According to the World Health Organization, cardiovascular diseases are the most common cause of death in the world. Among this group of disorders of the heart and its blood vessels are arrhythmias.
The pacemaker is an electronic device that controls and monitors the electrical activity of the heart and generates impulses in the heart. It consists of a generator (battery) that sends the impulses and wires that transmit the information.
How is the pacemaker placed?
The generator is implanted in different places, depending on the patient’s age. In adults, it is placed under the clavicle in the upper part of the thorax (endovenous pacemakers), while in young children it is in the anterior and upper abdominal wall (epicardial pacemakers). The battery is long lasting but needs to be changed every 10 years.
What is the difference between endovenous and epicardial pacing?
The endovenous mode is the most common technique. As the name suggests, the lead is introduced through a vein, usually axillary, subclavian or cephalic, to reach the heart by contacting the atrial or ventricular muscle walls.
In the epicardial mode, the electrodes are implanted on the external surface of the heart (atrium or right ventricle) through a small substernal incision (see picture). This technique is used when the patient is small (less than 15kg) and his veins are too small to be able to introduce the electrodes.
When should a pacemaker be placed?
Each case is unique depending on the severity, cause, symptoms, age or type of arrhythmia. If a patient suffers from slow arrhythmias, as a general rule, a pacemaker is required. Patients should have a pacemaker:
- With sinus dysfunction, slow arrhythmias and congenital heart disease.
- With some type of atrioventricular block of poor prognosis, Mobitz II type, advanced or complete.
- With congenital atrioventricular block with symptoms or with special conditions (ventricular dysfunction, prolonged pauses between beats…).
- With congenital heart disease with atrioventricular block with hemodynamic compromise.
- Patients operated on for congenital heart disease who develop postoperative atrioventricular block (second-degree, advanced or complete block) and who persist for more than 7-10 days after surgery.
What are the risks of pacemaker implantation?
Pacemaker implantation is considered a simple, low-risk operation (0.4%), as is generator replacement. When removing endocavitary dysfunctional leads the risk increases (1%), as well as when removing the battery and leads together (2%).
What lifestyle can you lead with a pacemaker?
A child with a pacemaker can lead a normal life, including numerous activities. There is no problem when it comes to sports, even those with sudden arm movements. It is recommended to avoid contact sports in order to prevent shocks to the pacemaker.
There is no problem to travel by any means of locomotion. It must be taken into account that to drive one month after the operation and to have a positive medical report every two years.
Any laser treatment can be used as long as it is not applied on the area where the implant is located.
What can interfere with the pacemaker?
In general, the devices do not usually interfere with pacemakers. Nevertheless, a series of recommendations are made:
- Do not stay near strong electromagnetic fields (such as high-power electrical transformers, industrial induction furnaces, etc.).
- Do not use percussive machinery (drills in percussive mode, etc.).
- Do not use electric blankets or electrostimulation gadgets.
- Do not bring a magnet close to the pacemaker
- There may be small interferences in the security detectors in stores, but this is not a problem.
- Metal detectors in airports and banks do not pose any problem for the device, but may activate the alarms (it is recommended to carry the pacemaker card with you and report it beforehand).
- At hospital level, it is contraindicated to undergo diathermy (the so-called currents) or positron emission tomography (PET). When an MRI is performed, it is recommended to notify the professional in question.