The beginning of the 20th century was marked by the rapid development of technology in all branches of human life.
Innovative medical research carried out in the 1920s showed the ability of the myocardium to contract under the influence of electric current pulses.
The essence of the research was able to make a revolution in the treatment of certain heart diseases, which was demonstrated by an external device to maintain the rhythm created in 1927.
However, due to the large size and relatively small resource of the electronic components of the time, the development of pacemakers was frozen for decades..
The device in its modern sense was created only in 1958 by Swedish scientists and was named Siemens-Elema. Since then, the design and operation principle of pacemakers is being improved annually: the devices become more functional, reliable and durable.
Appointment device and device
To understand how a modern pacemaker works, you need to find out what it is. The pacemaker (EX) or, as it is also called, artificial pacemaker (IVR), is a microprocessor device equipped with an independent power supply and located in a sealed metal box, most of the time made of titanium alloy.
The device design includes:
- living place – It serves to accommodate the internal elements of the pacemaker and its isolation from body tissues.
- Control and communication unit. – It is necessary to coordinate the work of the modules, the exchange of information with control and diagnostic devices.
- Memory block – Stores statistical information about the operation of the device.
- Sensor unit – Able to detect changes in the heart and correct the effects of a pacemaker.
- Unit of work – It generates and transmits electrical impulses to the heart.
- Drums – serves as a power source for the remaining elements of the pacemaker, is supplied with mechanisms to save energy and disable non-basic functions when the load falls below the threshold level.
The functions of the pacemaker consist of perceiving the heart’s own rhythm, detecting pauses and other faults in its functioning and eliminating these faults generating impulses and transmitting them to the corresponding chambers of the heart.
If the proper rhythm is stable and satisfies the needs of the organism, impulses are not generated.
An optional feature of some high-tech stimulants is the prevention of arrhythmias, tachycardias and other disorders through special work programs.
What are pacemakers?
Currently, there are many types of pacemakers, which differ from each other in terms of design, functionality and other criteria. The classification of the devices can be carried out for several reasons, but the main characteristics of the design characterize the specific aspects of the stimulation.
Depending on them we will emit:
- Single chamber pacemaker: affects an atrium or a ventricle
- Two chambers: simultaneously affect the atrium and the ventricle.
- Three chambers: affect both the atria and one of the ventricles
- Cardioverter defibrillators (ICD, ICD) are used in case of a high risk of a complete arrest of the blood circulation.
To understand in which cases a particular pacemaker model should be used, its code of letters can be used, taking into account the design features and functionality of the device.
Includes 3 to 5 letters of the Latin alphabet, which, depending on the serial number on the brand, indicate:
- Stimulated camera device.
- Detectable camera.
- The nature of the response of the heart to the impulse.
- Parameters of frequency adaptation of the device.
- View of the response of the device to the tachycardia.
The main letters used in the marking of the pacemaker are the first letters of the English words: atrium (atrium), ventricle (ventricle), double (two, both), single (one), inhibition (trigger), trigger (stimulation) , adaptable to speed (frequency adaptation). The final code, which marks the types of pacemakers, can be seen as follows: AAI, VVIR (aka – PEX), DDDR, etc.
Taking into account the classification of the IVR, you can not ignore the temporary pacemaker. It is an external device that is connected to the patient’s heart by the resuscitator in the event of a sudden cessation of natural cardiac activity or frequent and dangerous fainting.
Indications for installation
The most common heart diseases for which a pacemaker is recommended are:
- Sick sinus syndrome
- Autrioventricular block.
Arrhythmia is a pathological condition characterized by a change in the frequency and sequence of stages of excitation and contraction of the heart. When arrhythmias interrupt the normal functioning of the body and there are a number of serious complications.
Arrhythmias can be caused by different causes, but the most common are:
- Ischemic heart disease
- Heart failure
- Cardiomyopathy and myocarditis
- Heart defects (both congenital and acquired).
- Mitral valve prolapse
- Toxic effects, including smoking, alcoholism, use of narcotic substances.
- Mixed effects, manifested by atrial or ventricular fibrillation (heart rate increases to 250 beats / min and more).
The pacemaker is not implanted in all the cases listed. Some infractions can be performed without surgical intervention, affecting the source of the problem with medical preparations or other factors.
The syndrome of sinus node weakness (SSSU) reflects disturbances in the functioning of the sinoatrial mechanism to control the rhythm of the contractions of the heart.
Arrhythmias and blockages associated with SSS include:
- Lowers the minimum heart rate to 40 beats / min. and below, and the heart rate under load – up to 90 beats / min. and down
- Pause between contractions, more than 2.5 seconds.
- Alternation of bradycardia and tachycardia.
- Severe sinus bradycardia
- Brady-systolic mitral arrhythmia
- Headphone driver “migration”
- Sinoauricular block, etc.
Here you can find the difference between heart rate and pulse.
According to various sources, SSS is found in 6% -25% of people who went to cardiologists for help. Most of them recommend installing a pacemaker.
The atrioventricular block (AVB) indicates a violation of conduction of the impulses from the atria to the ventricles, which leads to the interruption of the cardiac rhythm and hemodynamics.
There are three degrees of atrioventricular block:
- Incomplete conductivity Indicates that the electrical impulse is driven more slowly than usual. It does not require treatment, however, it can lead to the appearance of AVB 2nd and 3rd grades. The first degree does not apply to cases in which a pacemaker is installed.
Conductivity of some pulses. It is manifested by episodes of weakness, darkening of the eyes, sometimes, loss of consciousness. The treatment of second-degree AVB is usually associated with the use of medications, although a pacemaker is sometimes recommended.
- Complete non-conductive. In third-degree AVB, the ventricles contract extremely rarely, which leads to frequent and prolonged loss of consciousness and, sometimes, sudden cardiac arrest (cardiac death). When a disease of this type is detected, the pacemaker is installed immediately.
We reviewed the indications for the stimulator installation, it remains to be understood in which cases the cardiac stimulation can be dangerous.
The device is not configured:
- Patients with blood coagulation problems.
- Overweight patients
- Patients who constantly take certain types of medications.
- People suffering from mental disorders.
- People who have bad habits and do not get rid of them.
Some years ago, there were also contraindications for age, but nowadays, both a child and an elderly person can supply the device.
Characteristics of the operation.
The surgery to install a pacemaker is a small surgical procedure and is performed in an X-ray operating room. The first step is to determine the installation site.
The most common options are:
- Left subclavian area: for right-handers, left-handers with tissue damage on the right side of the chest
- Right subclavian area: left-handed, right-handed with tissue damage on the left side of the chest
- Other places connected by the veins to the chambers of the heart, if for some reason the classic options are impossible.
Let’s see how the operation is going. The algorithm usually includes the following sequence of actions:
- Disinfection and management of local anesthesia (for various reasons, general anesthesia is not used during pacemaker adjustment).
Dissection of subcutaneous fat, if necessary – muscle tissue.
- Isolation of the lateral vein of the arm or other suitable vein.
- Conduction of electrodes through a vein with simultaneous radiological control of the process.
- Verification of the correct connection of the electrodes through external monitoring and diagnostic equipment.
- Fixation of electrodes in Vienna.
- Niche preparation for the instrument in the desired area.
- Connect the pacemaker to the electrodes.
- Sewing cut.
- Postoperative treatment of wounds.
An experienced surgeon can do it all for 20-30 minutes however, with an atypical installation location or the connection of several cameras at the same time, the time of surgery may increase.
The installation cost of the device.
There is no unequivocal answer to the question of how much an operation of this type costs, everything depends on the reputation and prices of the clinic, the characteristics of the technologies used in it. In the health clinics of the heart of Moscow, the cost of the operation will be from 100 to 600 thousand rubles, in St. Petersburg the price varies from 60 to 300 thousand.
The provincial clinics are ready to do the work for 25-100 thousand rubles.
But it is important to understand that these amounts only take into account the installation of the device. For the pacemaker itself you will have to pay another 2500-10000 dollars.
Patients who receive treatment by fee can obtain a full range of services for $ 3,500-5,000.
This amount includes:
- Placement and content in the clinic.
- Pacemaker cost
- Cost of consumables
- Payment for the work of doctors and medical personnel.
Patients with severe cardiac arrhythmias who have general medical insurance, install a pacemaker for free.
How to live with a pacemaker?
Despite the opportunity to return, in fact, to the previous life, a patient with a pacemaker still has to follow certain rules.
The first and most important are regular and timely visits to the doctor who makes an additional observation of the patient.
The following sequence of visits is usually assigned:
- Three months after installing a pacemaker.
- Six months after the first postoperative visit.
- Once every six to twelve months according to the doctor for a routine examination.
- Outside the plan: in cases of electric shock sensations, the return of the symptoms of the disease, the appearance of signs of inflammation in the place of installation of the device.
- After the expiration of the life of the pacemaker declared by the manufacturer (usually from 6 to 15 years).
Like any implantable medical device, the pacemaker has its pros and cons. Much has already been said about the professionals, that is, the positive effect of the device on the work of the heart and the body in general.
But it is important to remember that living with a pacemaker after surgery is paying attention to the details that used to seem insignificant.
We will have to abstain from this type of work and actions:
- Strong effort at the shoulder girdle.
- Being close to high voltage power lines, powerful wireless communications translators
- Checking the metal detector and going through the magnetic frame of the airport, shops.
- Magnetic resonance, lithotripsy, physiotherapy and ultrasound in the vicinity of the device installation site.
In daily life a series of restrictions will also appear. Special care should be taken when working with electrical appliances, and especially with powerful electrical tools, to avoid any electrical shock.
The mobile phone must be kept at a distance of no more than 20-30 cm from the place of installation of the pacemaker.
It is also recommended not to bring a camera, player and other portable electronic devices to the device. Otherwise, patients with a pacemaker live a full life, eliminating the problems associated with alterations in heart rhythm.
When is it necessary to replace the device and how is it done?
During a routine doctor’s visit, a pacemaker is diagnosed and, if necessary, reprogrammed. However, in some cases it may be necessary to replace the instrument.
These cases include:
- End of warranty period.
- Low residual battery charge
- The occurrence of irreparable faults.
A special case is the replacement of the stimulator for the installation of a more modern and functional model. The process of replacing a pacemaker is similar to the installation process and is also performed under local anesthesia.
During the operation, the status of the electrodes is monitored and, if necessary, new ones are installed.