyarrhythmia. If tachyarrhythmia is additionally observed and there is a high probability of ventricular fibrillation, then a model with cardioversion and defibrillation is selected.

An additional division of models is carried out taking into account the area of ​​influence (single-chamber, two-chamber, three-chamber). Therefore, fixation is carried out on one or two ventricles, as well as to one atrium, depending on the model.

What is needed for preliminary diagnosis?

• ECG in 12 leads;
• Echo-CG;
• Holter ECG monitoring for 1-2 (sometimes more) days;
• Stress ECG.
• CT scan or x-ray of the chest.
• Ultrasound examination of the heart.
• Dopplerography.
• Endocardial electrophysiological study.
• Consultation with an arrhythmologist to determine indications for surgery and select the type of pacemaker;

How is a pacemaker installed at the CELT clinic?

A pacemaker is a small device that is placed in subcutaneous tissue chest, under the pectoralis major muscle.

The operation does not involve general anesthesia. The patient is given a drug that has a sedative effect. The area of ​​the chest where the pacemaker will be placed is numbed. By making a small skin incision parallel to the collarbone, a pacemaker is implanted. Special thin electrodes are passed from the pacemaker into the heart cavity through large veins, through which the pacemaker sends impulses that help the heart maintain a normal rhythm. For medical reasons, a single-chamber pacemaker may be implanted, which stimulates only the right ventricle, a dual-chamber pacemaker, which sequentially stimulates the atria and ventricle, or a three-chamber pacemaker, which transmits impulses to the atrium, right and left ventricles.

The duration of the intervention for implanting a single-chamber pacemaker is about 30 minutes, two- or three-chamber - from 60 to 150 minutes.

The patient remains in the hospital under observation for 1 to 3 days. Before the patient goes home, the doctor programs the device. After installing a pacemaker, it is recommended to avoid physical activity for a month.

Postoperative period

Recovery after installation of a pacemaker takes at least a month (sick leave is required). The time period increases if the installation was performed after a heart attack. In hospital, recovery will take no more than 10 days. During this period, specialists will monitor the patient’s well-being and general condition, as the following complications are possible:

• Thromboembolism.
• Internal bleeding.
• Hematomas and swelling.
• Infection and increase in body temperature.
• Pain syndrome.

The chance of these complications occurring is no higher than 7%. Additionally, in the hospital, the patient uses acetylsalicylic acid and painkillers. This is necessary to eliminate pain and reduce the risk of blood clots.

Indications for installing a heart pacemaker (or artificial heart pacemaker, IVR) are absolute and relative. Indications for installing a heart pacemaker are indicated every time there are serious interruptions in the rhythm of the heart muscle: large pauses between contractions, a rare pulse, atrioventricular blockade, syndromes of increased sensitivity of the carotid sinus or weakness of the sinus node. Patients with such diseases are those who definitely need to have a pacemaker installed.

The cause of such deviations may be a violation of the formation of an impulse in the sinus node ( congenital diseases, cardiosclerosis). Bradycardia usually occurs due to one of four possible reasons: pathology of the sinus node, pathology of the AV node (AV block), pathology of the legs (fascicular blocks) and depression of the autonomic nervous system (manifested by neurocardial syncope).

Absolute indications for surgery to install (use) a pacemaker include the following diseases:

bradycardia with clinical symptoms (dizziness, fainting - syncope, Morgagni-Adams-Stokes syndrome, MAS); a recorded decrease in heart rate (HR) to values ​​less than 40 during physical activity; episodes of asystole on the electrocardiogram (ECG) lasting more than 3 seconds; persistent atrioventricular block of II and III degrees in combination with two or three fascicle blocks or after myocardial infarction in the presence of clinical manifestations; any types of bradyarrhythmias (bradycardias) that threaten the life or health of the patient and in which the heart rate is less than 60 beats per minute (for athletes - 54 - 56).

Indications for installing a pacemaker are rarely heart failure, in contrast to cardiac arrhythmias that accompany it. In severe heart failure, however, we may be talking about asynchronous contractions of the left and right ventricles - in this case, only the doctor decides on the need for surgery to install a pacemaker.

Relative indications for pacemaker implantation:

atrioventricular block of the second degree, type II, without clinical manifestations; atrioventricular block of the third degree at any anatomical site with a heart rate under load of more than 40 beats per minute without clinical manifestations; syncope in patients with two- and three-fascicle blocks not associated with ventricular tachycardia or complete transverse block, with the impossibility of accurately identifying the causes of fainting.

If there are absolute indications for implantation of a pacemaker, the operation is performed on the patient as planned after examination and preparation, or urgently. There are no contraindications to pacemaker implantation in this case. If there are relative indications for implantation of a stimulator, the decision is made individually, taking into account, among other things, the patient’s age.

The following diseases are not indications for installing a heart pacemaker based on age: atrioventricular block of the first degree and atrioventricular proximal block of the second degree of type I without clinical manifestations, drug blockades.

It should be noted that each country in the world has its own recommendations for installing heart pacemakers. Russian recommendations largely repeat those of the American Heart Association.

In what cases is a pacemaker placed on the heart?

A heart pacemaker is installed only in cases where there is a real risk to the patient’s life and health. Today, both single-chamber and dual- and multi-chamber devices are used. Single-chamber drivers are used in the treatment of chronic atrial fibrillation (to stimulate the right ventricle) and for sick sinus syndrome, SSS (to stimulate the right atrium). However, more and more often, a two-chamber device is installed in case of SSSU.

SSSU manifests itself in one of four forms:

symptomatic - the patient has already lost consciousness or had some kind of dizziness; asymptomatic - the patient has bradycardia on the ECG or daily monitoring(on “holter”), but the patient does not express any complaints; pharmacodependent - bradycardia occurs only against the background of usual doses of drugs with a negative chronotropic effect (antiarrhythmic drugs and beta blockers). When the drugs are discontinued, the symptoms of bradycardia disappear completely; latent – ​​there is no clinical or bradycardia in the patient.

The last two forms are recognized initial stage sinus node dysfunction. The patient can wait up to several years with implantation of the pacemaker, but it is only a matter of time before the operation becomes an emergency planned one.

What other heart conditions require a pacemaker?

In addition to the heart diseases described above, a pacemaker is installed to treat dangerous arrhythmias: ventricular tachycardia and ventricular fibrillation to prevent sudden cardiac death. In the presence of atrial fibrillation, the indications for installing a pacemaker are emergency (the patient in this case already loses consciousness or has tachybradyform). And the doctor cannot prescribe drugs to increase the rhythm (risks of fibrillation attacks) and cannot prescribe antiarrhythmic drugs(the brady component is enhanced).

The risk of sudden death during bradycardia with attacks of MAS is considered low (according to statistics, about 3% of cases). Patients diagnosed with chronic bradycardia also have a relatively low risk of syncope and sudden death. With such diagnoses, the installation of a pacemaker is largely preventive in nature. Such patients, due to adaptation to their heart rate, rarely complain of dizziness or fainting, but they have a whole range of concomitant diseases, which the installation of an IVR will not relieve.

Timely implantation of a pacemaker allows one to avoid the development of brady-dependent heart failure, atrial fibrillation, and arterial hypertension. According to experts, currently up to 70% of operations are carried out for preventive purposes.

In case of transverse blockade, pacemaker implantation is mandatory regardless of the cause, symptoms, nature of the blockade (transient or permanent), and heart rate. Here the risks of death for the patient are extremely high - installation of IVR allows increasing the survival rate of patients to values ​​close to those of healthy people. And the operation is emergency.

In two cases:

complete blockade that appeared during acute myocardial infarction; complete blockade resulting from cardiac surgery

it is possible to wait up to 2 weeks (it is possible to resolve the problem without installing an pacemaker). With congenital complete blockade, indications for pacemaker implantation already exist in adolescent children. Congenital blockade develops in utero (the cause is mutations of chromosomes 13 and 18). In this case, children do not have MAS attacks, because they are completely adapted to their bradycardia.

Unfortunately, bradycardia only intensifies with age, by the age of 30 (the average lifespan of a patient with similar disease) Heart rate may decrease to 30 beats per minute. Installation of a stimulator is mandatory and is planned. Emergency implantation is carried out in case of fainting. If the heart rate is critical, then the operation is performed even at the age of several days or months.

Treatment of blockage in a child depends on whether it is congenital or not. If it is congenital, it is registered in the maternity hospital, and the diagnosis is known even during pregnancy. If acquired, then it is considered to be obtained as a result of the myocardium. In the second case, adolescence is not expected - the pacemaker is implanted regardless of age.

More than three hundred thousand permanent pacemakers (pacers) are installed around the world each year because patients with some severe heart lesions require an artificial pacemaker.

Types of pacemakers

A pacemaker is an electronic device that generates electrical impulses using a special circuit. In addition to the circuit, it contains a battery that supplies energy to the device and thin wires-electrodes.

Exist different kinds heart pacemakers:

single-chamber, which are capable of stimulating only one chamber - the ventricle or atrium; dual-chamber, which can stimulate two cardiac chambers: both the ventricle and the atrium; Three-chamber pacemakers are required for patients with heart failure, as well as in the presence of ventricular fibrillation, ventricular tachycardia and other life-threatening types of arrhythmias.

Indications for installation of a pacemaker

Are you still wondering what a pacemaker is for? The answer is simple - an electrical pacemaker is designed to impose the correct sinus rhythm on the heart. In what cases is a pacemaker installed? To set it, there can be both relative and absolute indications.

Absolute indications for a pacemaker

Absolute indications are:

bradycardia with pronounced clinical symptoms - dizziness, syncope, Morgagni-Adams-Stokes syndrome (MAS); episodes of asystole lasting more than three seconds, recorded on the ECG; if during physical activity the heart rate is recorded below 40 per minute; when persistent atrioventricular block of the second or third degree is combined with two-bundle or three-bundle blockades; if the same blockade occurs after myocardial infarction and manifests itself clinically.

In cases of absolute indication for the installation of a pacemaker, the operation can be performed either planned, after examinations and preparation, or urgently. With absolute indications, contraindications to the installation of pacemakers are not taken into account.

Relative indications for pacemaker

The relative indications for a permanently implanted pacemaker are as follows:

if third-degree atrioventricular block occurs at any anatomical site with a heart rate under a load of more than 40 beats, which is not clinically manifested; the presence of atrioventricular block of the second type and second degree without clinical manifestations; syncope in patients against the background of two- and three-fascicular blockades, not accompanied by ventricular tachycardia or transverse block, while it is not possible to establish other causes of syncope.

If the patient only has relative readings In order for an operation to install a heart pacemaker to be performed, the decision to implant it is made individually, taking into account the patient’s age, physical activity, concomitant diseases and other factors.

When is the installation of a pacemaker not justified?

In fact, a pacemaker has no contraindications for its installation, except in the case of its unjustified implantation.

Such insufficient grounds for implantation are:

first degree atrioventricular block without clinical manifestations; proximal atrioventricular block of the first type of the second degree, without clinical manifestations; atrioventricular block that can regress (for example, caused by medication).

How is a pacemaker placed?

Now let's talk about how a pacemaker is installed. If you watch a video of how a pacemaker is installed, you will notice that the cardiac surgeon performs it under X-ray control, and the total procedure time varies depending on the type of implanted device:

a single-chamber pacemaker will require half an hour; for a two-chamber pacemaker – 1 hour; A three-chamber pacemaker requires 2.5 hours to install.

Typically, surgery to install a pacemaker occurs under local anesthesia.

The operation to implant an pacemaker consists of the following steps:

Preparing for surgery. This includes debridement of the surgical site and local anesthesia. An anesthetic drug (novocaine, trimecaine, lidocaine) is injected into the skin and underlying tissues. Installation of electrodes. The surgeon makes a small incision in the subclavian region. Next, the electrodes under X-ray control are inserted sequentially through the subclavian vein into the desired cardiac chamber. Implantation of the pacemaker housing. The device body is implanted under the collarbone, and it can be installed subcutaneously or deepened under the pectoral muscle.

In our country, the device is more often implanted in right-handed people on the left, and in left-handed people on the right, which makes it easier for them to use the device.

The electrodes are connected to the already implanted device. Device programming. It is produced individually to suit the patient’s needs, taking into account the clinical situation and the capabilities of the device (which also determine the cost of the pacemaker). In modern devices, the doctor can set the basic heart rate, both for the state of physical activity and for rest.

Essentially, this is all the basic information about how a pacemaker is installed.

Complications after pacemaker installation

It is worth knowing that complications after installing a pacemaker occur in no more than 3-5% of cases, so you should not be afraid of this operation.

Early postoperative complications:

violation of the tightness of the pleural cavity (pneumothorax); thromboembolism; bleeding; violation of insulation, displacement, fracture of the electrode; infection of the surgical wound area.

Long-term complications:

ECS syndrome – shortness of breath, dizziness, decreased blood pressure, episodic loss of consciousness; pacemaker-induced tachycardia; premature failures in the ECS.

Surgery to insert a pacemaker should be performed by an experienced surgeon under X-ray guidance, which avoids most of the complications that arise at an early stage. And in the future, the patient must undergo regular examinations and be registered with a dispensary.

If there are complaints about deterioration in health, the patient should immediately consult with the attending physician.

What can and cannot be done if you have a pacemaker?

Living with a pacemaker has limitations regarding physical activity and electromagnetic factors that may prevent the device from working correctly. Before any examination or course of treatment, it is necessary to warn doctors about the presence of an pacemaker.

Living with a heart pacemaker imposes the following restrictions on a person:

undergo an MRI; engage in hazardous sports; climb high-voltage power lines; approach transformer booths; put a mobile phone in your breast pocket; stay close to metal detectors for a long time; undergo shock wave lithotripsy without preliminary adjustment of the pacemaker or perform electrocoagulation of tissues during surgery.

Cost of installing a pacemaker

Basically, since pacemaker implantation is paid for by the compulsory medical insurance fund, the cost of installing a pacemaker is usually zero.

But sometimes patients themselves pay for it and additional services (this applies to foreigners and people who do not have compulsory medical insurance).

The following prices apply in Russia:

implantation of a pacemaker – from 100 to 650 thousand rubles; implantation of electrodes – minimum 2000 rubles; surgical manipulations – from 7,500 rubles; Staying in the ward costs at least 2,000 rubles per day.

The overall cost is most influenced by the ECS model and the prices of the selected clinic. For example, in a provincial cardiology center, simple implantation of an outdated domestic pacemaker model can cost at least 25,000 rubles. In large vascular clinics that use modern imported devices and provide additional services, the cost jumps to 300 thousand rubles.

How to behave after installing a pacemaker?

First postoperative week

The postoperative wound should be kept clean and dry according to the recommendations of the medical staff. If the early postoperative period is favorable, five days after surgery it is already permissible to take a shower, and a week later most patients return to their usual work schedule. To prevent the seams from coming apart, you should not lift more than 5 kg for the first time. You can't do heavy homework, and when doing lighter work, you need to listen to how you feel and immediately put off work if unpleasant sensations appear. You can't force yourself.

One month after surgery

Exercising after having a pacemaker installed is not only useful, but also necessary. Long walks are beneficial. But tennis, swimming pool and other strenuous sports will have to be postponed for a while. Over time, the doctor monitoring the patient's health may remove some restrictions regarding sports. You need to visit the doctor according to plan: after 3 months - the first examination, after six months - the second, and then every six months or a year.

If a person feels discomfort or anxiety about the operation of the pacemaker, then they should consult a doctor immediately.

Life after pacemaker implantation

Electrical devices. Although pacemakers are equipped with protection against interference from other electrical devices, strong electric fields should still be avoided. The use of almost all household appliances is allowed: TV, radio, refrigerator, tape recorder, microwave oven, computer, electric razor, hair dryer, washing machine. To avoid interference, you should not approach the pacemaker implantation site closer than 10 cm to an electrical appliance, lean against the front wall of the microwave (and generally avoid it) or the screen of a working TV. You should stay away from welding equipment, electric steelmaking furnaces, and high-voltage power lines. It is not advisable to go through control turnstiles in shops, airports, and museums. In this case, upon discharge from the hospital, the patient is given a device passport and an owner’s card, which must be presented during the search, after which it can be replaced by a personal search. The KS is also not afraid of most office equipment. It is advisable to develop the habit of grasping appliance plugs and other voltage sources with the hand further away from the pacemaker. Mobile phone. Long conversations on it are undesirable, and you need to hold the receiver 30 cm or more from the CS. When talking, hold the tube to the ear on the opposite side of the implantation site. Do not carry the handset in your breast pocket or around your neck. Sport. It is prohibited to engage in contact and traumatic sports, that is, team sports, martial arts, since any blow to the abdominal cavity or chest can damage the device. For the same reason, shooting with a gun is not recommended. With a pacemaker, you can return to walking, swimming and such physical exercises that allow constant monitoring of your well-being and allow you to follow safety rules.

The area of ​​the body where the pacemaker was implanted should not be exposed to direct sunlight. It should be kept covered with some kind of cloth at all times. Also, avoid swimming in cold water. It is especially important for car enthusiasts to remember that they should not touch live wires while repairing a car or replacing a battery.

Validity period and how long do people live with a pacemaker?

On average, the lifespan of a pacemaker is determined by the capacity of the battery, designed for 7-10 years of operation. When the battery life is approaching, the device will give a signal during the next scheduled examination. After this, you should replace the battery with a new one. Therefore, the question of how long people can live with a pacemaker also depends on the regularity of visiting the doctor. There is an opinion that, being a foreign body, the CS can harm a person. This is not at all true, despite the fact that often there is no alternative to installing it. In order to continue a fully fulfilling life, you have to put up with only minor restrictions that are worth it. In addition, it can be installed completely free of charge.

You can often hear the question of how long people can live with a pacemaker, especially from those for whom such surgery is recommended. Medical practice shows that people with an implanted pacemaker, provided they follow all the doctor’s recommendations, live no less than other people.

In other words, having a pacemaker can only prolong life, not make it shorter.

Have you already had a pacemaker installed? Or do you still have to undergo this operation? Tell your story and feelings in the comments, share your experience with others.