Pacemaker implantation is a medical procedure used to treat arrhythmias, primarily targeting patients with abnormal cardiac electrophysiological activity leading to bradycardia or rhythm disturbances. This treatment involves implanting an electronic device within the body that sends electrical impulses to stimulate the heart muscle to contract, thereby maintaining a normal heart rate and ventricular coordination. Suitable candidates include patients with sick sinus syndrome, atrioventricular block, and other conditions, effectively alleviating symptoms such as dizziness, fatigue, and even syncope caused by slow heart rates.
Pacemakers are classified into single-chamber and dual-chamber types. Single-chamber pacemakers stimulate only the ventricle or atrium, while dual-chamber pacemakers synchronize the contraction of both the atrium and ventricle. Their working principle involves transmitting electrical impulses via electrode leads to the myocardium, mimicking the electrical signals of a normal cardiac pacemaker site. Modern pacemakers often feature rate response functions, adjusting heart rate according to patient activity levels, and some advanced models can automatically detect arrhythmias and activate defibrillation functions.
The primary indications include:
The procedure is usually performed under local anesthesia. The physician implants a pacemaker pulse generator subcutaneously beneath the clavicle and inserts electrode leads into the atrium or ventricle via a vein. The operation lasts approximately 1-3 hours. The basic pacing rate is typically set at 60-70 beats per minute, adjusted based on the patient’s age and physiological needs. Regular follow-up is required every 6-12 months to check battery life and device functionality.
Main benefits include:
Possible complications include:
Contraindications include:
Anticoagulants (e.g., warfarin) may increase bleeding risk during surgery, requiring dose adjustments beforehand. Before using electrical shock therapy or MRI, the pacemaker must be turned off or reprogrammed. When used concomitantly with certain antiarrhythmic drugs, close monitoring of ECG changes is necessary to prevent interference between electrical impulses and medication effects.
Clinical studies show that pacemakers can reduce the annual mortality rate of severe bradycardia patients by 30-50%. Long-term follow-up data indicate that 85% of patients experience significant symptom improvement within one year after implantation, with notable enhancements in cardiac function indices and exercise tolerance. The 2019 European Society of Cardiology guidelines list pacemaker therapy as a Class I recommendation for sick sinus syndrome.
Short-term symptom management may consider oral atropine or similar medications, but these do not address the underlying cause. Severe cases may require combined therapies such as cardiac resynchronization therapy (CRT) or implantable cardioverter defibrillators (ICD). For patients with high surgical risk or those refusing implantation, pharmacological modulation of cardiac rhythm can be evaluated, though caution is needed due to potential side effects like tachyarrhythmias.
Preoperative assessment includes cardiac function evaluation and blood tests, and informing the doctor of current medications, especially anticoagulants. On the day of surgery, the surgical site should be cleaned, and fasting instructions followed. Patients with diabetes or chronic illnesses should adjust medications to reduce surgical risks.
What precautions should be taken during daily activities after implantation?Initially, avoid vigorous exercise or heavy lifting to prevent lead displacement. In daily life, stay away from strong magnetic environments (such as certain medical devices or industrial equipment) and regularly check pacemaker function. Light activities like walking and swimming are generally safe, but specific restrictions should be advised by the physician.
What are the signs of battery depletion and how is it replaced?Signs of impending battery depletion include palpitations, dizziness, or syncope. Regular follow-ups can predict replacement timing. The replacement procedure is similar to implantation, usually performed under local anesthesia, with a shorter operation time and quick recovery. Follow the physician’s instructions for scheduling replacement.
What complications can a pacemaker cause and how to respond?Potential complications include infection at the surgical site, lead displacement, or subcutaneous hematoma. If symptoms such as fever, severe pain, or swelling at the pacemaker site occur, seek medical attention immediately. Long-term follow-up may reveal arrhythmias or device malfunction, which require reprogramming or further investigation.
Do I need to adjust the use of everyday electrical devices after implantation?Most common electronic devices (such as mobile phones and microwave ovens) do not interfere with pacemaker function. However, avoid strong magnetic fields (such as certain industrial welders or MRI scans). Before using new electronic products, consult your doctor, and carry your pacemaker ID card for emergencies.
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