Bakuleva dispensary observation of a single-chamber pacemaker. Restrictions in everyday life and profession. How a pacemaker is installed from the patient’s point of view

Indications for installing a heart pacemaker (or artificial cardiac pacemaker, IVR) are absolute and relative. Indications for installing a heart pacemaker are discussed every time there are serious interruptions in the rhythm of the heart muscle: long pauses between contractions, rare pulses, atrioventricular blockades, syndromes hypersensitivity carotid sinus or weakness 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 blockades) and autonomic depression 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); recorded decrease in heart rate (HR) to values less than 40 with physical activity; episodes of asystole on the electrocardiogram (ECG) lasting more than 3 seconds; persistent atrioventricular block II and III degree in combination with two or three-bundle blocks or after myocardial infarction if present 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(for stimulation of the right ventricle) and for sick sinus syndrome, SSS (for stimulation of 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 during 24-hour 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 (risk of fibrillation attacks) and cannot prescribe antiarrhythmic drugs (the brady component increases).

Risk sudden death in case of bradycardia with attacks, MAC 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 helps avoid the development of brady-dependent heart failure, atrial fibrillation, 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. There are risks here fatal outcome for the patient are extremely high - IVR installations can increase 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 heart attack myocardium; 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 ( average term life of a patient with a similar disease) heart rate can 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 not expected - 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. At absolute readings 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, accompanying illnesses 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 treatment of the surgical field and local anesthesia. An anesthetic drug (novocaine, trimecaine, lidocaine) is injected into 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:

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

Long-term complications:

EX 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 further 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 do it during surgery electrocoagulation of tissues.

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. With a favorable course of early postoperative period 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 postpone work if you experience discomfort. 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 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, etc. physical exercise, which allow 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 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 foreign body, 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, subject to all 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.

The installation of pacemakers in patients with cardiovascular diseases has been practiced all over the world for many years.

The main purpose of this device is to maintain normal contraction of the myocardium of the heart, as well as to prolong the life of the body.

Radical indications for installing a stimulator

Installation of a pacemaker is mandatory if:

The patient is diagnosed with bradycardia, accompanied by constant dizziness, fainting;
termination bio electrical activity heart rate for 3 or more seconds (can be monitored during an ECG);
2-3 degree atrioventricular block is supplemented by other cardiopathy;

When installing a stimulator is absolutely necessary, it can be done in emergency and without undergoing additional preoperative studies.

development of atrioventricular block, but without pronounced symptoms;
Fainting conditions of the patient due to intraventricular blockades, while no other causes of fainting are observed.

In cases where the installation of the device is only recommended and is not mandatory, the patient independently makes the decision to implant a pacemaker.

Installation of a pacemaker: do's and don'ts?

A device such as a pacemaker has its justified contraindications. The main ones are exposure to electromagnetic fields and physical activity, which impair the operation of the device. Before any examination, it is mandatory to warn about the presence of an implant.

After installing a pacemaker, the following contraindications exist in the patient’s life:

MRI examination;
heavy physical activity;
be near electrical substations;
carry a mobile phone or magnets in your breast pocket;
stay close to metal detectors for a long time;
Carrying out cholelithotripsy (shock wave treatment) only after preliminary adjustment of the pacemaker.

First 7 days after implantation

In the first week after installation of a pacemaker, you must adhere to the following recommendations:

The postoperative wound should be kept sterile and dry. Treatment is carried out according to the recommendations of the doctor and medical personnel;
if no complications are observed in the first 4-5 days, the incision site successfully regenerates, then you are allowed to take a non-hot shower;
Until the wound is completely healed, lifting weights over 5 kg is prohibited.

First month after implantation

As mentioned above, if you have a pacemaker, physical activity is not allowed, but this applies to heavy and prolonged exercise. The most suitable physical activity is walking, and its duration is selected individually by the patient. If in the first six months the patient’s health is satisfactory, there are no deviations in the operation of the pacemaker, then you can resort to other light sports, for example, visiting the pool or table tennis.

It is also necessary to regularly visit a cardiologist; a routine examination for patients with pacemakers is once every 6 months.

How to live after having a pacemaker installed?

There are no restrictions that could significantly affect the patient’s life. It is allowed to use all household appliances: refrigerator, radio, microwave oven, computer, etc. However, in order to protect the device from possible violations, you should not approach all household appliances closer than 15 cm. Avoid any contact with welding equipment and high-voltage wires. Upon discharge, the patient is given a passport for the pacemaker, where all restrictions and recommendations are carefully described.

As for the use of mobile phones, there are no obvious contraindications, however, communication should not be prolonged. It is advisable not to keep the phone near where the pacemaker is located.

As mentioned above, sports are allowed, but only light types. Under no circumstances should you engage in combat sports or others where the risk of injury is high. Any, even minor blow to the gastrointestinal tract and thoracic region can seriously damage the functioning of the pacemaker.

Life expectancy after pacemaker installation

If we talk about life expectancy after installation of an pacemaker, then the patient’s regularity of visiting the doctor plays a role here. The operating time of the device is on average from 7 to 9-10 years. When the time comes to change the battery, the device will emit a special signal during the examination. It is for this reason that it is believed that the patient’s life span directly depends on the frequency of visits to the cardiologist.

The lifespan of patients who regularly follow doctors' recommendations and undergo routine examinations is the same as that of people without an pacemaker.

After the device is implanted, you will need to stay overnight in the clinic. Doctors will check your heart rhythm to make sure it is working properly.

The patient may experience pain in the area where the device is placed for several days to several weeks. As a rule, the pain is quite moderate. The doctor will recommend which analgesics are best to take.

Will need to be avoided active work and hard work for a month. Usually a few days are enough to return to a normal rhythm of life. Most patients return to work after implantation. The timing depends on many factors, including the type work activity.

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Possible complications after installation of a pacemaker and risks

The operation is generally quite safe. If problems arise, they may include:

Swelling, bleeding, hematomas or infections in the area where the device is placed.
Damage blood vessels or nerve endings.
Lung collapse (air pocket in the lungs).
Poor reaction to the anesthetic used during the procedure.

Before the operation, the doctor will tell you in detail about the benefits and risks of installing this device.

Limitations of life with a pacemaker - how to live after surgery?

Pacemakers have protective shields so that most objects a person uses or comes into contact with them will not affect the normal operation of the device. However, items that generate or use electricity or transmit wireless signals - such as a portable generator, electric drill or cellular telephone– have electromagnetic fields. Some of these fields may affect the operation of the device. If electromagnetic fields surrounding an object are too close to the pacemaker, the device will detect them and this may temporarily affect its performance.

Avoid close or prolonged contact with electrical appliances or equipment that have strong magnetic fields:

MP3 players, cell phones. New frequencies are becoming available in radio communications. Their application mobile phones make pacemakers less reliable.
Household appliances, for example, microwaves, electric drills, electric blankets, electric shavers, heating pads.
High voltage wires.
Metal detectors.
Equipment for welding for industrial use.
Electric current generators.

These items will disrupt the transmission of electrical impulses in the pacemaker. The patient will not be able to determine whether a breakdown has occurred. The risk depends on the proximity and duration of interactions with the above devices.

If a person experiences dizziness, changes in heart rate, or receives an electric shock while using any device, they should simply discontinue the interaction. Any temporary effect is unlikely to cause reprogramming or damage to the pacemaker. The device is designed to return to normal operation. If symptoms continue and there is no improvement, you should consult a doctor as soon as possible.

If the item is used for its intended purpose and is in good working order, there is no known risk when using the following items:

Charger for household batteries.
CD/DVD or recorder.
Curling tongs.
Dishwasher.
Electric blanket.
Electric guitar.
Electric scales.
Hair straightener.
Jacuzzi.
Ionizing air filter.
Kitchen appliances (blender, bottle opener, refrigerator, stove, toaster).
Massage chair.
Microwave.
Remote control.
TV.
Battery powered flashlight.
Soldering iron.
Laser pointer.
Calculator.
Copy machine.
Laptop, desktop PC.
Digital music player (iPod).
Fax machine.
Barcode Scanner.
A printer.
Radio AM/FM
Scanner.

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Minimal risk

The following items should be kept at least 16 centimeters from the pacemaker:

Electric portable kitchen appliances (mixer or knife).
Remote control, antenna.
Electric razor.
An electric toothbrush.
Magnetic exercise bike.
Hand hairdryer.
Massager.
Sewing machine.
Treadmill.
Vacuum cleaner.
A circular saw.
Electrically driven battery.
Electric chainsaw.
Manual meat grinders.
Electric lawnmower.
Cordless screwdriver.
Router.
Soldering iron.
Ham Radio - 3 watts or less from antenna.
Cell phone – 3 watts or less from antenna.
Wireless communication devices (computers, headsets, modems, routers, smartphones, Bluetooth™)
Wireless controllers (game consoles, Xbox™*, Playstation™, Nintendo™)

It is necessary to maintain a distance of at least 31 cm between the following objects and the pacemaker.

Car/motorcycle – elements of the ignition system.
Electric fence.
Transformer.
Induction hob.
Boat motors.
Car battery.
Components of the ignition system of gasoline-powered tools (lawn mower, snow blower, lawn mower, chainsaw).

You must maintain a distance of at least 61 cm between the following objects and the pacemaker.

Connecting cables.
Welding equipment with current up to 160 amperes. It is not recommended to interact with welding equipment with a current exceeding 160 amperes.

Do not get closer than two meters to welding machines and generators.

Experts do not recommend carrying phones or iPods in your shirt over a pacemaker. The phone can be held by the ear, the MP3 player in the hand, away from the pacemaker.

Medical procedures can also affect the pacemaker's performance, including:

MRI, which uses a powerful magnet to create images of internal organs. Metal objects are attracted to the magnet and should not be used near the MRI. The magnet may interrupt stimulation and slow down the device. If an examination needs to be carried out, some models can be reprogrammed. You should discuss the possible risks and benefits with your doctor before the scan.
Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive procedure that uses shock waves to break up kidney stones. This method safe for most pacemaker patients if reprogrammable. Close monitoring will be necessary after lithotripsy and for several months to ensure that the device is working properly. Patients with certain types pacemakers implanted in the abdomen should avoid this procedure. Each specific case is discussed with a doctor before and after treatment.
Transcutaneous electrical nerve stimulation is used to relieve acute or chronic pain. Several electrodes are placed on the skin and connected to a pulse generator. Most studies have shown that this procedure rarely inhibits bipolar electrical stimulation. Occasionally, it may inhibit monopolar pacing for a short period of time. This can be resolved by reprogramming the pulse generator.
Diagnostic radiation (such as X-rays) does not appear to have any effect on the pacemaker pulse generators. However, therapeutic radiation (for example, to treat cancerous tumors) may damage the device. The extent of damage is unpredictable and may vary depending on the equipment system. But the risk is significant and increases as the radiation dose increases. It is recommended to protect the pacemaker as much as possible and move it if it is in the immediate radiation area. During similar treatment It is necessary to undergo regular electrocardiograms to monitor the condition of the heart. Also check the pulse generator between and after procedures.
Electrocautery used to stop bleeding during surgery.
Dental equipment does not adversely affect pacemakers. However, some patients may experience increased stimulation while the drill is in use.
Short-wave or microwave diathermy uses high-intensity signals. They can bypass the pacemaker's protection, interfere with operation, or permanently damage the pulse generator.

Treatments that require some precautions. You should inform your doctor that the device is implanted:

Ablation.
Acupuncture.
Argon plasma ablation.
A means for stimulating bone tissue growth.
Colonoscopy – removal of polyps.
Axial computed tomography.
Electroconvulsive therapy.
Electrodialysis.
Electrosurgery and other procedures that use an electrical probe to control bleeding.
Electromyography.
External defibrillation.
Hyperbaric oxygenation.
Magnetic therapy.
Lithotripsy.
Interference current therapy.
Microcurrent therapy.
Mechanical ventilation.
Electronic muscle stimulators.
Neutron radiation.
Radiation therapy (external x-ray, radiosurgery).
Stereotactic surgery.
Transcranial magnetic stimulation
Transcutaneous nerve stimulation.
Transurethral needle ablation.
Transurethral resection of the prostate
Virtual colonoscopy with CT.

Notification required medical workers with whom the patient interacts, that there is a pacemaker, including dentists, medical technicians. Equipment used by doctors and dentists can affect pacemaker performance. The presence of this device is also indicated by special cards, bracelets and neck jewelry.

Exercise stress

In most cases, a pacemaker does not interfere with sports or any physical activity (for example, bowling, golf, playing tennis, fishing, etc.). Should be avoided contact types sports - martial arts, wrestling, boxing, football, etc. Because they can damage the device or dislodge the wires in the heart.

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Further care

Your doctor will check your pacemaker approximately every three months. Unfortunately, over time, devices stop functioning properly:

Wires move or break.
The battery becomes unusable.
The disease is progressing.
Other equipment interferes with the transmission of electrical signals.

You will need to visit your doctor several times a year to check that your pacemaker is working. Certain functions can be explored remotely using a phone or the Internet.

An electrocardiogram is performed to detect changes in the electrical activity of the heart.

Pacemaker replacement - service life

Battery life ranges from 5 to 15 years (average 6-7 years), depending on how actively the device is used. The doctor will replace the alternator along with the battery before the battery begins to discharge. Replacing them is a less difficult operation than the original one. They can also change the wires of the device. The doctor will notify you at subsequent visits if any components need to be changed.

Removal similar systems is a potentially high-risk procedure. The most common cause is infection. If any part of the system becomes infected, it is usually impossible to cure the infection without complete removal all equipment from the body. Doctors disconnect the pulse generator from chest wall and remove all the wires from the veins and heart. Another reason is wire breakage or insulation failure.

Specialized societies have developed guidelines for safe removal or removing the device. They contain instructions for removal, information on the qualifications and training of the attending physician, methods and tools used. Israeli cardiac surgeons perform pacemaker replacement and removal operations in accordance with international standards.

Questions from our patients

Is it possible for the pacemaker to experience painful shocks during intimacy or during some daily activities?

This happens rarely. The device is programmed in such a way that there is no similar actions. This can happen if specific criteria are specified. If you experience unexplained painful shocks, you should consult a doctor to determine the cause and make adjustments to the device program.

Will it be possible to resume sexual activity after installing a pacemaker?

It's a natural part of life. Of course, a person will want to resume sex life when he feels comfortable. However, if such a question arises, it will be useful to discuss it with your doctor.

Are pacemakers compatible with MRI devices?

Currently, most pacemakers change settings or become temporarily inoperable under the influence of MRI. However, there are special models, which, under certain conditions, may be applicable when undergoing MRI.

Is it possible to go through anti-theft security sensors in stores?

Similar sensors in stores and libraries generate electromagnetic fields that detect embedded “tags” on products. Under special circumstances, these fields may temporarily interfere with pacemaker performance. Significant interventions are unlikely to be possible if the pace is passed through the detectors. Recommended:

Be aware that they are there.
Go through them at a normal pace.
Do not linger around such systems.

If symptoms occur, you should quickly move away from the equipment. The pacemaker will resume its previous mode of operation as soon as the person leaves the field of action of this technique.

Is it possible to go through security systems installed at airports or ships?

Given the short inspection period, it is unlikely that the pacemaker will be affected by the detectors. To minimize the risk of temporary interference with the operation of the device, you must undergo inspection without touching the metal surfaces around this equipment. Do not stop or linger while passing through the arch at a normal pace. If a hand-held metal detector is used, instruct the employee not to hold it over the pacemaker. Alternatively, a manual search may be requested. In case there are doubts about the security system, you can present the device identification card, request alternative check and follow the instructions.

Do household magnets affect pacemakers and implantable defibrillators?

Although most electromagnetic fields in the home environment rarely interfere with pacemaker function, it is recommended that you keep the device away from the device by maintaining a distance of at least 15 cm.

These may include microwave ovens, kitchen appliances, cordless phones, radios, televisions, video games, CD players, hair dryers, electric shavers, electric toothbrushes, electric blankets, lawn mowers, garage door locks, computers, etc.

Removing the item returns the pacemaker to normal.

Why should you avoid welding?

Unlike most other household tools, 160 amp welding equipment has a temporary effect on normal function pacemaker.

What if you have to use a welding machine?

You should work in a dry room with dry gloves and shoes.
Maintain a distance of 60 cm between the equipment and the implanted device.
Welding cables should be kept as far away from the pacemaker as possible. The working area distance should be approximately 1.5 m.
Stop working immediately if dizziness or fainting occurs.

9. Why should you avoid using a chainsaw?

The electromagnetic energy generated by a chainsaw is similar to that of other gasoline-powered electric tools. If electromagnetic interference occurs with the device, symptoms such as dizziness and lightheadedness may occur. In this case, a working chainsaw carries very high risk injury compared to other power tools.

Is it possible to fly on an airplane with a pacemaker?

There are no special risks associated with flying.

In general, patients with implanted pacemakers can fly a few days after surgery if there is no pneumothorax; if it does occur, after two weeks.

Can you drive a car with a pacemaker?

You cannot drive for at least seven days after the operation to install the device, but after recovery you can. It is worth further consulting with your doctor.

How long do people live with a pacemaker?

The first pacemaker was transplanted in 1958 at the Karolinska Institute in Sweden. The first patient to receive the implanted device was Arne Larsson, who died in 2001 at the age of 86, outliving the inventor and surgeon.

A pacemaker cannot cure the disease, but it does improve a person's symptoms and quality of life. If proper follow-up care is provided, the patient's life will be long. Millions of people with pacemakers live full and active lives.

Apply for treatment

The price of a heart pacemaker is determined by its type (type) and country of origin (imported devices are more expensive than domestic ones). The price of a pacemaker varies from 10.5 thousand rubles for a Russian single-chamber device without frequency adaptation to 450 thousand rubles or more for an imported three-chamber device. The price for two-chamber pacemakers in Russia ranges from 80 to 250 thousand rubles for domestic devices and from 150 thousand for foreign ones.

In general, the cost of a pacemaker is:

domestic ones, without frequency adaptation - from 10.5 to 25 thousand rubles: the cheapest options, do not support on-demand operating mode functions, cannot record information about the heart rhythm (often such information, however, turns out to be unclaimed);
modern Russian single-chamber stimulators costing from 25 to 50 - 55 thousand rubles often have a service life longer than imported analogues(abroad, it is believed that a device that has served for 7-8 years is obsolete and must be replaced either way: in Russia, for obvious reasons, the situation is somewhat different), modern, but simple in functionality devices are nevertheless closed the needs of most patients;
imported single-chamber ones - from 80 - 100 thousand rubles (or 1 - 1.2 thousand dollars);
modern domestic cardiac pacemakers costing from 80 to 250 thousand rubles;
imported analogues of two-chamber devices - manufactured by Medtronic, StJudeMedical, Guidant (USA) and Biotronic (Germany) - costing from 2 - 2.2 thousand dollars (at the old rate - from 100 thousand rubles, now - from 140 - 160): the most expensive models (from 250 thousand rubles), having the functions of switching sleep and wakefulness modes, saving ECG data;
Russian production– cost from 300 thousand rubles;
imported three-chamber devices - from 450 thousand rubles;
price of transesophageal pacemaker (used in diagnostic purposes) ranges from 54,000 to 88,000 rubles (there may be both cheaper and more expensive transesophageal models).

However, the price of a heart pacemaker in Russia is not always relevant - the patient can receive the device under a quota (from the regional or federal budget), but will be covered from the mandatory funds. health insurance(OMS). For example, in Moscow, the federal budget covers the cost of purchasing single-chamber devices for a patient, and the budget of the city of Moscow covers two-chamber and three-chamber devices.

I was supplied with an imported two-chamber device, also according to a quota, although I am not a Muscovite - a Volgograd resident. Those. The patient does not have to spend money on the operation itself and on the device. However, there are several nuances regarding. Also, the patient may want to install an imported device instead of the domestic one offered free of charge (under quota) - in this case, the IVR is purchased at his own expense, but the compulsory medical insurance fund will partially cover its cost - in the amount of the price of the Russian analogue.

Thus, the cost of a heart pacemaker is determined by its type, brand and production. However, we should also add here the prices for electrodes for the pacemaker:

Russian (for a long time they were considered fragile and brittle, now, it seems, no longer) - from 1,500 rubles;
imported (there are even sports ones) - from 2000 - 2500 rubles.

How much does a heart pacemaker cost in total?

In most cases, the operation, the device itself, and the electrodes (wires) to it are free for Russian citizens. The cost is relevant in the following cases:

quotas for devices have expired - this happens towards the end of the year;
no compulsory medical insurance policy;
the operation is performed in private clinic(the device is also purchased there);
the device is bought with your own money;
the operation is carried out abroad.

Let's summarize. The price of an implantable pacemaker ranges from 10,500 to 450,000 rubles or more. In most cases, the operation is carried out according to a quota and at the expense of the compulsory medical insurance fund - it costs zero. According to the quota, pacemakers are installed free of charge for disabled people and healthy people, children, adults and pensioners.

How much does a pacemaker cost in Germany?

The price of pacemakers in Germany starts from 2 – 3 thousand euros and reaches 20 thousand (cardioverters-defibrillators). In Germany, a wide range of ECS models are offered from such manufacturers as, and, of course, (German manufacturer).

Cost of a pacemaker in Israel

The price for a pacemaker in Israel, together with the operation, reaches 20 - 45 thousand dollars, of which 16 - 25 thousand are for implantation, and the rest is for the pacemaker itself. I must say that prices in Israel are very high, for example, Holter ECG monitoring here will cost 200 dollars - for me in Volgograd it cost 3,000 rubles, taking into account the primary and secondary appointment with a cardiologist (in a paid clinic), or 50 dollars (at the exchange rate for This moment).

How much does a pacemaker cost in the regions of the Russian Federation?

With time internal organs a person wears out and loses functional ability. This also applies to cardiovascular system. Modern techniques allow us to identify features of organ pathologies circulatory system.

The best option for correcting the functioning of a muscular organ is a cardiac pacemaker (CS). The device allows patients to live fully, without feeling pain in the chest.

Device functions

Pacemaker is a miniature device that provides the required number of contractions to the heart muscle. It normalizes the functioning of the circulatory system organ due to atrioventricular blockade.

When the pulse increases, the cardioverter-defibrillator “reprograms” the heart, followed by restoration of the normal rhythm due to electrical stimulation of the myocardium. Another type of device, a pacemaker, is used when the heart contracts slowly to ensure sufficient release of blood into the vessels.

The pacemaker generates impulses only if the rhythm is disrupted. The device does not work during normal contraction of the heart muscle. Thanks to the CS, it is possible to avoid stopping the organ of the circulatory system.

The stimulant has its pros and cons. The advantages include long service life (from 7 years), and the disadvantages are the high cost of installation.

Types of pacemakers

Devices are divided into groups depending on their purpose and configuration.

after surgical intervention on the heart,
for warning vascular pathologies caused by taking medications,
to relieve an attack of ventricular fibrillation.

Long-term pacemakers are needed to combat arrhythmia.

They are divided into 3 groups:

Single-chamber, equipped with one electrode. It is implanted into the left ventricle. CS is not used for atrial arrhythmias.
Two-dimensional, containing 2 electrodes. One is placed in the atrium, and the second in the ventricle. The advantage compared to the single-chamber model is control of rhythm changes in both the atrial and ventricular sections.
Three-chamber – modern models devices. Electrodes are implanted into the left ventricle and into the right parts of the muscular organ. Due to this arrangement of electrodes, optimal conditions to synchronize contractions.

The pacemaker is selected depending on the type cardiovascular pathology and the patient's health status. The cardiologist informs the patient about treatment tactics and the specifics of preparing for surgery to implant a pacemaker.

Indications for surgery

Rhythm disturbance- a symptom of numerous disorders in the circulatory system. The most common cause of the condition is myocardial infarction and widespread cardiosclerosis. In practice, cardiac surgeons cannot always determine the cause of dangerous attacks.

Exist the following readings to install the device:

taking medications to maintain contractile function heart muscle in case of insufficiency of the blood supply organ:
regular attacks of ventricular fibrillation against the background of atrial fibrillation,
disruption of the conduction of electrical impulses from the atrium to the ventricles, accompanied by loss of consciousness,
weakness of the sinus node.

Contraindications to the procedure

There are no absolute prohibitions for installing a CS. The operation is performed even for patients suffering from acute myocardial infarction, which is accompanied by serious heart rhythm disturbances or atrioventricular block.

If the patient does not have vital indications for installation of the device, then the operation may be delayed for a while.

The procedure is postponed:

for acute viral and infectious diseases,
with exacerbation of chronic pathologies,
at psychological disorders in the patient, which interfere with productive contact.

There are no age-related contraindications for surgery to install a pacemaker. In each case, the doctor determines the indications and temporary prohibitions for the procedure.

Preparatory activities

If implantation of a pacemaker is prescribed to a patient as planned, then before the operation it is advisable to undergo instrumental and laboratory diagnostic examinations:

daily ECG and blood pressure, recording disturbances in work heart rate within a period of 1 to 3 days,
consultation and initial examination with a cardiologist and arrhythmologist,
blood tests - general and biochemical (to identify the level of coagulation of biological fluid),
blood test for viral diseases(hepatitis, HIV, syphilis).

For persons suffering from peptic ulcers organs of the gastrointestinal tract, FGS is additionally recommended. Drugs prescribed after the installation of a pacemaker have a negative effect on the mucous membranes of the stomach and can cause internal bleeding.

At chronic diseases ENT organs will require consultation with an otolaryngologist. Foci of infection in the body give rise to complications in the heart, so before the planned installation of a CS, their sanitation is required. Patients who have had a stroke are additionally prescribed MRI.

Stages of the operation

The operation to install the device lasts up to 2–3 hours. The duration of installation of a single-chamber device is 30 minutes, a two-chamber device is 1.5 hours, and a three-chamber device is up to 2.5 hours.

The intervention occurs in stages:

The surgical field is prepared for anesthesia. The drugs are administered subcutaneously and intramuscularly.
Electrodes are inserted into various parts of the heart. The surgeon makes an incision in the collarbone area and then places the electrode in the desired chamber. To accurately perform manipulations, the surgeon needs to take x-rays of the surgical field.
The electrodes are connected to the body of the pacemaker, which is implanted under the pectoral muscle.
The device is programmed according to individual needs sick. The doctor sets the baseline heart rate at rest and during exercise. After this, the edges of the wound are sutured.

Modern devices are miniature, so they are invisible on the human body.

Price for surgery

The cost of the operation includes the installation of an pacemaker, diagnostic measures, the price of electrical wires.

The price of the intervention also depends on the type of device:

Rehabilitation period

After installation of a pacemaker, the patient experiences discomfort and pain in the surgical area for several weeks.

The consequences of the procedure include:

hematoma formation in the intervention area,
increase in body temperature,
the appearance of a headache.

Unpleasant symptoms go away on their own or are eliminated with medications for symptomatic therapy– antibiotics, non-steroidal drugs.

24 hours after the intervention, the person is allowed to get out of bed, and after 7 days - to return to normal life.

Features of life with ECS

In most cases, the device does not lead to cardiac complications and is not felt by patients. Despite this, after the operation certain restrictions are introduced regarding the patient’s lifestyle.

The patient is not allowed:

engage in sports where there is a risk of injury chest(boxing, hockey, football, rugby, etc.),
perform exercises using weights on the chest muscles,
located near the transformer booths,
fly on an airplane,
drink alcohol in large quantities.

It is not prohibited to use household appliances. The basic rule in this case is to maintain a safe distance between the device and the pacemaker (from 20-61 cm depending on the type of household appliance).

If the pacemaker is installed due to severe heart failure, then the patient is assigned disability group 2 or 3.

Medical procedures for a patient with a pacemaker are prohibited:

CT and MRI. CT scans are performed only with the consent of the doctor.
Physiotherapeutic measures using magnetic or electrical radiation.
Ultrasound with beams directed directly at the device.

Before conducting examinations, the patient warns the doctor about the device he has.

Forecast

The pacemaker lasts up to 7–10 years, it all depends on the battery capacity. During the next inspection, the device will give sound signal, indicating the need to replace it.

After the battery has expired, it is replaced with a new one.

How long do they live after having a pacemaker installed?

People with an implanted stimulator live longer than without it. The opinion that CS can harm a person is erroneous.