Pacemaker Device in Turkey

Contents:

• What is a Pacemaker Device in Turkey?
• What are the Types of Pacemakers?
• Why is a Pacemaker Installed?
• How is a Pacemaker Inserted?
• Things to Consider After Pacemaker Surgery
• How Long Do Pacemaker Patients Live?

What is a Pacemaker?

A pacemaker is a metallic device weighing approximately 20 grams that sends small electrical pulses to the heart muscle to maintain a proper heart rate and rhythm. It is used when the heart’s nerve impulses are not effectively transmitted from the focal nerve cell, leading to a slowed heart rate due to conditions affecting the heart’s conduction system. A pacemaker, which monitors the natural rhythm of the heart and aids contraction through various signals based on the condition, can be applied in two different ways: temporarily or permanently.

The contraction and relaxation of the heart occur through nerve signals produced by specific tissues within the heart. Known as the sinoatrial node and the atrioventricular node, these neural focal points act as natural pacemakers. When these cells experience issues, the heart cannot contract and relax as it should, disrupting circulation rapidly. Pacemakers are employed to stimulate the heart externally, aiming to treat such conditions.

What are the Types of Pacemakers?

Temporary Pacemaker: Temporary pacemakers are devices intended to be removed once the patient’s heart rhythm normalizes. Comprising a cable that reaches the heart via the neck, under the collarbone, arm, or groin area, and a small external box, temporary pacemakers can be easily removed when the patient’s general condition improves.

Permanent Pacemaker: Permanent pacemakers, typically placed just below the collarbone and beneath the skin, are used for chronic conditions like atrioventricular block, tachycardia, bradycardia, hypertrophic cardiomyopathy, and congestive heart failure. Permanent pacemakers, which provide necessary stimulation for heart contraction and relaxation, are categorized based on the stimulated heart area:

1. Single-Chamber Pacemaker: Composed of one cable, this pacemaker stimulates either the right atrium or the right ventricle of the heart.
2. Dual-Chamber Pacemaker: Pacemakers that stimulate both the right atrium and right ventricle. One cable is placed in the right ventricle and another in the right atrium to facilitate contraction in both areas when necessary.
3. Triple-Chamber Pacemaker: Also known as a biventricular pacemaker or cardiac resynchronization therapy pacemaker (CRT-P), this device is used in heart failure treatment. With three separate cables placed in the right atrium, right ventricle, and left ventricular areas, this device ensures the weakened heart muscle contracts appropriately, synchronizing each heart chamber’s function.

Why is a Pacemaker Installed?

In a heart with a natural rhythm, a nerve impulse originating from the sinoatrial node stimulates the ventricles after passing through the atrioventricular node, maintaining a sequential contraction and relaxation rhythm across all chambers. In cases where the heart cannot generate or transmit these electrical impulses from one node to another, the heart muscle cannot function correctly, potentially leading to severe health issues like heart attacks and heart failure. Pacemakers are installed in the relevant heart chamber to ensure proper nerve transmission when these impulses cannot be produced or transmitted correctly.

The main indicators for pacemaker implantation include:

• Subsequent atrioventricular (AV) blocks in adults
• Chronic bifascicular and trifascicular heart blocks
• Pre-existing blocks due to heart attacks
• Sinus node dysfunction
• Tachycardic rhythm disorders
• Hypersensitive carotid sinus syncope and neurocardiogenic syncope
• Conditions like hypertrophic cardiomyopathy, dilated cardiomyopathy, and heart transplant

How is a Pacemaker Inserted?

Pacemaker insertion is performed in a sterile operating room or catheterization lab. The day before the procedure, areas such as the chest, armpits, and groin are shaved, and each area is thoroughly cleaned. Before the procedure, the designated area is cleansed with an antiseptic solution for 10 minutes. The operation begins in the sterile environment by covering the patient with a sterile dry cloth, leaving the intervention site exposed.

While local anesthesia is generally preferred for pacemaker implantation, deep sedation or general anesthesia may sometimes be necessary. The veins in the patient’s neck, armpit, arm, or just below the collarbone are typically used for access. The catheter enters the appropriate vein, with the electrode part of the pacemaker visualized using fluoroscopy before being inserted into the heart. The box-like portion of the device, known as the generator, is usually placed within the right or left pectoral muscle. Following this, the vein and muscle tissue incisions are closed, and the patient is transferred to the recovery unit if required.

Things to Consider After Pacemaker Surgery

• During the first week post-surgery, pain may be experienced. Only doctor-approved painkillers should be used during this time.
• Fever over 38°C, along with symptoms such as redness, bleeding, swelling, or discharge at the surgical site, could indicate an infection. Since infections related to heart procedures can cause severe health issues, any sign of infection should prompt immediate consultation with a doctor.
• If the pacemaker is placed above the arm, it may be necessary to restrict arm movement on the pacemaker side for the first one to two months. If the device is inserted through the chest, arm restrictions are unnecessary.
• During the first two months, avoid lying on the pacemaker side and any activities that apply excessive pressure to the area.
• Pacemakers are affected by certain radiation sources, such as X-rays and MRI. Patients with pacemakers are advised to avoid X-ray scanning devices found at airports, shopping malls, security points, and courts, requesting manual inspection instead by showing their pacemaker card to security guards.
• Power stations, substations, weapon detectors, radar fields, and high-voltage lines can impact pacemaker function. Patients exposed to these should consult with their cardiologist and the pacemaker company to evaluate the device.

How Long Do Pacemaker Patients Live?

Pacemakers are used to treat disorders that affect the heart’s nerve conduction system. The success of treatment varies based on the type and severity of the condition, the patient’s age, general health, and the presence of other conditions. Factors such as regular follow-ups are critical for effective treatment and longevity.

Regular cardiac check-ups post-implantation are essential for the proper treatment of existing heart conditions. Cardiac monitoring should not be neglected, and periodic evaluations are necessary to ensure the optimal functioning of the pacemaker.