Implantation of pacemakers

When is a pacemaker required?

Pacemakers help regulate the rhythm of the heart when natural stimulation fails, meaning they are used when the heart rate is slower or faster than it should be, with irregular beats, or if there is a blockage in the electrical system of the heart. Normally there are two causes:

• Inability of the sinus node to produce a sufficient number of beats per minute. The pacemaker must be placed if symptoms appear, such as loss of consciousness, heart failure or angina, if they are related to a decrease in heart rate, which is called bradycardia.
• When the beats produced by the nodule of the heart muscle fail: disorder in the atrioventricular nodule and the distal conduction system. A pacemaker must be put in, depending on the severity of the disorder and the symptoms. It is indicated when there is a complete auriculoventricular block. If it is a second-grade block and there are symptoms, a pacemaker must be put in, if it is a first-degree block, it is not necessary.

How is it installed?

There are two types of pacemaker:

• Permanent
• Temporary

The artificial pacemaker consists of an electric impulse generator, the pacemaker, and a conductive cable. To install it, an incision is made in the chest, below the left collarbone.

The cable is inserted into the right atrium or the right ventricle, depending on the disease. If the patient only needs one electrode, it is placed in the right ventricle. If he or she needs two, the other is placed in the right atrium.

We check it is placed properly by means of a radiological procedure and, if everything is correct, it is connected and remains under the skin. Afterwards the incision is sutured.

Once implanted, the electrodes transmit signals to the heart that the device detects as signals, and sends the electrical impulses to the heart to stimulate it rhythmically.

Precautions

• Avoid resting objects on the area where the device is installed.
• Current regulations in Spain do not allow patients to drive until three months after the installation (General Drivers’ Regulation. Royal Decree 772/1997. BOE no. 135. 6 June 1997)
• Mobile phones: keep away from the pacemaker and hold to the ear on the opposite side.
• Computers: it is recommended patients keep the CPU tower 30 or 40 cm from the pacemaker.
• Magnetic gates in banks, airports, shopping centres: it is advisable the patient avoid these. The patient should show their European Pacemaker Patient Identification Card. If it cannot be avoided, walk through at a normal pace without stopping.
• Do not handle electrical items or car motors.
• If there are high-voltage devices in your work environment, check with your surgeon
• Some medical examinations may interfere with the functioning of the pacemaker. If you need to undergo any examination, let your doctor know you carry a pacemaker.
• Magnetic bracelets do not affect pacemakers.

Watch out for...

• ... signs of infection: redness, swelling or puss coming out of the wound. Severe pain appears that does not go away after your usual painkillers
• ... haematoma, bleeding or a bump in the area where the pacemaker is.

Always carry your European pacemaker patient card with you, as it contains all the information about the type of pacemaker and its settings.