Permanent Pacemaker Implantation: How It Works, Different Types, and Key Benefits

What Is a Permanent Pacemaker Implantation?

A permanent pacemaker is a tiny device inserted in the chest or belly to control abnormal cardiac rhythms (arrhythmia). Pacemaker Implantation procedures are performed to control the individual’s heart rhythm on a long-term basis. The device can be implanted temporarily or permanently and uses electrical impulses to ensure the heart beats at a normal rate.

The electrical signal that enables your heartbeat begins at the sinoatrial node (the heart’s natural pacemaker). The signals originating in the SA node travel from the top of the heart to the bottom in a synchronised manner, resulting in a heartbeat. An abnormality in the electrical system causes the heart to beat too fast, too slow, or irregularly. A pacemaker allows your heart to beat at a steady rate and rhythm.

What Heart Conditions require a Pacemaker?

Age-related changes in heart tissue, heart damage (surgery, heart illness, or previous heart attack), congenital heart issues, drugs (beta-blockers or calcium channel blockers), and certain medical conditions can all require the use of a pacemaker.

You may require a pacemaker if you have:

• Bradycardia is an abnormally low heart rate

• Heart block (issues with the heart's electrical activity)

• Cardiac conditions that might produce irregular heartbeats

Depending on usage, the pacemaker’s battery can typically last for 5 to 15 years. When the battery runs low, replacement surgery is required.

Some signs you may require a pacemaker are:

• Dizziness

• Heart palpitations

• Dizziness and lightheadedness

• Chest pain or tightness

• Shortness of breath

• Fainting

Permanent Pacemaker Implantation Procedure

Pre-procedure

A thorough evaluation is done before the procedure, which involves blood tests, a chest X-ray, and an electrocardiogram (EKG). Based on the results, the type of pacemaker and technique are decided.

During the procedure

The pacemaker Implantation procedure is carried out under local anaesthesia or mild sedation. A small incision is made near the collar bone and the leads are inserted through the veins and guided with the help of fluoroscopic imaging. The tip of the lead is attached to the heart muscle, whereas the other end is connected to the pacemaker device placed under the skin.

Post-procedure

The patient is monitored in the hospital for a short while after surgery. Most patients can resume their normal routine after permanent pacemaker implant surgery with restrictions on arm movement to allow the pacemaker to be secured in its place. Regular check-ups are necessary to ensure the pacemaker is functioning properly.

Types of Pacemakers

Most pacemakers consist of a pulse generator (a portion of the device that generates electrical signals) and one or more leads (wires that deliver electrical impulses from the pulse generator to the heart).

Depending on the needs, pacemaker is classified as:

• Single-chamber pacemaker

The pacemaker sends electric impulses to either the right atrium or the ventricle. The device is preferred when only one chamber requires pacing.

• Dual-chamber pacemakers

These devices help control the duration between the contraction of the atrium and ventricles. 

• Biventricular pacemaker

Also known as Cardiac Resynchronisation Therapy, these devices are used for patients with heart failure. They help coordinate signals between the heart's lower chamber.

• Wireless pacemaker

The pulse generator and the electrodes are combined in a single device and positioned in the right ventricle.

Risks Associated With Pacemaker Implantation

Like any other surgical procedure, permanent Pacemaker Implantation carries risks such as infection at the surgical site, allergic reaction to anaesthesia, bleeding or bruising, blood clots, damage to the nerves and blood vessels, and lead displacement. The scar tissue can also develop around the pacemaker or develop pacemaker syndrome. In rare instances, puncture of the heart muscle can occur.

Most of these complications are temporary and are not life-altering. However, the pacemaker can malfunction or stop working properly, resulting in the worsening of the arrhythmia symptoms. If this happens, you should contact your cardiologist immediately.

Life After Pacemaker Implantation

• You need to avoid specific devices and equipment to prevent their interference with the pacemaker's function.

• Carry an identification card indicating the presence of a pacemaker for emergencies or while passing through a security system.

• Avoid being around equipment with a magnet.

Conclusion

Individuals with cardiac conditions affecting their heart and function may require a pacemaker to help their heart beat at a normal rate and rhythm. Permanent Pacemaker Implantation helps reduce symptoms and prevent complications. If you or your loved one requires pacemaker implantation, visit Manipal Hospitals, Pune.