Download Pacemaker Implantation - Queensland Cardiovascular Group

PACEMAKER IMPLANTATION
Normal Electrical Pathways In
The Heart
top of the right atrium in an area
called the sinus node. Functionally,
the atria act as reservoirs/ priming
chambers for the ventricles.
From the sinus node the electrical
signals spread through the atria and
meet another group of specialised
cells between the atria and
ventricles. This is called the atrioventricular node (AV node).
From the AV node the electrical
impulses pass through to the
ventricles which are the main
pumping chambers.
Your heart is a muscle that pumps
blood throughout your body sending
oxygen enriched blood and
nourishment to all of your body
cells.
The heart consists of four chambers
and is split into the left and right
sides of the atria (top half) and
ventricles (bottom half). Your heart
rate is generally controlled by a
discrete, specialised group of heart
cells called pacemaker cells. These
pacemaker cells are in turn
controlled by your brain and
numerous other factors.
The pacemaker cells that control
your heart are located in the very
As long as the electrical impulses
travel at regular intervals, your
heart will beat at a steady rhythmic
pace. The rate will vary depending
on your level of activity.
Who Needs a Pacemaker
The most common condition
requiring a pacemaker is
bradycardia; a heart rate that is too
slow for the body’s demands.
Bradycardia:- is most commonly
caused by one or both of the
following:
¾ Sick sinus syndrome: when
the sinus node sends out
www.qcg.com.au
PO Box 525 · Spring Hill, Qld 4004 · 07-3839-0677 · Fax: 07-3016-1199 · [email protected]
This information is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice. Those with
questions or need more information should check with their physician. Copyright ©2005 Queensland Cardiovascular Group. All rights reserved.
connected to the pulse
generator and are extremely
flexible. They are able to
withstand the twisting and
bending caused by normal
body movement and
heartbeats.
electrical impulses too slowly
or irregularly.
¾ Heart block: when the
electrical impulse is slowed,
becomes irregular or is
stopped. Heart block can
occur at the AV node or along
the conduction pathways.
Symptoms of bradycardia may
include dizziness, extreme fatigue,
shortness of breath or fainting
spells.
What does a pacemaker do?
A pacemaker restores regular
electrical impulses to your heart.
The pacemaker has 2 basic parts:
¾ A pulse generator: This
contains the battery and
circuitry. This functions like
a miniature computer, by
controlling the timing of
electrical impulses sent to
the heart
¾ Pacing leads: which are
insulated wires through which
the electrical impulses
travel. The leads are
At the tip of the lead is a metal
electrode. It is through this
electrode that the pacemaker
monitors (or senses) the heart’s
electrical activity and is able to
send out electrical impulses when
the heart needs them.
Pacemakers have a special sensor
that detects changes in your
exercise state. The pacemakers’
circuitry interprets these changes
and increases or decreases the
pacing rate to meet your body’s
demands. It will increase with
physical activity i.e. walking,
gardening or exercising and will
slow down accordingly with rest or
sleep.
Types of pacemakers:
The type of pacemaker you require
will depend upon your medical
condition. You may require a single
chamber, dual chamber or biventricular pacemaker.
www.qcg.com.au
PO Box 525 · Spring Hill, Qld 4004 · 07-3839-0677 · Fax: 07-3016-1199 · [email protected]
This information is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice. Those with
questions or need more information should check with their physician. Copyright ©2005 Queensland Cardiovascular Group. All rights reserved.
In many heart rhythm disturbances,
your heart may beat normally part
of the time and therefore your
pacemaker will only work when
required.
Your pacemaker stores information
about your heart’s rhythm. It is
completely programmable and if
your pacing requirements change
this is easily attended to in your
doctor’s rooms without the need for
any further hospitalisation.
Single chamber pacemaker
A single chamber pacemaker uses
one lead, placed in the right
ventricle to sense and pace that
chamber.
Dual chamber pacemaker
A dual chamber pacemaker requires
two leads, one placed in the right
atrium and the other in the right
ventricle.
A dual chamber pacemaker monitors
both the atrial and ventricular
activity to see if pacing is needed.
When pacing does occur the
contraction of the atrium is
followed closely by the ventricular
contraction. This action results in
timing which closely mimics the
heart’s natural pattern of
contraction.
Bi-Ventricular pacemaker
A bi-ventricular pacemaker has
three leads, one in the right atrium,
one in the right ventricle and one
placed within a vein that lies on the
outside surface of the left ventricle.
This pacemaker works in a similar
way to a dual chamber pacemaker.
The addition of the left ventricular
lead allows coordination of
electrical impulses between the
right and left ventricles helping
them to contract at the same time.
How is a pacemaker implanted?
The pacemaker is implanted
transvenously. The leads are
introduced into a vein in the left
upper chest region. The lead is
then threaded through the vein to
the appropriate chamber in the
heart. The procedure is performed
www.qcg.com.au
PO Box 525 · Spring Hill, Qld 4004 · 07-3839-0677 · Fax: 07-3016-1199 · [email protected]
This information is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice. Those with
questions or need more information should check with their physician. Copyright ©2005 Queensland Cardiovascular Group. All rights reserved.
in the Cardiac Catheter Theatre and
requires only a local anaesthetic.
The procedure
¾ Before the procedure
Ask any questions regarding
your uncertainties
When you are admitted to the ward
you will be asked to:
• Have nothing to eat for 6 hours
before the test.
• You may be required to have
blood tests and an
electrocardiogram (ECG).
• Have your right groin shaved.
• Have an antiseptic shower to
help remove germs from your
skin.
• Have a needle (IVC) inserted into
an arm vein connected with an
IV line to a bag of fluid (drip).
• Before the test you will receive
a tablet to help you relax.
¾ During the procedure
The pacemaker is implanted
transvenously. The leads are
introduced into a vein in the left
upper chest region. The lead is
then threaded through the vein to
the appropriate chamber in the
heart. The procedure is performed
under local anesthetic.
Duration: - The procedure should
take approximately 60 – 90
minutes.
¾ After the procedure
On return to the ward you will be
monitored overnight and will remain
resting in bed until next morning.
The IV cannula will be removed
approximately 6 hours after
returning to the ward and the
dressing over the pacemaker site
will be removed the next morning.
Food and fluids may be given to you
upon return to the ward.
The morning of discharge
A nurse will remove the dressing
prior to discharge. The monitoring
leads will be removed once your
pacemaker has been checked. You
may still experience some pain at
the insertion site. This should be
eased by taking panadol as
directed.
Upon the advice of your doctor you
should be able to return to your
normal activities of daily life. You
can safely use common household
appliances including microwave
ovens, televisions, video and
computer games, gardening
machinery and portable phones etc.
You will receive a booklet produced
by the manufacturer of the
pacemaker along with a pacemaker
identification card.
Avoid these probable sources of
electrical interference:
•
•
Magnetic underlays used to
alleviate the pain of arthritis.
Mobile phones – use on the
opposite ear to the side of the
pacemaker.
www.qcg.com.au
PO Box 525 · Spring Hill, Qld 4004 · 07-3839-0677 · Fax: 07-3016-1199 · [email protected]
This information is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice. Those with
questions or need more information should check with their physician. Copyright ©2005 Queensland Cardiovascular Group. All rights reserved.
•
•
•
•
•
MRI scanners.
TENS machines used by
physiotherapists.
Electrical arc welding
equipment.
Dielectric heaters used in
industry to bend plastic.
Electric steel furnaces.
Airport screening devices
Airport screening devices may
detect the pacemaker’s metal case.
It will be necessary to present your
pacemaker card to obtain clearance.
Mobile Phones
Studies have indicated that there
may be some potential interaction
between mobile phones and
pacemakers. This may be due
either to the radiofrequency signal
or the magnet housed within the
phone. The effect is temporary and
may include preventing pacing when
the phone is within close proximity
(15 cm/6 inches).
• Maintain a minimum distance of
15 cm between your device and
a hand-held mobile phone.
• Hold the phone to the ear
opposite your device.
• Don’t carry your phone in your
breast pocket.
Medical procedures
Always tell any health professional
that you have a pacemaker and
show your ID card. Most medical
procedures are unlikely to interfere
with your pacemaker except MRI
scanners.
Follow up visits
An important feature of your
pacemaker is the ability for your
doctor to program it to suit your
individual needs. This takes place
at regular routine check-ups that
your doctor will schedule; the first
after 3 months and then 12 monthly
thereafter. At these check ups your
doctor will also ensure that your
pacemaker is functioning correctly.
A typical follow up visit may last
about 20 minutes. During this time
you will be connected to a
programmer (including ECG
monitoring). This enables
information to be passed to your
doctor and programming
instructions given to your
pacemaker.
Information gathered may include:
• How your device has performed
since your last visit.
• Checking the battery to see how
much energy remains. The
battery life is able to be
calculated accurately and the
device is replaced well before
the battery is flat.
www.qcg.com.au
PO Box 525 · Spring Hill, Qld 4004 · 07-3839-0677 · Fax: 07-3016-1199 · [email protected]
This information is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice. Those with
questions or need more information should check with their physician. Copyright ©2005 Queensland Cardiovascular Group. All rights reserved.
Your responsibilities
Your pacemaker will monitor and
treat your heart automatically. But
you must make an effort to follow
your doctor’s instructions and keep
follow up appointments.
You should:
• Ask your doctor or nurse any
questions about anything you
are unsure of.
• Take medications as prescribed
by your doctor.
• Carry your ID card with you at all
times.
• Inform your family doctor, your
dentist and emergency
personnel that you have a
pacemaker.
www.qcg.com.au
PO Box 525 · Spring Hill, Qld 4004 · 07-3839-0677 · Fax: 07-3016-1199 · [email protected]
This information is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice. Those with
questions or need more information should check with their physician. Copyright ©2005 Queensland Cardiovascular Group. All rights reserved.