Pacemaker is a machine by which we give stimulus to the heart muscles, supporting them to pump the heart. Pacemaker can be temporary or permanent based on the patients condition.
The implantation procedure is done by a heart specialist either from the veins neat the groin or from below the clavicle veins. Any patient who’s pulse rate is very slow and the patient is showing symptoms like giddiness, blackouts. The pulse rate of such patient’s heart require an external electrical stimulus, this can be temporary or permanent. If the condition is temporary where heart rate is low due to a heart attack, such patients require a temporary pacemaker.
The pacemaker electrode is inserted through a view wither the femoral vein, jugular vein or sub clavicle vein through a needle. This electrode is introduced inside the right ventricle of the heart. The other end of the wire is connected to an external pacemaker through with the stimulus of 60, 70, 80 etc. and the amount of current that is required to Stimulus the heart wall is delivered. As and when the patient regains his own heart rate then we switch off the machine and remove that wire.
However, if someone has a permanent problem, i.e. he has a low pulse due to a heart block, or heart rate generation problem from the SA node. Then a permanent pacemaker is required. These are smaller pacemaker of 1”X1” in size. The electrode of this pacemaker is generally inserted through sub clavicle vein to the right ventricle of the heart. While for some pacemaker another electrode is introduced and inserts in the right atrium. While the pacemaker is fixed below the subcutaneous tissue and is sutured there. As this machine is permanently placed its is called permanent pacemaker and the process is called permanent pacemaker implantation. This pacemaker will send impulses at a fixed rate.
We generally use Demand type pacemaker, which only stimulate the heart as long as the heart rate is low. If the heart rate goes becomes more than the heart rate set by the pacemaker; The pacemaker stops stimulating the heart and lets the heart beat on its own until such time the rate goes below the rate set in the machine.
There are two types of pacemakers.
Single chamber pacemaker in which a single electrode is introduced in the right ventricle to introduce the stimulus in the lower chamber. If the patient has the symptoms due to low pulse rate a single chamber suffices.
Dual chamber pacemaker, these pacemakers employ two electrodes one in the right ventricle and another in the right atrium. These pacemakers are better as they work as a normal physiology of the heart by making sure first the upper chamber contracts then the lower chamber contracts.
These permanent pacemakers generally last for 8-10 years pending on the patient’space requirement. The battery of the pacemaker is checked annually. If the battery is nearing exhaustion the pacemaker is replaced with a new pacemaker with a new battery,
After implantation, the patient who was having episodes of giddiness and blackouts stops having such episode and is able to live a normal life, with some restrictions.