The modern rhythm of life often leads to a number of diseases of the cardiovascular system, including those directly related to heart rhythm disturbances. The joint efforts of cardiac surgeons and resuscitators back in the middle of the last century led to the development of a device for normalizing heart rate, which made it possible to prolong the lives of many people.

A pacemaker is a compact device that returns the heart to a normal rhythm. A stimulator implanted under the skin corrects the work of the heart muscle with directed electrical impulses and stops the resulting fibrillations and arrhythmias without medical intervention.

The doctor pre-programs the pacemaker, taking into account the diagnosis and predicted risks. A capacious battery allows the stimulator to operate for 7-10 years without the need for additional intervention or maintenance.

Many different types of pacemakers are used. The most common are single-chamber and dual chamber stimulators with frequency adaptation option.

Any ECS necessarily contains:

• battery providing uninterrupted operation devices;
• a microcircuit that determines the need for additional stimulation, its frequency, duration and strength;
• electrodes, which are spiral-shaped wires. The impulse from the stimulator unit to the heart is transmitted directly through them.

The dimensions of the pacemaker without electrodes, as a rule, do not exceed 10 centimeters, and the weight is 50 grams. To avoid rejection of the device by the body after implantation, its body is coated with a titanium alloy.

IN modern medicine, cardiac surgeons use following types pacemakers:

• single chamber pacemaker– directs the impulse to the right ventricle and does not affect the functioning of the atria. Works with one electrode;
• two-chamber – carries the impulse to the right ventricle and right atrium of the heart, controlling the time between their contractions with two electrodes;
• three-chamber new generation– improves the quality of heart function and ensures intravascular hemodynamics, directing impulses to both ventricles and the right atrium.

There are stimulators equipped with special sensors - frequency-adaptive. They record changes in temperature, changes in breathing rate, changes in nervous system. Then the operation of the pacemaker is adapted to the received data, for maximum comfortable work hearts.

Some devices contain a built-in defibrillator. With its use, it is possible to immediately and automatically stop an attack of arrhythmia or fibrillation that has begun, almost imperceptibly for a person.

Modern pacemakers automatically record, save and analyze data on changes in heart function. Thus, it becomes possible to promptly adjust the treatment.

Indications and contraindications for installation

The pacemaker has various indications for installation. It could be like congenital diseases, and purchased.

These include:

When choosing a specific type of stimulator, the doctor pays attention to all the pros and cons of a particular device and the characteristics of the patient’s disease.

The operation to install a pacemaker is quite safe for the patient, absolute contraindications are missing. For some acute conditions the operation is postponed until they are stopped.

Most striking examples such states are: acute stomach(exacerbation peptic ulcer Gastrointestinal tract, appendicitis, acute pancreatitis), acute inflammatory diseases, psychiatric illnesses due to which the patient has no contact. These contraindications are relative, that is, temporary.

Examination before surgery

Before the operation, the patient must undergo an examination of the heart and the body as a whole. This significantly minimizes everything possible risks operations. The examination determines further treatment tactics.

The standard list of required studies includes:

These are not the only ones possible research, their list may vary depending on the complications and characteristics of the patient.

The operation and its duration

This operation is minimally invasive (small) and is performed under local anesthesia. But the operating room must have an X-ray machine.

Before the operation, anesthesia is performed, the duration of which rarely exceeds 40 minutes. This is enough to make an incision in the chest and insert an electrode into the desired area of ​​the heart. In the case of installation of two- or three-chamber devices, the procedure is repeated with the remaining cavities of the heart.

The doctor then programs and tests the device. After a trial ECG, if it satisfies the surgeon, the stimulator body is fixed under the skin of the pectoral muscle or in the subclavian region. After which the tissues are sutured and sutures are applied.

In some cases, the pacemaker is installed in the abdominal area. Guided by the results of examinations, the characteristics of the disease and individual nuances, the doctor determines how the pacemaker is installed.

Postoperative period and possible complications

At the end of the operation, the patient is transferred to the ward intensive care. For the first 2-3 hours after surgery, you must lie on your back. In the ward, the heart is monitored, blood pressure is measured, and monitoring is carried out general condition. If there are no complications, the patient is transferred to the general ward.

The first day is necessary bed rest, after which physical activity can be increased. To prevent infection, the doctor prescribes a course of antibiotics and antifungal drugs. Antiplatelet agents and anticoagulants prevent thrombosis.

If necessary, the patient receives painkillers. On the 5-8th day, the patient's stitches are removed and he is discharged home. IN in rare cases in the early postoperative period the following complications are possible:

• swelling in the area of ​​the postoperative wound;
• bleeding;
• hematoma formation;
• addition of infection;
• damage to blood vessels;
• pneumothorax;
• pulmonary embolism.

The possibility of such consequences occurring is no more than 5%. Such complications develop mainly in patients with secondary pathology, chronic diseases, weakened immunity, or due to violations of the rules of asepsis and antisepsis.

Rehabilitation

Over the next month and a half, the patient must visit an arrhythmologist at least once a week. This is necessary to make sure normal operation stimulant, absence of withdrawal syndrome and other adverse reactions. In the future, the number of visits to the doctor will decrease significantly. It will be enough to visit it once or twice a year. At the same time, lead a full-fledged lifestyle without worrying about the performance of your heart.

For several months, you should not sharply raise the arm on which the device is installed. Do strenuous physical activity, lift weights. Physical education for the next 3 months is also excluded.

Life after installing the device

Only 6% of people with installed pacemakers experience the following complications some time after surgery:

• inflammation of the heart chamber at the site of electrode attachment;
• swelling in the area where the generator is attached;
• instrument offset;
• load intolerance.

Restrictions in everyday life and profession

A person who has a pacemaker installed must always take into account the restrictions that have appeared in his life:

One of the frequently asked questions before surgery from patients is whether it is possible to fly on an airplane and what to look for at the airport. Often the flight itself is not a contraindication. You should not stand near metal detectors for long periods of time. Be sure to have documents with you confirming the presence of ECS in the body.

Sports and physical education

For the first 1.5-3 months after surgery, you should limit sports activities to full recovery body. Then, gradually increasing the load, you can and should begin classes. It is worth giving up those sports that contribute to the breakdown or malfunction of the pacemaker, such as wrestling, football, skydiving, hockey.

Medical procedures

Many types of medical tests are contraindicated for a patient with an artificial pacemaker. Banned:

• some types of ultrasound;
• electrotherapy;
• lithotripsy;
• magnetotherapy.

Almost every prohibited procedure can be found with a permitted alternative. Some models of stimulants have no contraindications for medical examinations. When visiting any medical institution You should definitely have with you documents confirming the presence of the device in the body, indicating the model.

Device service life and life expectancy

If used properly, the pacemaker will last 7-10 years. To prevent the battery from being completely discharged, you should visit your doctor at the appointed time and if you have any complaints.

If during the examination the doctor sees that the battery charge is almost exhausted, an operation to replace the pacemaker is prescribed. Replacement of the old pacemaker is carried out under local anesthesia. It is allowed to keep the old electrodes, but it is recommended to change them too.

How long people live with this device depends on many factors: the patient’s age, the presence of chronic diseases, and lifestyle. If the patient follows all the doctor’s recommendations and prescriptions, uses the device carefully, consults a doctor in a timely manner, healthy image life is waiting for him full life with minor restrictions.

The installation of pacemakers in patients with cardiovascular diseases has been practiced all over the world for many years.

The main purpose of this device is to maintain normal contraction of the myocardium of the heart, as well as to prolong the life of the body.

Radical indications for installing a stimulator

Installation of a pacemaker in mandatory case necessary if:

• The patient is diagnosed with bradycardia, accompanied by constant dizziness and fainting;
• cessation of bioelectrical activity of the heart for 3 or more seconds (can be monitored by performing an ECG);
• 2-3 degree atrioventricular block is supplemented by other cardiopathy;

When the installation of a stimulator is absolutely necessary, it can be carried out in an emergency and without undergoing additional preoperative studies.

• development of atrioventricular block, but without pronounced symptoms;
• Fainting conditions of the patient against the background of intraventricular blockades, while no other causes of fainting are observed.

In cases where the installation of the device is only recommended and is not mandatory, the patient independently makes the decision to implant a pacemaker.

Installation of a pacemaker: do's and don'ts?

A device such as a pacemaker has its justified contraindications. The main ones are exposure to electromagnetic fields and physical activity, which impair the operation of the device. IN mandatory, before any study you need to warn about the presence of an implant.

After installing a pacemaker, the following contraindications exist in the patient’s life:

• MRI examination;
• heavy physical activity;
• be near electrical substations;
• carry a mobile phone or magnets in your breast pocket;
• stay close to metal detectors for a long time;
• cholelithotripsy ( shock wave treatment) only after preliminary adjustment of the pacemaker.

First 7 days after implantation

In the first week after installation of a pacemaker, you must adhere to the following recommendations:

• The postoperative wound should be kept sterile and dry. Treatment is carried out according to the recommendations of the doctor and medical personnel;
• if no complications are observed in the first 4-5 days, the incision site successfully regenerates, then you are allowed to take a non-hot shower;
• Until the wound is completely healed, lifting weights over 5 kg is prohibited.

First month after implantation

As mentioned above, if you have a pacemaker, physical activity is not allowed, but this applies to heavy and prolonged exercise. The most suitable physical activity is hiking, and their duration is selected by the patient individually. If in the first six months the patient’s health is satisfactory, there are no deviations in the operation of the pacemaker, then you can resort to other light sports, for example, visiting the pool or table tennis.

It is also necessary to regularly visit a cardiologist; a routine examination for patients with pacemakers is once every 6 months.

How to live after having a pacemaker installed?

There are no restrictions that could significantly affect the patient’s life. It is allowed to use all household appliances: refrigerator, radio, microwave oven, computer, etc. However, in order to protect the device from possible violations, you should not approach all household appliances closer than 15 cm. Avoid any contact with welding equipment and high-voltage wires. Upon discharge, the patient is given a passport for pacemaker, where all restrictions and recommendations are carefully described.

As for the use of mobile phones, there are no obvious contraindications, however, communication should not be prolonged. It is advisable not to keep the phone near where the pacemaker is located.

As mentioned above, sports are allowed, but only light types. Under no circumstances should you engage in combat sports or others where the risk of injury is high. Any, even minor blow to the gastrointestinal tract and thoracic, can seriously damage the operation of the pacemaker.

Life expectancy after pacemaker installation

If we talk about life expectancy after installation of an pacemaker, then the patient’s regularity of visiting the doctor plays a role here. The operating time of the device is on average from 7 to 9-10 years. When the time comes to change the battery, the device will emit a special signal during the examination. It is for this reason that it is believed that the patient’s life span directly depends on the frequency of visits to the cardiologist.

The life expectancy of patients who regularly follow doctors' recommendations and undergo routine examinations is the same as that of people without an pacemaker.

The beginning of the 20th century was marked by the rapid development of technology in all sectors of human life.

Innovative medical research, carried out in the 1920s, showed the ability of the myocardium to contract under the influence of impulses electric current.

The essence of the research was capable of revolutionizing the treatment of certain heart diseases, as proven by the external rhythm device created in 1927.

However, due to the large dimensions and relatively short service life of electronic components of that time, the development of pacemakers was frozen for decades.

The device in its modern sense was created only in 1958 by Swedish scientists and was named Siemens-Elema. Since then, the design and operating principle of pacemakers have been improved every year - the devices have become more functional, reliable and durable.

Purpose and design of the device

To understand how a modern pacemaker works, you need to understand what it is. Electrocardiac pacemaker (ECS) or, as it is also called, artificial driver rhythm (IVR), is a microprocessor device equipped with an independent power source and located in a sealed metal case, most often made of titanium alloy.

The design of the device includes:

1. Frame– serves to accommodate the internal elements of the pacemaker and isolate them from body tissues.
2. Control and communication unit– necessary for coordinating the operation of modules and exchanging information with control and diagnostic devices.
3. Memory block– stores statistical information about the operation of the device.
4. Sensor block– is able to detect changes in the functioning of the heart and correct the effects of the pacemaker.
5. Working block– forms and transmits electrical impulses to the heart.
6. Battery– serves as a power source for the remaining elements of the pacemaker, is equipped with mechanisms for saving energy and disabling non-basic functions when the charge drops below a threshold level.

The functions of a pacemaker are to sense the heart's own rhythm, detect pauses and other failures in its operation, and eliminate these failures by generating impulses and transmitting them to the appropriate chambers of the heart.

If your own rhythm is stable and corresponds to the needs of the body, impulses are not generated.

An optional feature of some high-tech stimulators is the prevention of arrhythmia, tachycardia and other disorders through special work programs.

What types of pacemakers are there?

Currently, there are many types of pacemakers, differing from each other in design, functionality and other criteria. Classification of devices can be carried out according to various signs, but the main ones are the design features that characterize the specifics of stimulation.

Depending on them, they are distinguished:

• Single-chamber pacemakers - affect one atrium or one ventricle;
• Two-chamber – act on the atrium and ventricle simultaneously;
• Three-chamber – affect both atria and one of the ventricles;
• Cardioverter-defibrillators (ICD, IKVD) - used in the case of high risk complete stop of blood circulation.

To understand in what cases a specific pacemaker model should be used, its letter code, which takes into account design features and functionality of the device.

It includes 3-5 letters of the Latin alphabet, which, depending on the serial number in the marking, indicate:

1. Camera stimulated by the device.
2. The camera detected by the device.
3. The nature of the heart's response to an impulse.
4. Device frequency adaptation parameters.
5. Type of device response to tachycardia.

The main letters used in the marking of a pacemaker are the first letters English words: Atrium (atrium), Ventricle (ventricle), Dual (two, both), Single (one), Inhibition (suppression), Triggering (stimulation), Rate-adaptive (frequency adaptation). The final code used to mark types of pacemakers may look like this: AAI, VVIR (aka PEX), DDDR, etc.

When considering the classification of IVR, one cannot ignore the temporary pacemaker. It is an external device that is connected to the patient’s heart by a resuscitator in the event of a sudden cessation of natural cardiac activity or frequent dangerous fainting.

Indications for installation

The most common heart conditions for which a pacemaker is recommended are:

• Arrhythmia;
• Sick sinus syndrome;
• Atrioventricular block.

Arrhythmia is pathological condition, which is characterized by a change in the frequency and sequence of stages of excitation and contraction of the heart. With arrhythmia it is disrupted normal functioning organ and a number of serious complications arise.

Arrhythmias can be caused for various reasons, but the most common are:

• Coronary heart disease;
• Heart failure;
• Cardiomyopathy and myocarditis;
• Heart defects (both congenital and acquired);
• Mitral valve prolapse;
• Toxic effects, including smoking, alcoholism, drug use;
• Mixed influences manifested atrial fibrillation atria or ventricles (heart rate increases to 250 beats/min or more).

A pacemaker is not implanted in all of these cases. Some violations allow you to do without surgical intervention, influencing the source of the problem medicines or other factors.

Sick sinus node syndrome (SSNS) reflects disturbances in the sinoatrial mechanism that controls heart rate.

Arrhythmias and blockades associated with SSSS include:

• Drop in minimum heart rate to 40 beats/min. and lower, and heart rate under load is up to 90 beats/min. and below;
• Pauses between contractions exceeding 2.5 seconds;
• Alternating bradycardia and tachycardia;
• Severe sinus bradycardia;
• Bradysystolic mitral arrhythmia;
• "Migration" of the atrial driver;
• Sinoauricular blockade, etc.

Features of the operation

The operation to install a pacemaker is a minor one. surgical interventions and is performed in the radiology operating room. The first step is to determine the installation location.

The most common options are:

• Left subclavian region - for right-handers, left-handers with tissue damage right side breasts;
• Right subclavian region - for left-handers, right-handers with tissue damage on the left side of the chest;
• Other places connected by veins to the chambers of the heart - if the classic options are not possible for any reason.

Let's see how the operation goes. The algorithm usually includes the following sequence of actions:

For an experienced surgeon, 20-30 minutes will be enough for all this, but if the installation site is atypical or several cameras are connected at once, the surgical intervention time may increase.

Device installation cost

There is no clear answer to the question of how much such an operation costs - it all depends on the reputation and prices of the clinic, and the features of the technologies used in it. In Moscow heart health clinics, the cost of the operation will be from 100 to 600 thousand rubles, in St. Petersburg the price ranges from 60 to 300 thousand. Provincial clinics are ready to do the work for 25-100 thousand rubles.

But it is important to understand that these amounts only take into account the installation of the device. For the pacemaker itself you will need to pay another 2500-10000 dollars.

Patients treated under a quota can receive full complex services for 3500-5000 dollars.

This amount includes:

• Accommodation and maintenance in the clinic;
• Cost of a pacemaker;
• Cost of consumables;
• Payment for the work of doctors and medical staff.

For patients with serious heart rhythm disorders who have general health insurance, a pacemaker is installed free of charge.

How to live with a pacemaker?

Despite the opportunity to return, in fact, to their previous life, a patient with a pacemaker should still adhere to some rules.

The first and most important thing is regular, timely visits to a doctor who carries out further monitoring of the patient.

The following sequence of visits is usually prescribed:

1. Three months after the pacemaker was installed.
2. Six months after the first postoperative visit.
3. Once every six to twelve months, by agreement with your doctor for a routine examination.
4. Unscheduled - in cases of sensation of electrical discharges, return of symptoms of the disease, appearance of signs of inflammation at the site of installation of the device.
5. After the pacemaker’s service life, as stated by the manufacturer, has expired (usually 6-15 years).

Like any implantable medical device, a pacemaker has its pros and cons. About the advantages, that is positive impact A lot has already been said about the device on the functioning of the heart and the body as a whole. But it's important to remember that living with a pacemaker after surgery means paying attention to details that previously seemed unimportant.

You will have to refrain from the following types of work and actions:

Being near high-voltage power lines and powerful wireless communication translators;

Checking with a metal detector and passing through magnetic frames at the airport, shops;

Carrying out MRI, lithotripsy, physiotherapy, as well as ultrasound in the immediate vicinity of the device installation site.

There will also be a number of restrictions in everyday life. Should be shown special caution When working with electrical appliances, and especially with powerful power tools, avoid any electric shock. The mobile phone should be kept at a distance of no closer than 20-30 cm from the place where the pacemaker is installed.

It is also recommended not to bring a camera, player or other portable electronics near the device. Otherwise, patients with a pacemaker live life to the fullest, getting rid of problems associated with heart rhythm disturbances.

In what cases is it necessary to replace the device and how is it carried out?

During a routine visit to the doctor, the pacemaker is diagnosed and, if necessary, reprogrammed. However, in some cases it may be necessary to replace the device.

Such cases include:

• End of warranty period;
• Low remaining battery charge;
• The occurrence of fatal faults.

A special case is replacing the stimulator to install a more modern and functional model. The process of replacing a pacemaker is similar to the process of installing one, and is also performed under local anesthesia. During the operation, the condition of the electrodes is monitored and, if necessary, new ones are installed.

Video

Over time internal organs a person wears out and loses functional ability. This also applies to cardiovascular system. Modern techniques allow us to identify features of organ pathologies circulatory system.

The best option for correcting the functioning of a muscular organ is a heart pacemaker (CS). The device allows patients to live fully, without feeling pain in the chest.

Device functions

Pacemaker is a miniature device that provides the required number of contractions to the heart muscle. It normalizes the functioning of the circulatory system organ due to atrioventricular blockade.

When the pulse increases, the cardioverter-defibrillator performs “reprogramming” of the heart, followed by restoration of the normal rhythm due to electrical stimulation of the myocardium. Another type of device, a pacemaker, is used when the heart contracts slowly to ensure sufficient release of blood into the vessels.

The pacemaker generates impulses only if the rhythm is disrupted. At normal contraction heart muscle the device does not work. Thanks to the CS, it is possible to avoid stopping the organ of the circulatory system.

The stimulant has its pros and cons. The advantages include long service life (from 7 years), and the disadvantages are the high cost of installation.

Types of pacemakers

Devices are divided into groups depending on their purpose and configuration.

• after heart surgery,
• for warning vascular pathologies caused by taking medications,
• to relieve an attack of ventricular fibrillation.

Long-term pacemakers are needed to combat arrhythmia.

They are divided into 3 groups:

• Single-chamber, equipped with one electrode. It is implanted into the left ventricle. CS is not used for atrial arrhythmias.
• Two-dimensional, containing 2 electrodes. One is placed in the atrium, and the second in the ventricle. The advantage compared to the single-chamber model is control of rhythm changes in both the atrial and ventricular sections.
• Three-chamber – modern models of devices. Electrodes are implanted into the left ventricle and into the right parts of the muscular organ. Due to this arrangement of the electrodes, optimal conditions are created for synchronizing contractions.

The pacemaker is selected depending on the type of cardiovascular pathology and the patient’s health status. The cardiologist informs the patient about treatment tactics and the specifics of preparing for surgery to implant a pacemaker.

Indications for surgery

Rhythm disturbance- a symptom of numerous disorders in the circulatory system. The most common cause of the condition is myocardial infarction and widespread cardiosclerosis. In practice, cardiac surgeons cannot always determine the cause of dangerous attacks.

There are the following readings to install the device:

• taking medications to maintain contractile function heart muscle in case of insufficiency of the blood supply organ:
• regular attacks of ventricular fibrillation against the background of atrial fibrillation,
• disruption of the conduction of electrical impulses from the atrium to the ventricles, accompanied by loss of consciousness,
• weakness of the sinus node.

Contraindications to the procedure

There are no absolute prohibitions for installing a CS. The operation is performed even on patients suffering from acute heart attack myocardium, which is accompanied by serious disturbances of heart contractions or atrioventricular block.

If the patient does not have vital signs to install the device, the operation may be delayed for a while.

The procedure is postponed:

• for acute viral and infectious diseases,
• with exacerbation of chronic pathologies,
• at psychological disorders in the patient, which interfere with productive contact.

There are no age-related contraindications for surgery to install a pacemaker. In each case, the doctor determines the indications and temporary prohibitions for the procedure.

Preparatory activities

If implantation of a pacemaker is prescribed to a patient as planned, then before the operation it is advisable to undergo instrumental and laboratory diagnostic examinations:

• daily ECG and blood pressure, recording disturbances in the heart rhythm in the period from 1 to 3 days,
• consultations and initial examination from a cardiologist and arrhythmologist,
• blood tests - general and biochemical (to identify the level of coagulation of biological fluid),
• blood test for viral diseases(hepatitis, HIV, syphilis).

For persons suffering from peptic ulcers organs of the gastrointestinal tract, FGS is additionally recommended. Drugs prescribed after the installation of a pacemaker have a negative effect on the mucous membranes of the stomach and can cause internal bleeding.

For chronic diseases of the ENT organs, consultation with an otolaryngologist will be required. Foci of infection in the body give rise to complications in the heart, so before the planned installation of a CS, their sanitation is required. Patients who have had a stroke are additionally prescribed MRI.

Stages of the operation

The operation to install the device lasts up to 2–3 hours. The duration of installation of a single-chamber device is 30 minutes, a two-chamber device is 1.5 hours, and a three-chamber device is up to 2.5 hours.

The intervention occurs in stages:

• The surgical field is prepared for anesthesia. The drugs are administered subcutaneously and intramuscularly.
• Electrodes are inserted into various departments hearts. The surgeon makes an incision in the collarbone area and then places the electrode in the desired chamber. To accurately perform manipulations, the surgeon needs to take x-rays of the surgical field.
• The electrodes are connected to the body of the pacemaker, which is implanted under the pectoral muscle.
• The device is programmed according to the individual needs of the patient. The doctor sets the baseline heart rate at rest and during exercise. After this, the edges of the wound are sutured.

Modern devices are miniature, so they are invisible on the human body.

Price for surgery

The cost of the operation includes installation of the pacemaker, diagnostic measures, and the price of electrical wires.

The price of the intervention also depends on the type of device:

Rehabilitation period

After installation of a pacemaker, the patient experiences discomfort and pain in the surgical area for several weeks.

The consequences of the procedure include:

• hematoma formation in the intervention area,
• increase in body temperature,
• the appearance of a headache.

Unpleasant symptoms go away on their own or are eliminated with drugs for symptomatic therapy - antibiotics, non-steroidal drugs.

24 hours after the intervention, the person is allowed to get out of bed, and after 7 days - to return to normal life.

Features of life with ECS

In most cases, the device does not lead to cardiac complications and is not felt by patients. Despite this, after the operation certain restrictions are introduced regarding the patient’s lifestyle.

The patient is not allowed:

• engage in sports where there is a risk of injury chest(boxing, hockey, football, rugby, etc.),
• perform exercises using weights on the chest muscles,
• located near the transformer booths,
• fly on an airplane,
• drink alcohol in large quantities.

It is not prohibited to use household appliances. The basic rule in this case is to maintain a safe distance between the device and the pacemaker (from 20-61 cm depending on the type of household appliance).

If the pacemaker is installed due to severe heart failure, then the patient is assigned disability group 2 or 3.

Medical procedures for a patient with a pacemaker are prohibited:

• CT and MRI. CT scans are performed only with the consent of the doctor.
• Physiotherapeutic measures using magnetic or electrical radiation.
• Ultrasound with beams directed directly at the device.

Before conducting examinations, the patient warns the doctor about the device he has.

Forecast

The pacemaker lasts up to 7–10 years, it all depends on the battery capacity. During the next inspection, the device will beep, indicating the need to replace it.

After the battery has expired, it is replaced with a new one.

How long do they live after having a pacemaker installed?

People with an implanted stimulator live longer than without it. The opinion that CS can harm a person is erroneous.

The operation to install a pacemaker occurs under local anesthesia and lasts about 40–60 minutes. When the patient has already been given a heart pacemaker, he is taken to the intensive care unit and left here for 2 - 2.5 hours, after which several tests are performed, an x-ray is taken and, if all is well, the patient is taken to the general ward, where he will undergo the following 10 days.

How is a heart pacemaker placed - for arrhythmia, sick sinus syndrome, blockades and other diseases? The pacemaker is placed over the shoulder (under the collarbone), above the left or right breast, in one of the least mobile zones human body, which allows you to avoid kinks and, as a result, frequent breakdowns of the electrodes (wires) of the pacemaker.

The pacemaker can be re-installed on the same side (after removing the old device) with the same or new electrodes (in blood vessel up to 5 electrodes can remain simultaneously). A pacemaker for the heart can be placed on the opposite side, and even in abdominal cavity– the implantation site is chosen by the doctor.

The procedure for installing a pacemaker is identical for men and women, children, adults and the elderly. The operation is usually performed under local anesthesia, although a pacemaker can be installed under general anesthesia. IN specialized centers(cardiology, thoracic surgery) and large hospitals install pacemakers almost on the fly.

What is a pacemaker and how is it implanted?

An electric pacemaker (PAC) or artificial heart pacemaker (driver) is a device for maintaining the heart rate at a level not lower than a predetermined one. As a rule, for healthy person The norm is heart rate (heart rate) at the level of 70 - 80 beats per minute, for athletes and athletes this value can be lower - and be up to 54 - 60. At the same time, the heart rate should never slow down more than 3 s between heartbeats.

When the heart rate drops below 54 or the interval between contractions reaches 3 seconds or more, installation of an pacemaker is recommended. My heart rate dropped to 26 beats per minute (at night), and the time between contractions reached 5 seconds. With this, I ended up having an operation to implant a pacemaker.

The pacemaker is implanted under local anesthesia (in some cases it may also be necessary general anesthesia) – in my case, if my memory serves me right, a drug based on novocaine was used. But a lot depends on availability allergic reactions. First, a painkiller is injected (I had to inject it 3 or 4 times: I worked out in the gym for a long time - more than 10 years, since 2005 - and, as it turned out, I pumped up quite well pectoral muscles: several layers, each of which required “chipping”).

If the anesthesia is not enough, it is injected again. Possible painful sensations during the operation: pain and burning - you need to inform the surgeon about this, and they will give you an additional injection of painkiller. The operation itself consists of several stages:

skin incision and subcutaneous tissue, muscle tissue; cutting out a hollow under the pacemaker (a small piece of meat is physically removed); moving electrodes through the veins to the heart and fixing them here; testing the operation of electrodes; pacemaker implantation and suturing.

How long does the surgery to install a pacemaker take?

The operation itself to install a pacemaker lasts 40–60 minutes, in my case it took about 45 minutes. This includes the time for treating the incision site with an antiseptic and applying sutures. The operation is considered as a minor surgical intervention, but, at the same time, is classified as heart surgery and is included in the list medical services, covered compulsory medical insurance policy or fulfilled according to quotas (but not always - there are bureaucratic snags).

After the operation I was placed for 2 hours next to intensive care unit(there were no places here - they were all occupied by patients with more real threat for life). After about one and a half to two hours, an electrocardiogram (ECG) is taken and an x-ray is taken. After which, if all is well, the patient is transported to the general ward.

How is a pacemaker installed from the patient’s point of view?

Nothing was required of me - just lie still. The operation was carried out under local anesthesia, the head was asked to turn in the direction opposite to the implantation site - and throughout the operation I watched a monitor with data on my blood pressure and heart rate. There was music playing in the background (which characterizes the complexity of the operation as not very high).

So that I could not see the incision and the progress of the operation, even turning my head or squinting (if I had such a desire), a bar was installed above my neck, and a towel was hung on it - as a result, I did not see anything that was happening “below” the chin. Thus, my entire participation in the operation came down to observing the monitors (I even saw an x-ray of how the electrodes were being pushed towards the heart - already on the second monitor that appeared in my field of vision at the final stage).

It was also my responsibility to inform the surgeon if I felt pain at the incision site. Actually, a slight pain, burning, pressure and, when the first impulses were sent through the electrodes, a strange non-painful sensation, as if a current was running through the veins - that’s all I felt. In the first two hours after the operation, I also felt that something was touching my heart (electrodes) - this feeling persisted, gradually fading, for a couple of days after the operation.

Overall, the operation was completely painless for me. And, as I later learned, this is the case for the vast majority of patients. However, with me, the man spent the night in intensive care after the operation (he did not appear in the ward since the evening when he was taken to the operation - and showed up the very next day, however, he remained cheerful). Doctors consider the operation to be a stream operation and told what kind of recent years 10 there was not a single case of failure.

And here - about how to live with a pacemaker:

Pacemaker Insertion

Description

The procedure is performed to install a pacemaker. A pacemaker is a small, battery-powered device that helps maintain normal heartbeats by sending electrical impulses to the heart.

Reasons for installing a pacemaker

A pacemaker may be installed in the following cases:

The body's natural pacemaker, the sinoatrial (SA) node, does not work properly. When the SA node is not working properly, the heart may beat too slowly; There is a malfunction of the atrioventricular (AV) node, the part of the heart's electrical system that sends signals from the SA node to the ventricles. This results in a very slow heartbeat; Heart function should be improved in people with severe symptoms of congestive heart failure and weakened heart muscle (cardiomyopathy); After heart surgery.

Possible complications of pacemaker installation

Complications are rare, but the procedure is not guaranteed to be risk-free. If you are planning to have a pacemaker installed, your doctor will review the list possible complications which may include:

Heavy bleeding; Infection; Pacemaker malfunction; Rupture of the heart muscle (rare); Stimulation of the diaphragm (the large muscle between the chest and abdominal cavities) is unnecessary in this case.

Factors that may increase the risk of complications:

Obesity; Smoking; Excessive alcohol consumption; bleeding or blood clotting disorders; Taking certain medications regularly.

You should discuss these risks with your doctor before the procedure.

How is a pacemaker installed?

Preparation for the procedure

Before the procedure, the doctor may prescribe:

Blood tests; Chest X-ray is a test that uses X-rays to photograph the structure inside the chest; An electrocardiogram is a test that records the activity of the heart by measuring the electrical current through the heart muscle.

A few days before the procedure:

Consult your doctor about any medications you are taking. In the week before surgery, you may be asked to stop taking certain medications: Anti-inflammatory drugs (such as aspirin); blood thinners such as clopidogrel (Plavix) or warfarin (Coumadin); Eat a light meal the night before your procedure. Don't eat or drink anything after midnight.

Anesthesia

Local anesthesia will be used. This means that only the surgical area will be numbed. Anesthesia is given by injection.

Description of the pacemaker installation procedure

You will lie on a hard table. Heart rate will be monitored, blood pressure and breathing. The doctor makes a small incision under the collarbone. A pacemaker will be inserted through this incision. The wires are led through a vein under the collarbone to the heart. Once installation is complete, the cut will be closed with stitches.

Immediately after the pacemaker procedure

Heart rate and blood pressure will be monitored.

How long will it take to install a pacemaker?

About 2 hours.

Installing a pacemaker - will it hurt?

Anesthesia will prevent pain during surgery. You may experience pain and tenderness after surgery. Your doctor will give you pain medication to reduce discomfort.

Care after pacemaker installation

Before leaving the hospital, the pacemaker will be programmed according to your pacing needs. When you return home, follow these steps to ensure a normal recovery:

Ask your doctor when it is safe to shower, swim, or expose the surgical site to water; Once you feel normal, you can return to your daily activities. This may take about two weeks; For 4-6 weeks, avoid physical activity, especially those associated with top part bodies; Avoid excessive arm/shoulder movement on the pacemaker side for two weeks. This will help prevent the wires from moving; Do not drive for one week after surgery; The stitches will be removed within one week; Procedures to avoid after pacemaker insertion: MRI; Heat therapy (often used in physical therapy); High voltage or radar technology (e.g. arc welding, high-voltage wires, radar installations or smelting furnaces); Radio and television transmitters; Do not carry your mobile phone in your pocket directly above the device. In addition, headphones and MP3 players near the pacemaker may cause interference; Turn off your car or boat engine when working around it. (They can confuse the device); Tell your doctor and dentist that you have a pacemaker; Consult a physician regarding the safety of passing through airport security detectors with your device; Be sure to follow your doctor's directions.

A hard ridge may form on the skin along the incision, which usually resolves as the wound heals.

Contacting your doctor after having a pacemaker installed

After leaving the hospital, you should consult a doctor if the following symptoms appear:

Signs of infection, including fever and chills; Redness, swelling, severe pain, profuse bleeding or any discharge from the incision; Pain that does not go away after taking prescribed pain medications; Cough, shortness of breath, chest pain; Heartbeat disorders; New painful symptoms.

If a life-threatening situation arises, you should immediately seek medical help.

A pacemaker (Pacemaker) is a small device that generates electrical impulses to cause the chambers of the heart to contract in a specific pattern. In other words, it is an artificial pacemaker that synchronizes the work of the atria and ventricles. The purpose of its implantation is to replace the lost function of the natural source of electrical impulse - the sinus node.

Most often, surgery to install a pacemaker is performed when the sinus node has failed. The second option is the appearance of a block in the conduction system of the heart.

Purposes of pacemaker installation

Pacemakers are divided into temporary and permanent. The first ones are used when a short-term problem with the heart occurs, for example, arrhythmia appears against the background of acute myocardial infarction. If heart rhythm disturbances have become chronic, then a permanent CS is established. There are absolute and relative readings to implantation of pacemakers for long periods.

Absolute readings:

Sick sinus syndrome;

Symptomatic sinus bradycardia;

Tachycardia-bradycardia syndrome;

Atrial fibrillation with sinus node dysfunction;

Complete atrioventricular block (third degree);

Chronotropic incompetence (a condition in which the sinus node does not respond adequately to physical or emotional stress; even at maximum physical activity heart rate does not exceed 100 beats per minute);

Long QT syndrome;

Cardiac resynchronization therapy with biventricular pacing.

Relative readings:

Cardiomyopathies (hypertrophic or dilated);

Severe neurocardiogenic syncope.

Back in 1958, cardiac surgeon Ake Senning was the first to implant a CS in a human. Since then, the installation of a pacemaker has been considered the method of choice in the treatment of bradycardia and heart block. The number of operations performed is steadily growing. For example, the annual increase in implantation of conventional pacemakers in England is 4.7%, and cardiac defibrillators - 15.1%.

treat sinus bradycardia

You will learn about the reasons sinus bradycardia, symptoms, treatment and diagnosis of pathology.

more about drug treatment ventricular tachycardia.

Types of pacemakers

“Adaptation” to each type of heart rhythm disturbance prompted the development various types pacemakers and their operating modes. All modern CS are capable of perceiving internal electrical activity heart and stimulate it only when the heart rate drops below the programmed level. Essentially, they all have a built-in “sensor” that senses the need to change your heart rate in response to physiological needs.

For permanent cardiac pacing, three types of devices are used:

● single-chamber (PM-VVI): the electrode is placed either in the right ventricle or in the right atrium;

● two-chamber (PM-DDD): two electrodes are installed (in the right ventricle and in the right atrium), this is the most common type of CS;

● three-chamber (PM-BiV): used in so-called cardiac resynchronization therapy. As a rule, one electrode is implanted in the right atrium and in both ventricles. These pacemakers are usually installed in patients with chronic heart failure. They are able to “resynchronize” the work of the ventricles, which helps improve the pumping function of the heart. They are also called biventricular pacemakers. Cardiac resynchronization therapy may include implantation of a cardioverter-defibrillator.

Implantation technique

How is surgery to install a pacemaker performed? The procedure is performed in a specially equipped operating room under local anesthesia (general anesthesia is rarely used). It belongs to the category of minimally invasive surgical interventions.

Transvenous access to the chambers of the heart is used. That is, the wires (electrodes) coming from the pacemaker are placed intravenously.

To do this, the subclavian vein is most often catheterized. After which a small incision (3.8 - 5.1 cm) is made in the subclavian region, where a subcutaneous pocket is created where the pacemaker is implanted. Less commonly used for this purpose is the lateral saphenous vein hands. Very rarely, access to the chambers of the heart is used through the axillary, internal jugular or femoral veins.

The guide catheter(s) are then inserted through a puncture in the vein into the right atrium. If necessary, a second catheter is sent along the same route and installed in another chamber. Or a puncture in another vein is used for this. After which the electrodes are directed through the conductors into the chambers of the heart.

Electrodes are attached to the endocardium (the inner lining of the heart) in two ways. Passive fixation - at the end of the electrode there is a hook that “clings” to the endocardium. Active fixation - using a special fastening resembling a corkscrew, the electrode is screwed into the inner shell.

At the end of the procedure, specific tests are done to ensure the reliability of the installed pacemaker. Self-absorbing sutures are placed on the skin, and the arm is immobilized with a bandage for 24 hours.

How long the operation to install a pacemaker lasts will be influenced by its course and possible force majeure circumstances during the procedure. The CS implantation procedure itself, as a rule, does not exceed 3 hours. The duration of hospitalization is usually 24 hours.

Prevention infectious complications using antibiotic therapy is mandatory. Cefazolin 1 g is usually prescribed one hour before the procedure or alternatively 1 g of vancomycin in case of allergy to penicillin and/or cephalosporins. The day after implantation, chest X-rays are performed to ensure that the electrodes and pacemaker are positioned correctly and that there are no possible complications (for example, pneumothorax).

To learn how to install a pacemaker, watch this video:

Complications

Naturally, many patients, worried about future intervention in the body, think about how dangerous the operation to install a pacemaker is. Although CS implantation is considered a minimally invasive procedure, there is still a possibility of complications occurring both during and after the operation. In large clinics with extensive experience in performing implantations, the rate of early complications, as a rule, does not exceed 5%, and late complications – 2.7%. The mortality rate ranges from 0.08 - 1.1%.

Fistula in the area of ​​pacemaker implantation

Early complications:

Bleeding (formation of hematomas in the pocket where the CS is installed);

Thrombophlebitis and phlebitis;

Electrode displacement;

Infectious inflammation in the implantation area;

Pneumothorax;

Hemothorax;

Infarction of the area of ​​the heart wall where the electrode is fixed;

Anaphylaxis;

Air embolism;

Device malfunction.

Late complications:

pocket erosions (destructive changes in the tissues around the joint); electrode displacement; phlebitis or deep vein thrombosis; systemic infection; atrioventricular fistula; device failure; endocarditis; thrombus formation in the right atrium.

Technological advances and improvements in surgical procedures have led to a significant reduction in the incidence of complications. Recovery after the procedure is usually quick. However, during the first two to four weeks, there is pain and discomfort that limits mobility in the arm. Displacement of the electrodes, their separation from the place of fixation - the most common problem which may occur after implantation.

Recovery period

Most people feel great, much better than before the procedure. Usually on the second day after implantation they can return to their everyday life in full.

How rehabilitation goes after surgery to install a pacemaker is also influenced by the patient’s behavior and compliance with the doctor’s recommendations, which include:

During the first 48 hours, it is necessary to avoid getting moisture into the postoperative wound.

If swelling, pain, or local warmth appears in the area of ​​the sutures, you should consult a doctor.

During the first 4 weeks, you must limit movement in the arm on the side on which the pacemaker is installed.

Further observation

People who have a permanent pacemaker should follow their doctor's recommendations and adhere to certain restrictions. The first examination is usually scheduled after 3 months, then after six months. The frequency of subsequent examinations is twice a year, provided there is nothing disturbing. If you experience fainting, dizziness, or your heart rate drops below the programmed level, you should visit a doctor earlier than planned.

Sometimes a problem can occur when the lead loses contact with the heart. This situation requires its replacement. As a rule, it is not removed from the vein, but is disconnected from the pulse generator. A new electrode is attached, which is first moved along the vein along the old one and fixed to the heart.

Replacing the battery

Energy source used in permanent pacemaker, has a limited service life (from 5 to 10 years). The battery is located inside the metal body of the device and is its integral part. Therefore, when its charge is depleted, a procedure is required to replace the pulse generator.

Under local anesthesia, a skin incision is made in the pocket area, the old device is removed (the electrodes are first disconnected), and a new one is implanted in its place. The operation of the new pacemaker is checked, after which stitches are placed. The patient is sent home on the same day.

To see what signal a pacemaker gives when its battery runs out, watch this video:

Cost of the procedure

The cost of installing modern pacemakers, not including their cost, can range from $3,500 to $5,000.

As a rule, the installation of a pacemaker significantly improves the patient’s quality of life if he suffers from arrhythmia, which is accompanied by severe symptoms of heart failure. These electrotherapeutic devices have proven themselves and have been used effectively for the past 60 years. Complications during their installation and further use are very rare.