Pacemaker indications by age. Rules of life after the installation of a pacemaker

Normally, the heart contracts rhythmically, obeying the impulses of its own pacemaker. But sometimes the natural pacemaker stops working properly, the pulse slows down, the blood supply to the brain and other vital important organs is under threat.

In such cases, cardiologists implant an artificial pacemaker in the patient - pacemaker (EC), colloquially called pacemaker.

Indications for installation and types of EX-

The installation of a pacemaker may be recommended for patients with a slow pulse, especially if such arrhythmias are accompanied by the appearance of dizziness, fainting or syncope. Pacemakers may be frequency adaptive which allow the heart rate to increase physical activity, or without frequency adaptation.

Three-chamber pacemakers, in addition to performing the function of a pacemaker, can be indispensable for the treatment of heart failure, allowing the ventricles to contract synchronously and increase the force of contractions. These pacemakers are also called resynchronizers.

And some cardioverter pacemakers can suppress life-threatening arrhythmias such as ventricular tachycardia and ventricular fibrillation. Similar cardioverter-defibrillators used to prevent sudden cardiac death.

It should be noted that indications for the installation of the pacemaker are determined only by a doctor, cardiologist-arrhythmologist. Only he can correctly set the readings and choose the optimal pacemaker, resynchronizer or cardivertor for each specific case.

Indications

• Sick sinus syndrome.
• Arrhythmias with a decrease or increase in the speed of the heartbeat.
• intracardiac blockade.
• Sinoatrial blockade.
• Long QT Syndrome.
• Ventricular tachycardia.
• Ventricular fibrillation.

Varieties of pacemakers

There are implantable cardioverter defibrillators and standard pacemakers. The former set the correct rhythm and eliminate arrhythmia, while the latter affect only the heart rhythm. The use of electrical pacemakers is advisable for bradyarrhythmias. If tachyarrhythmia is additionally observed and there is a high probability of ventricular fibrillation, then a model with cardioversion and defibrillation is selected.

An additional division of models is carried out taking into account the area of ​​influence (single-chamber, two-chamber, three-chamber). Therefore, fixation is carried out on one or two ventricles, as well as on one atrium, depending on the model.

What is needed for preliminary diagnosis?

• ECG in 12 leads;
• Echo-KG;
• Holter ECG monitoring for 1-2 (sometimes more) days;
• Stress ECG.
• CT scan or X-ray of the chest.
• Ultrasound examination of the heart.
• Dopplerography.
• Endocardial electrophysiological study.
• Consultation with an arrhythmologist to determine indications for surgery and choose the type of pacemaker;

How is the installation of a pacemaker in the CELT clinic performed?

A pacemaker is a small device that is placed in the subcutaneous tissue of the chest, under the pectoralis major muscle.

The operation does not involve general anesthesia. The patient is given a drug that has a sedative effect. The area of ​​the chest where the pacemaker will be placed is anesthetized. Making a small skin incision parallel to the collarbone, a pacemaker is implanted. Special thin electrodes are passed from the pacemaker to the heart cavity through large veins, through which the pacemaker sends impulses that help the heart maintain normal rhythm. By medical indications a single-chamber pacemaker that stimulates the right ventricle only, a dual-chamber pacemaker that sequentially stimulates the atria and ventricle, or a three-chamber pacemaker that transmits impulses to the atrium, right and left ventricles can be implanted.

The duration of the intervention for the implantation of a single-chamber pacemaker is about 30 minutes, a two- or three-chamber one is from 60 to 150 minutes.

The patient remains in the hospital under observation for 1 to 3 days. Before the patient goes home, the doctor will program the device. After installing a pacemaker, it is recommended to avoid physical activity for a month.

Postoperative period

Recovery after the installation of a pacemaker takes at least a month (sick leave is issued). The terms increase if the installation was performed after a heart attack. In the hospital, recovery will take no more than 10 days. During this period, specialists will monitor the patient's well-being and general condition because the following complications are possible:

• Thromboembolism.
• Internal bleeding.
• Hematomas and swelling.
• Infection and rise in body temperature.
• Pain syndrome.

The chance of occurrence of the listed complications is not higher than 7%. Additionally, in the hospital, the patient uses acetylsalicylic acid and painkillers. This is necessary to eliminate pain syndrome and reduce the risk of thrombosis.

Installing a pacemaker is no longer something special. The operation is carried out under local anesthesia. An incision is made parallel to the collarbone, the pacemaker electrodes are inserted into the heart muscle. The process is displayed on the monitor screen.

As soon as the electrodes are connected to the heart, the pacemaker immediately begins to work, the heart rhythm returns to normal. The device turns on in violation of impulse conduction and stabilizes heart contractions.

Installing a pacemaker

Electronic devices that generate pulses sinus node, are of the following types:

1. Single chamber, the simplest. Stimulates a separate organ of the cardiac ligament: chamber, ventricle or atrium.
2. The action of the two-chamber is directed to both cardiac chambers, the ventricle and the atrium.
3. Three-chamber pacemakers are used in cases of severe heart failure that causes arrhythmia and ventricular fibrillation.

Indications for pacemaker surgery:

Preparing for cardiac surgery is the same as preparing for any type of surgery. The patient donates blood and urine. Analyzes (general and specific), are carried out special studies: chest x-ray, cardiography. When chronic diseases additional examinations are ordered.

As contraindications to surgery, bradyarrhythmias with complications (MAS syndrome) are considered, but there are no absolute contraindications.

Factors that increase the risk of postoperative complications:

• diseases of the hematopoietic system;
• the need to constantly take certain medications;
• Availability bad habits;
• obesity.

Installing a pacemaker takes about 2-2.5 hours. You will have to spend 24 to 48 hours in the hospital room. At first, constant monitoring of the work of the heart and blood pressure is necessary.

Back to index

rehabilitation period

At first, the patient may feel pain in the area of ​​​​the suture and the region of the heart. Filmed pain anesthetics prescribed by a doctor. Self-selection of drugs is prohibited.

Each patient is instructed in detail on how to behave during the rehabilitation period, warned about complications. The reactions of the body to the installation of the device are individual, and general advice it is impossible to give. Mandatory recommendations:

• do not drive a car for 2 weeks;
• avoid physical activity for at least 1.5 months.

The stitches are removed within a week as the scar heals.

You may experience the following symptoms within a week after surgery:

• pain that is not relieved by prescribed anesthetics;
• shortness of breath, cough;
• general swelling, redness of the scar, discharge from the incision;
• signs infection: fever and febrile condition,

Then you need to apply for medical care. These symptoms indicate the occurrence of complications.

After the operation, you can ordinary life without forgetting some limitations. Avoid contact with TV transmitters, radar installations and radio transmitters various types try not to be exposed to high voltage currents. You can not be examined on tomographs, connect to therapeutic activities physiotherapy.

At airports and in many stores, there are warnings about the danger of passing through magnetic frames for people with a pacemaker. If there is no such warning, you need to approach the persons responsible for the inspection and inform them of the presence of the device. You must have the owner's card with you. Always be aware of the presence of a pacemaker when seeking medical attention.

A mobile phone or other device that projects radiation should not be carried in a pocket in contact with the heart area. The duration of the devices is from 7 to 15 years. At the end of the device's service life, it must be replaced immediately. The presence of a pacemaker increases life expectancy and improves its quality. But you need to remember: this device is placed on a new heart.

This is a device that regulates the heart rate and helps to maintain it at the level necessary for a normal and fulfilling life.

In medical practice Increasingly, there are patients for whom a pacemaker is a vital necessity. The device helps to cope with heartbeat disorders that would previously lead to disability and early death patient.

Cardiac disorders inevitably lead to the loss of functionality of others. internal organs, including the central nervous system, due to lack of oxygen. Pathological condition can develop with a too slow heart rate (bradycardia), arrhythmia complicated by tachycardia, and organ blockade, in which the conduction of electrical impulses fails.

The need for a pacemaker and indications for installation occur in the following diseases:

• Weak sinoatrial node syndrome, in which the heart rate drops to 40 or less. It also includes sinus blockade, bradycardia and bradyarrhythmia (attacks of reduced rhythm frequency are replaced by episodes of tachycardia).
• Atrioventricular blockade (impaired atrioventricular conduction) 2-3 degrees.
• Pathologies carotid sinus – plummet the frequency of heart beats during irritation of the place of expansion of the internal carotid artery. May be provoked active movement head or squeezing the neck with clothing. Manifested severe dizziness and fainting.
• The need for drug therapy(for example, "Amidarone") to normalize the contractile function of the heart in various blockades and arrhythmias.
• Other types of bradycardia, which are accompanied by convulsions and / or loss of consciousness due to a short-term complete stop electrical system heart (asystole).
• Paroxysmal ventricular tachycardia.

• Atrial fibrillation.
• Regular cases of extrasystoles with a high probability of transition to ventricular fibrillation, left ventricular failure, often resulting from a heart attack.

The installation of a pacemaker is indicated in cases where life-threatening conditions cannot be dealt with by medical methods.

What are pacemakers?

To have an idea about the installation method and the types of devices, it is necessary to understand what a pacemaker is and what is the principle of its operation.

A pacemaker (pacer), also called an artificial pacemaker, is a device that supports or enforces normal frequency heart rate, suppresses other foci of excitation of the impulse and monitors the patient's own pulse.

The structure of the EX

Modern models of artificial pacemakers resemble mini-computers: they consist of electrodes, a complex microcircuit and a battery, which allows them to work on average for about 10 years. New pacemakers are also designed for a long service life - up to 12-15 years.

With the help of a microcircuit, the device recognizes the electrical potential of the myocardium - in other words, the cardiogram. Electrodes with a sensitive head are implanted into the thickness of the heart muscle, transmitting information about impulses and returning electrical charges that normalize the beat rhythm.

The dimensions of the instrument vary depending on the model and functions, and average weight is about 50 g. Setting up the EKS is performed by a computer programmer within the medical institution where the operation was carried out to implement it.

Classification

Pacemakers are divided by purpose and the number of electrodes. By purpose, they are classified into:

• Pacemakers (pacemakers), which are used for bradycardia to ensure the normal rate of blood ejections.
• Cardioverter-defibrillators, which, in addition to the function of a pacemaker with rare contractions of the heart, are able to recognize the state of fibrillation and restore the normal beat rate using a strong electrical discharge of 12-35 J or special stimulation circuits.

According to the number of electrodes, the EX-s are divided into:

• Single chamber. The pacing lead is placed in the left ventricle and initiates contraction of other cavities. It is rarely used, since if the atrial and ventricular rhythms coincide, the blood circulation of the heart is disturbed. Useless for supraventricular arrhythmias.
• Two-chamber. Equipped with two electrodes, which are placed in the ventricle and atrium. Well control and coordinate the rhythm of contractions of the cavities.
• Three-chamber. They are the most optimal and physiological. Three electrodes are located in the two ventricles and the right atrium, respectively. Such models are actively used in dyssynchronous contractions of the left and right ventricles.

Pacing is also classified by duration. EX is installed for the following types impact:

• Permanent. Epicardial implantation is performed only on open heart special devices.

• Temporary. It is used before the installation of a permanent pacemaker, with drug overdose or transient failure heart rate. To stabilize the patient's condition, if necessary, resuscitation is used external or endocardial pacing. Placement of electrodes on the sternum is less effective than passing them through a central venous catheter directly into the atrium or ventricle.
• Diagnostic. Transesophageal stimulation is used to eliminate attacks of atrial arrhythmias, as well as to check the functionality of the heart in case of suspected paroxysmal tachycardia, sinus node pathology, atrioventricular conduction disturbance, coronary artery disease.

The ability to select a rhythm from the outside allows the use of a pacemaker as a replacement for bicycle ergometry and a treadmill test in diagnosing the causes of angina pectoris.

Labeling of pacemakers

For short designation, three-letter (ICHD) and five-letter (NBG) codes are used. The marking indicates the number of electrodes and the presence additional features. The letters of the code sequentially indicate:

1. Localization of implanted electrodes (A - atrial, V - ventricular, D - both cavities).
2. detectable camera.
3. Response to the received impulse (stimulation - I, suppression - T, both functions - D, no response - O).
4. Adaptation to the requirements of the patient's body to the frequency of contractions (load). Rate-adaptive pacemakers are labeled with the letter R.
5. The presence and parameters of other functions in tachycardia.

Contraindications

There are no absolute contraindications for implantation of a cardiac pacemaker, neither in terms of age, nor in terms of vital signs. The decision is made by surgeons and cardiologists regarding each clinical case. The operation may be recommended even for those patients who are already in the intensive care unit due to a heart attack. This is possible if the cessation of blood supply to a section of the heart muscle is accompanied by complete atrioventricular blockade or severe arrhythmia.

The date of the intervention may be postponed due to several clinical circumstances (indications) if the patient does not need an immediate pacemaker. These include:

• Fever or symptoms of infectious diseases.
• Aggravation chronic pathologies internal organs (asthma, peptic ulcer gastrointestinal tract).
• Mental disorders that exclude normal contact with the patient and reduce the likelihood of successful rehabilitation.

Preparation and tests before the intervention

List of required diagnostic procedures varies depending on the urgency of the operation and the standards of a particular clinic. Commonly performed preoperative and cardiac tests are:

Preparation for the operation includes consultation of the following doctors:

• Arrhythmologist.
• Otolaryngologist and dentist (they exclude or treat foci of infection).
• Other specialists in case of chronic diseases of the kidneys, central nervous system, endocrine system.

A few days before the intervention, doctors may request that NSAIDs and anticoagulants be discontinued. In parallel with this, it is necessary to lighten the diet, and on the day of the procedure, starting from midnight, do not eat or drink anything.

How is implantation performed?

The pacemaker is installed with local anesthesia sternum, less often - under general anesthesia. The whole procedure lasts 1-2 hours and includes the following steps:

1. After all diagnostic procedures, the patient is taken to the operating room. Local anesthesia of the sternum over the left clavicle is performed.
2. An incision is made in the skin and vein under the collarbone. The electrodes are passed through the vessel to the cavities of the heart. The progress of the detectors is controlled by X-rays.
3. When they reach the right chambers, the surgeon looks for the most good place for stimulation by checking the parameters of the heartbeat on the ECG. Upon completion of the search, the electrodes are fixed in the wall of the organ with "antennae" or a corkscrew-like fastening.
4. After installing the detectors in subcutaneous tissue a bed is being prepared for the EKS case. Having placed the device, doctors connect electrodes to it, stitch the wound and apply a sterile dressing. At the site of the seam, a noticeable scar later remains.

After the operation, the arrhythmologist programs the pacemaker by setting the cardiogram recording modes, cardiac muscle stimulation, load analysis parameters and selection of the degree of stimulation activity. Also in the settings, an emergency mode is set, which operates when the battery is low.

Within 6-10 days, the patient is observed in the hospital, receiving therapy from analgesics, anticoagulants and antibacterial drugs.

How long does a stimulator last?

The pacemaker is installed forever, but the duration of uninterrupted operation of one source of impulses does not exceed ten years. The service life of the EX is on average 8-10 years: it is determined by the capacity of the battery. After a complete discharge or failure of the stimulator due to non-compliance with safety standards or manufacturing defects, the device must be replaced. Often the electrodes last longer than the generators of electrical impulses, therefore, when reoperation can only install a new titanium case with a chip and a battery.

The warranty covers the first 3-5 years of operation of the device.

What is the cost of the operation?

If it is necessary to implant a heart pacemaker, the cost of the operation can be paid according to the quota, that is, the patient can do it free of charge, excluding the cost of travel, stay in a medical facility and accommodation during preparation for the procedure and rehabilitation. Due to the high demand for ECS, planned installation produced in sequence.

The price of electrostimulators varies depending on the manufacturer and device configuration. Single-chamber pacemakers will cost the patient 10-70 thousand rubles, two-chamber - 80-200, three-chamber - up to 450. The cost of electrodes, as well as the costs of implantation itself, are often considered separately.

Complications

Side effects after surgery, which can lead to a worsening of the patient's condition, are rare. According to statistics, complications are observed in 6.2% of elderly patients (over 65 years old) and 4.5% of people younger than this age. Probability deadly consequences orders of magnitude lower than these values. When installing a pacemaker, there is a risk:

• Infectious infections - suppuration of the incision, fistula formation, sepsis.
• Displacement of electrodes-detectors.
• Intracardiac bleeding.
• Stimulation of extracardiac muscles, diaphragm.
• Loss of the analyzing function of the EX, leading to failures of stimulation.
• Edema of the upper limb.
• Pneumothorax.
• Block large blood vessels.
• Fracture detector.
• Early end of battery life.

Most of these complications can be avoided with the correct implantation of the device, the use of quality equipment and adequate post-operative care. To protect yourself, you should pay attention to patient reviews of pacemakers from a certain manufacturer, as well as about operations by a particular doctor.

Lifestyle after surgery

Life with a pacemaker is full and different from reality healthy person only in a few aspects. Following the recommendations, the patient can work, do household chores and even get involved in sports.

In this case, it is necessary to observe safety precautions:

• Visit a cardiac surgeon and arrhythmologist once a quarter for 1 year after the implantation of the stimulator, once every six months - during the second and annually - in the future.
• Monitor your health status (well-being, blood pressure, pulse rate).
• Give up bad habits (alcohol, nicotine), establish a balance of work and leisure.
• Avoid some diagnostic methods (ultrasound of the sternum, MRI) and physiotherapy (impact magnetic fields warmth).
• Consult with a cardiologist before minimally invasive interventions (electrocoagulation, operations with electric scalpel incisions, fragmentation of stones in internal organs).
• Do not stay near high voltage power sources for a long time.
• Avoid blows to the sternum and falls.
• Mobile phone and sources electromagnetic radiation(including household ones) when using, it is desirable to place it on the other side of the body relative to the device, at a distance of more than 25-30 cm from it.

The patient needs to carry a document confirming the installation of the pacemaker with him: this will avoid detector checks that are dangerous for the operation of the device.

The patient's working capacity is established by the medical commission, taking into account the presence or absence of complications (IHD, CHF). A patient may be given a disability group if work at a particular workplace can cause serious harm to him or the device (contact with electric welding equipment, steel-smelting machines).

The presence of a pacemaker is not an absolute contraindication for bearing a fetus. But the patient should be observed by a cardiologist during the entire period of pregnancy and follow all the doctor's recommendations on nutrition and exercise. Childbirth takes place only through caesarean section operation is scheduled.

Physical activity should be moderate, without tension in the sternum. During the rehabilitation period (up to 3 months), sports are prohibited along with any intense upper body exercise.

Martial arts are banned for life due to the risk of blows to the device area, extreme sports, football, rugby, basketball, hockey, shooting, bodybuilding with weights on the pectoral muscles.

Bath and sauna are allowed only after consultation with a doctor in the absence of complications, after the end of rehabilitation. Visits should be infrequent and gentle.

Forecast

The use of pacemakers in medicine has made it possible to significantly increase the life expectancy of patients with arrhythmia, heart block, and weakness of the sinus node. With bradyarrhythmias and supraventricular tachycardias, the efficiency of device installation reaches 100%. With atrial and ventricular fibrillation, the pacemaker helps 80-99 patients out of 100.

Knowing not only your own indications for the installation of a pacemaker, but also what it is, what advantages and disadvantages the operation for its implantation brings, you can more confidently accept the right decision. EX allows you to eliminate unpleasant symptoms cardiac pathologies and in time to stop life-threatening conditions.

Article publication date: 05/22/2017

Article last updated: 12/21/2018

From this article you will learn: for what diseases a pacemaker is installed, how it is done. Types of pacemakers. Contraindications for installation possible complications. Life with a pacemaker: recommendations and limitations.

A pacemaker (pacemaker, artificial pacemaker, EX, IVR) is special device which, with the help of electrical impulses, sets the heart to the correct rhythm. The pacemaker saves the patient from sudden death due to either ventricular fibrillation. It maintains or imposes the correct rhythm on the heart. Some pacemakers can also stop arrhythmias as soon as they occur.

Installs and configures the EX-a qualified arrhythmologist. Further maintenance of this device is also handled by this doctor. You will need to visit him from time to time to check the operation of the pacemaker and, if necessary, to reprogram the device.

How a pacemaker works

What is a pacemaker and what are its components?

1. Generator (source) of electrical impulses, which is placed under the skin on the right or left side of the chest. This is a miniature device weighing about 50 g, equipped with its own battery.
2. Electrodes. They are carried out directly to the chambers of the heart, which must be affected. Through them, an electrical impulse is conducted from the source to the heart. Depending on the type of pacemaker, there can be from one to three electrodes.

The part of the device that is placed under the skin is covered with a titanium coating, so the risk of rejection is almost zero.

Indications and contraindications for the installation of a pacemaker

A pacemaker is implanted in patients with bradyarrhythmias (arrhythmias with a slow heartbeat), intracardiac blockades (impaired impulse conduction through the heart) and tachyarrhythmias (arrhythmias with an accelerated heartbeat).

Indications for the installation of EX:

Symptoms that indicate the installation of a pacemaker:

• With bradyarrhythmias: the pulse is below 40 beats per minute in the daytime, pauses in the heartbeat for more than 3 seconds.
• With tachyarrhythmias: fainting and pre-syncope on the background of attacks of tachyarrhythmias, increased risk.

Absolute contraindications missing.

Postponement of the operation is possible when:

• acute inflammatory diseases;
• exacerbation peptic ulcer gastrointestinal tract;
• acute phase mental illness in which it is impossible for the patient to contact the doctors.

There are no age restrictions: a pacemaker can be installed at any age.

Examination before installing a pacemaker

To make a decision to implant a pacemaker, the arrhythmologist will need the results of the following diagnostic procedures:

Varieties of pacemakers

According to functionality, they distinguish:

• Pacemakers - have only the function of setting the heart to the correct rhythm.
• Implantable defibrillators-cardioverters - in addition to imposing the correct rhythm on the heart, they can also stop arrhythmias, including ventricular fibrillation.

Patients with bradyarrhythmias are placed on conventional pacemakers, and patients with tachyarrhythmias and an increased risk of ventricular fibrillation are placed on pacemakers with the function of defibrillation and cardioversion.

Depending on the zone of influence, single-chamber, two-chamber and three-chamber EKS are distinguished. Single chamber pacemakers are connected to one of the atria or one of the ventricles. Two-chamber - to one atrium and one ventricle. Three-chamber (another name for such a pacemaker is a cardioresynchronizing device) - to one of the atria and both ventricles.

pacemaker implantation surgery

This surgery is performed under local anesthesia. The implantation process takes about an hour.

The operation to install a pacemaker is as follows:

1. Anesthetize the area of ​​the chest with local anesthesia.
2. One or more electrodes are passed through the vein to the desired chambers of the heart.
3. Check the parameters of the electrodes with an external device.
4. A small incision is made in the chest. A bed is formed in the subcutaneous fatty tissue for the main part of the device.
5. Install the device, connect to it the electrodes held to the heart.
6. Sew up the incision.

In most cases, the source of electrical impulses is located on the left. However, left-handers or in the presence of extensive scars on the left side of the chest can install it on the right.

Postoperative period

After installation will pass pacemaker, you will be given sick leave for 3-4 weeks. Except in cases where the pacemaker was installed after a heart attack (then the sick leave may last longer).

You will stay in the hospital under the supervision of doctors for 5-9 days. During this period it is possible pain in the area of ​​device implantation.

Among other possible complications in the first week after the installation of the device are possible:

• hematomas in the area of ​​the operation;
• bleeding;
• swelling at the site of implantation of the device;
• infection postoperative wound;
• damage to blood vessels;
• pneumothorax;
• thromboembolism.

The risk of complications is no more than 5%.

Your doctor may prescribe painkillers to relieve pain. You will also need to take acetylsalicylic acid(Aspirin) to prevent thrombosis. Antibiotics are prescribed to prevent or treat postoperative wound infection.

Further rehabilitation

Throughout the month, after you have already been discharged from the hospital, you will need to visit an arrhythmologist once a week to check if the device is working properly.

Within 1.5–3 months after implantation of the pacemaker, any physical activity on the arms, shoulders and pectoral muscles, as well as weight lifting, is prohibited. Also, you can not sharply raise your left (or right, if the device is installed on the right) hand up and sharply take it to the side.

Within 1-3 months after the installation of the device, you can not engage in physical education. Only possible physiotherapy prescribed by the doctor.

Complications in the future

In a remote time after installing the device, you may experience:

• Swelling of the arm from the side where the pulse generator is located.
• Inflammatory process in the heart at the site of electrode attachment.
• Displacement of the device from the bed in which it was installed.
• Fatigue during physical exertion (more often develops in older people).
• Stimulation of the diaphragm or chest muscles by an electrical impulse (possible if the device is installed incorrectly, as well as due to its malfunctions).

The risk of developing these complications is 6-7%.

Life with a pacemaker

Regularly visit an arrhythmologist to examine the pacemaker and, if necessary, reconfigure it. If there is no arrhythmologist in your city, then you will have to go to the clinic where he is, since ordinary cardiologists do not have special skills and equipment for diagnosing and reprogramming pacemakers. A consultation with an arrhythmologist lasts about 20 minutes.

Also, for people with pacing, there are restrictions in Everyday life, as well as in the areas physical activity, use of electronics, household appliances and tools, in passing medical procedures as well as in professional activities.

Limitations in daily life

Avoid putting pressure on the area where the electrical pulse generator is installed.

Don't hit the chest and fall on it. This can lead to both a breakdown of the pulse generator and a displacement of the electrodes located in the heart.

Do not stay near transformer boxes, electrical panels, power lines for a long time.

Do not stand for a long time near the "frames" at the entrance of shops and at airports.

Physical education and sports with a pacemaker

Physical activity and moderate sports activities are allowed for people with an established pacemaker (with the exception of the first 1.5–3 months after surgery).

Only sports in which there is a risk of impact to the pacemaker area, extreme sports, as well as excessive loads on the upper part body.

You can not engage in boxing, hand-to-hand combat and other martial arts, any kind of wrestling, football, rugby, basketball, hockey, parachuting, etc. It is also undesirable to engage in shooting.

AT gym exercises on the pectoral muscles using weights are prohibited.

Use of household appliances, electronics, tools

No risks have been identified for correct use the following appliances:

1. Fridge.
2. Dishwasher.
3. Electronic balance.
4. Ionizing air filters, air humidifiers, automatic fragrances.
5. Hair curlers and straighteners.
6. Calculator.
7. Battery powered flashlight, laser pointer.
8. Printer, fax, scanner, copier.
9. Barcode Scanner.

The use of other devices is also permitted. The only rule is to keep the necessary distance between the device and the pacemaker.

More about the distance in the table.

It is forbidden to use and be closer than 2.5 m from welding equipment over 160 amperes.

Restrictions in professional activity

Contraindicated professions:

• loader;
• electrician;
• electrician;
• welder.

There are no restrictions on working with a computer.

If the pacemaker was installed in connection with severe heart failure, it is possible to assign a disability of 3-2 groups.

Prohibited medical procedures

Patients with an established pacemaker should not undergo:

• MRI (however, there are some models of stimulators that allow you to undergo an MRI - check with the doctor who installed the device for you);
• Physiotherapeutic and cosmetic procedures using electric, magnetic and other types of radiation. These are electrophoresis, diathermy, heating, magnetic therapy, transcutaneous electrical nerve stimulation, etc. Full list you can check with your doctor.
• Ultrasound with the direction of the beam directly to the device.

Before performing any medical procedure or surgical interventions tell your doctor that you have a pacemaker installed.

Forecast: service life, efficiency

The warranty period for pacemakers is 3 to 5 years, depending on the manufacturer. The service life for which the battery of the device is designed is 8-10 years. After the battery is discharged or the device fails, the pacemaker will need to be replaced.

Often, the electrodes placed to the heart are still in good condition. In such cases, they are not touched, but only the main part of the device, the generator of electrical impulses, is replaced. If the device breaks down before the expiration of the warranty period, a free replacement is possible under warranty, unless the device breaks down through your fault.

The pacemaker is very effective in eliminating bradyarrhythmias. As for tachyarrhythmias, the device copes with seizures in almost 100% of cases, and with atrial flutter, flutter or ventricular fibrillation - in 80-99% of cases.

The process of installing a pacemaker is not as complicated as it might seem. Today, such a manipulation is equated to an operation to remove appendicitis. More questions arise in patients, how to live after the installation of the pacemaker, but the process itself surgical intervention important.

A pacemaker (pacer) is an electronic device that is equipped with a special circuit and is capable of generating electrical impulses. For normal operation The device must have a sufficient charge of the battery built into its small case. Thin electrodes depart from the EKS, which are brought to one, two or three chambers of the heart during the operation.

Every year, around 300,000 pacemakers are implanted around the world, which makes it possible to prolong the life of patients with severe cardiac disorders.

There are pacemakers various kinds. Most often, single-chamber and two-chamber ones are installed, with and without frequency adaptation. Before the operation, the patient is necessarily examined and the indications for implantation are determined, which can be absolute and relative. Most often, the pacemaker is installed with bradycardia, atrioventricular blockade, sick sinus syndrome.

Video Pacemaker implantation

Stages of pacemaker implantation

1. They do local anesthesia, the action of which is quite enough for a minimally invasive operation lasting 40-60 minutes. In rare cases, general anesthesia is performed.
2. A small incision is made above the left or right pectoral muscle, through which electrodes are inserted into large vessels.
3. By using x-ray examination one end of the electrodes is installed in the cardiac cavity, and the other is attached to the device.
4. The EX is placed in a small niche made above the pectoral muscle.
5. Perform a small test of the implanted device.
6. The incision site is sutured.

EKS can be installed both on the right and on the left side. Also, depending on the indications, the localization of the device in abdominal cavity. The final decision on the location of the device is made by the attending physician.

Region chest muscle is the most immobile in the human body, so when installing the EX-in this place, you can avoid bending and breaking the electrodes.

Re-implantation of the pacemaker is possible both in the same place and in a new, more suitable one. Pre-in without fail remove the old device. Electrodes can be installed new, or old ones can be connected. AT last case total located in blood vessel electrodes should not exceed five pieces.

Duration of pacemaker surgery

The operation is increasingly moving to the level of a minimally invasive procedure, as a result of which the time of its implementation is an inconspicuous 40-60 minutes. The fewer complications during implantation, the faster it goes. Nevertheless, the operation time depends a lot on the type of pacemaker:

• single-chamber is installed in about 40-60 minutes;
• two-chamber - approximately 1.5 hours;
• three-chamber - up to 2.5 hours.

Most of the time of the entire operation falls on antiseptic treatment and suturing, but in large-scale clinics, even these manipulations take a minimum of time.

After the operation, the patient, as a rule, is several hours in intensive care unit. If there are no places in it, they can be placed in the ward closest to it. In the absence of any complications, X-ray and electrocardiography are performed. A patient with a normal course postoperative period After about 2-3 hours, they are sent to the general ward. In the future, you must strictly adhere to the recommendations of the doctor, undergo examinations in a timely manner, which will extend the life of the device, which means significantly improve the quality of life of the patient.

What a patient should know about pacemaker implantation

There are several features that patients should be aware of when preparing for pacemaker implantation. In particular, during the operation, you need to lie still and, as a rule, look away from the surgical field. In some clinics, pleasant music is turned on for greater patient comfort.

The operating field is often completely fenced off from the field of view of the patient. For this, a special partition is used, on which a towel is hung. Therefore, even turning your head or squinting your eyes will not be able to see the progress of the operation or the incision. Thus, most often you have to look at the monitors or observe the X-ray, which is used to advance the electrodes through the vessels.

It is often the responsibility of the patient undergoing pacemaker implantation to inform the doctor about the discomfort that often occurs at the incision site. In most cases, there is a burning sensation, pressure, and after connecting the electrodes, you may feel that a current is running through the veins. But this manifestation gradually disappears after a few days.

It is important to remember that the vast majority of patients note the absolute painlessness of the pacemaker implantation operation. In extremely rare cases, there may be early complications: bleeding, thromboembolism, infection of the postoperative wound. Some patients have long-term complications in the form of pacemaker tachycardia, EKS syndrome, premature failure of the pacemaker. But at the same time, many doctors assure that there are practically no unsuccessful operations, so this procedure is considered streaming.

Pacemaker replacement surgery

Regular examinations by a cardiologist allow you to timely determine the decrease in the charge of the pacemaker. This often happens when the end of the battery life is approaching, then during the next check, the device emits a signal. Also an indication for the replacement of the pacemaker is inflammation in the area of ​​the implant and its breakage.

To replace the device, an operation is performed under local anesthesia. The electrodes may remain old, but it is better if they are replaced with new ones. Today, bipolar ones are increasingly being used, which are considered more durable and reliable. With proper attitude to the device on the part of the patient, it is possible to lead a better lifestyle for 7-10 years.