Implanted pacemakers: who needs? what is the procedure like?

Some people may need a pacemaker (pacemaker) to manage their heart function which is not as good as it used to be. A pacemaker is a small device the size of a matchbox that is implanted under the skin of the chest to control the heart rate. So, who needs the device and what is the procedure for inserting a pacemaker?

Who needs to install a pacemaker?

A pacemaker is an internal monitoring system device that is attached to the heart to measure the electrical activity, pulse pattern, heart rate, and temperature of the blood pumped by the heart. However, not everyone needs to be fitted with a pacemaker.

This tool will usually be applied to people who have heart rhythm problems (arrhythmias). Arrhythmias occur when the heart beats either too fast (tachycardia) or beats too slowly (bradycardia). Severe arrhythmic conditions can result in damage to other vital organs, even death.

A pacemaker may also be needed for people who have heart block problems (electrical signals are slowed down or interrupted).

How do pacemakers work?

The heart is supposed to work non-stop to pump blood around the body with the help of a natural electrical system that tells when the chambers of the heart should contract. When there is a disturbance in the pulse pattern or natural electrical impulses, the heart cannot beat normally.

Pacemakers work to mimic the action of your heart's natural electrical impulses. To perform this function, the pacemaker is made of two parts:

• Generator. It is a small metal container that holds a battery for producing electrical circuits to regulate the rate of electrical impulses sent to your heart.
• Lead wires (electrodes) consisting of one to three flexible cables. Each is placed in the chambers of your heart. Its function is to channel electrical signals to adjust your heart rate.

Pacemakers also have sensors that detect body movement or respiratory rate. If your pacemaker senses your heart is beating irregularly or too slowly, it will send a signal at a steady rate to normalize your beating. If the pacemaker senses your heart beating normally in its rhythm, it doesn't send out any signals.

The installation of a pacemaker eliminates the need for you to frequently go to the hospital to check for heart conditions.

Before deciding to install a pacemaker…

The decision to install a pacemaker must, of course, be with a doctor's approval. Even before pairing it, the doctor will monitor your health condition and the drugs you are currently using, as well as your medical history. The doctor will also first undergo a physical test and an overall examination of your heart.

What is the procedure for inserting a pacemaker?

Installation procedure pacemaker can be done through minor surgery or major surgery. In many cases, minor surgery is preferred because it is less time consuming and less risky.

In minor surgery, you will first receive local anesthesia under the skin of the collarbone of the left chest. The area is then slashed so that the doctor can drill a hole in the blood vessel there. Through these blood vessels, lead wires will be inserted and continued to be pushed until they enter the chambers of the heart.

After the lead wire is in the heart, it will then be tested to ensure that it is properly located and functioning properly. Depending on the type of device your doctor has chosen for your condition, there may be one, two, or three lead wires.

Meanwhile, the generator pacemaker will be inserted through the incision under the skin just below the collarbone after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side. So if you are right-handed, the device will be placed in the upper left chest. If you are left-handed, the device will be placed on your upper right chest.

After all pacemakers have been installed, the doctor will monitor their function via ECG. This includes checking the battery function of the generator. After confirming that the pacemaker is working, the doctor will close the skin incisions with stitches, adhesive strips, or special glue. Finally, the incision site will be bandaged.

Using only local anesthesia, you will wake up conscious during this procedure. However, it is very important that you remain still during the procedure so that the lead catheter does not move out of place and to prevent damage to the insertion site.

Minor surgery for pacemaker insertion usually lasts about an hour, or it can be longer if certain situations and conditions make the procedure more complicated.

Most people recover quickly after this procedure within a day. However, you still need to consult regularly with your doctor for scheduled examinations.

What are the possible side effects?

The most likely side effect and the most common is swelling, redness and pain at the incision site. This can happen for several days to weeks after surgery.

The pain is usually mild and can be relieved with over-the-counter pain relievers, such as paracetamol or ibuprofen. Make sure you consult with your doctor before taking painkillers.

What must be considered after doing this procedure

After undergoing pacemaker implant surgery, you must be aware of the potential for interference with electrical signals from electronic objects, such as cellphones, microwave ovens, and metal detectors. Do not go near electronic objects that emit radiation.

We recommend that you keep your cellphone in a pants pocket rather than in a shirt pocket.

If you must enter a building with a metal detection test, for example an airport, tell the authorities that you have a pacemaker implant and ask for other testing as metal detectors can interfere with the work of the pacemaker.

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