Pacemaker surgery: pros and cons

To maintain the heart's work, a special device is used - a pacemaker. Let's consider the features of this device, types, indications for use.

The heart is the motor of our body. It is a fibrous-muscular hollow organ, which, with its rhythmic contractions, ensures the flow of blood through the blood vessels. The powerful muscle is located in the chest. The heart is surrounded by a serous membrane on the outside and by an endocardium on the inside. The organ has two partitions made of muscle tissue, as well as membranes that create four different sections: the left and right ventricles, the left and right atrium.

Normally, a person does not notice how the heart works. But as soon as interruptions occur in the organ, this negatively affects the functioning of the entire body. A sick heart is not able to provide normal blood flow, which causes side effects from many organs and systems. For treatment, that is, restoring the heart's function, both therapeutic and surgical methods are used. The latter includes the installation of an artificial pacemaker.

So, a pacemaker is a medical electrical device that imposes a correct sinus rhythm on the heart. The main indications for installing this device are the following diseases:

• Severe bradycardia.
• Complete heart block (the ventricles and atria contract independently of each other).
• Severe degree of heart failure.
• Cardiomyopathy (structural disorders of muscle contractility).

Typically, the device is implanted in the left subclavian region under the pectoralis major muscle. Electrodes are passed to the heart chambers through the subclavian vein and fixed to the surrounding tissues. After the pacemaker is installed, a person's life changes. A number of restrictions and requirements appear. But despite this, the device will allow you to lead a full life.

What is it and what types are there?

A pacemaker is an electronic device that eliminates cardiac arrhythmia, restores and maintains normal functioning of the organ. Its size is no larger than a matchbox. It is sewn under the skin, and the electrodes enter the right atrium. The device imposes a constant rhythm of 60-65 beats per minute on the organ, preventing a decrease in heart rate.

There are several types of pacemakers (EP):

• Single-chamber – begin to work when bradycardia appears, that is, a heart rate of 40-50 beats per minute.
• Dual chamber – turns on automatically and continuously monitors your heart rate.
• Three-chamber – used to treat life-threatening conditions (severe ventricular arrhythmia).

The device consists of a microprocessor, electrodes, an electrical impulse generation system, and a battery. All components are packed in a titanium case, which is completely sealed and practically does not interact with surrounding tissues. The mechanism is placed close to the heart muscle and its electrodes are connected to the myocardium.

Through the electrodes, the microprocessor receives information about the electrical activity of the heart and, if necessary, generates impulses. All data on the operation of the device is stored in its memory for further analysis. All ECS settings are individual for each patient. The doctor sets the base heart rate, below which electrical impulses are generated.

The service life of the device is about 8-10 years. In the future, a repeat operation may be required to replace it. In this case, the manufacturer's warranty in most cases is about 4-5 years.

The first pacemaker

Every year the number of surgeries to install pacemakers grows. And this is not surprising, since the modern device has miniature dimensions and high functionality. Although 10-20 years ago pacemakers had impressive dimensions.

The method of cardiac stimulation was first used by Mark Leadwill in 1929. The anesthesiologist described an electrical device that could support the heart. His device gave electrical discharges of varying power and frequency. One electrode was inserted directly into the heart, and the second was applied to the skin after treatment with saline.

• The first fully implantable pacemaker was developed in the 50s and 60s of the last century. This period is considered golden in cardiac stimulation. The device was large and completely dependent on external electricity, which was its huge disadvantage. So in 1957, a power outage caused the death of a child who had this device installed.
• In 1958, the first portable pacemaker was designed and implanted. It was installed in the abdominal wall, and electrodes were connected to the heart muscle.
• In 1970, a lithium battery was created, which significantly extended the life of the devices. During this period, dual-chamber pacemakers were invented, affecting the atria and ventricles.
• In the 1990s, the world saw the first pacemakers with a microprocessor. They allowed collecting and storing information about the patient's heart rhythm. In addition, the device could adapt to the body, adjusting the heart's work and, if necessary, setting its rhythm.
• In the 2000s, a biventricular pacing system was developed for severe heart failure, improving cardiac contractility and patient survival.

Today, a pacemaker is a complex mechanism that has three main components:

1. Electronic circuit.
2. Lithium-ion battery-accumulator.
3. Titanium shell

The pacemaker saves the lives of millions of people around the world. Thanks to modern technology, its dimensions are quite miniature. The implantation of the device occurs in several stages, which allows patients not to experience physical or aesthetic discomfort from the mechanism located under the skin.

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Functions of a pacemaker

The main function of the artificial pacemaker is to control and stimulate the heart muscle. The mechanism is activated if a rare or irregular rhythm or skipped heartbeats occurs.

The functions of a pacemaker depend on the type of device. The mechanism can be single-, dual- or triple-chamber.

• Each stimulating chamber is designed to stimulate one part of the heart. Two-chamber devices stimulate the right ventricle and atrium, and three-chamber devices stimulate the right atrium and both ventricles.
• Cardiac resynchronization devices are equipped with sensors that monitor changes in the body.
• Devices of this kind are used in severe forms of heart failure, as they eliminate dyssynchrony, that is, uncoordinated contractions of the heart chambers.

Today, many pacemakers have been developed for a specific type of disorder. This expands the functionality of the device and increases its effectiveness in treating heart pathologies.

Indications for the procedure

To implant an artificial pacemaker, the patient undergoes a set of diagnostic tests that determine how necessary the pacemaker is. Indications for a pacemaker can be absolute and relative. The urgent need to install the device is indicated if serious disturbances in the functioning of the heart occur:

• Rare pulse.
• Long pauses between heartbeats.
• Sick sinus syndrome.
• Carotid sinus hypersensitivity syndrome.

The above problems arise with pathology of impulse formation in the sinus node. Similar occurs with congenital diseases and cardiosclerosis.

A permanent pacemaker is installed with the following absolute indications:

• Bradycardia with pronounced symptom complex.
• Morgagni-Adams-Stokes syndrome.
• Heart rate during physical activity is less than 40 beats per minute.
• Asystole according to ECG is longer than 3 seconds.
• Persistent atrioventricular block of the second or third degree with two- or three-fascicle blocks.
• Persistent atrioventricular block of II-III degree after myocardial infarction and in the presence of pathological symptoms.

In case of absolute indications, the operation is performed on a planned basis after a series of diagnostic studies or on an emergency basis.

Relative indications for pacemaker:

• Syncopal states with bifascicular and trifascicular blocks that are not associated with complete transverse block or ventricular tachycardias, but the true etiology is not established.
• Third-degree atrioventricular block at any anatomical site with a heart rate greater than 40 beats per minute without pronounced symptoms.
• Regressive atrioventricular block.
• Atrioventricular block II degree type II without symptoms.

In case of relative indications, the decision to install the device is made by the doctor, individually for each patient. The doctor takes into account the patient's age, the presence of concomitant diseases, and the level of physical activity.

Pacemakers are installed when there is a real risk to the patient's health and life. Today, two-, three- and four-chamber models are most often used. However, single-chamber devices can be implanted for certain indications.

Pacemaker for atrial fibrillation

A disturbance of the normal heart rhythm with a pulse of 300 beats per minute and chaotic excitation of the muscle fibers of the atrium is atrial fibrillation. The main goal of surgical treatment is to restore the heart rate to normal.

When deciding to implant an ECS to stop paroxysms, the AV node is destroyed, that is, a complete AV block is created or the atrial fibrillation zone in the atria is ablated. If this is not done, the pathology will move to the ventricle, which will cause life-threatening tachycardia. Most often, patients are implanted with a cardioverter defibrillator or a single-chamber ECS with a ventricular electrode.

The patient is also prescribed antiarrhythmic drugs, which help normalize the heart's work. A pacemaker is effective in 90% of cases for this pathology, so in some patients the disorder makes itself known again within a year.

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Pacemaker for heart failure

Heart failure develops with pathological changes in the vessels, myocardium and valve apparatus. The danger of this disorder is its rapid progression, tendency to decompensation and transition to a chronic form.

Implantation of an artificial pacemaker is possible if the disease has taken a severe congestive form. The action of the pacemaker is aimed at:

• Elimination of painful symptoms.
• Slowing down of structural changes in the heart.
• Elimination of functional dysfunction.
• Reduction of hospitalization periods.
• Increased survival and improved quality of life.

When choosing cardiology equipment, preference is given to single- and dual-chamber models. A cardioverter-defibrillator can also be installed for recurring ventricular arrhythmias that threaten life.

Pacemaker after heart attack

The main indication for implantation of a pacemaker after myocardial infarction is persistent atrioventricular AV block of II-III degree. When installing the device, it should be taken into account that the pacemaker changes the cardiogram data. Because of this, it becomes impossible to obtain reliable information about the condition of the organ.

That is, an artificial pacemaker can mask the symptoms of the disease. In this case, the patient is prescribed a set of laboratory tests and an ECG check with an ECS programmer.

Quota for pacemakers

According to the program of the Ministry of Health of Ukraine, funds are allocated annually from the country's budget for the purchase of implantable cardiac devices. The quota for pacemakers implies free installation of devices. First of all, this benefit applies to socially vulnerable groups of the population.

The procedure for installing the pacemaker according to quotas is determined by the order of the Ministry of Health. The queue for implantation is created in regional commissions that select patients who need expensive equipment.

To receive a quota for the installation of a pacemaker, you must:

• Undergo a comprehensive cardiological examination and obtain the appropriate conclusions from the attending physician and the medical advisory committee.
• The VKK forwards the application to the Ministry of Health commission, which reviews each patient’s case and makes a decision on whether to grant the benefit.

In Ukraine, single, dual, and triple-chamber pacemakers, as well as pacemakers with a defibrillator function, are installed under quotas. Operations are performed in regional centers and the capital, entirely at the expense of the state. Subsequent replacement of the device can be carried out both under a quota and at the expense of the patient.

In some cases, patients are given a quota for the device itself with the need to pay for the implantation procedure and subsequent rehabilitation. After the pacemaker is installed, the patient is again sent to the VKK to decide on assigning a disability group.

Preparation

Before the operation to install a permanent artificial pacemaker, the patient undergoes special preparation. It includes a set of diagnostic procedures:

• Laboratory tests.
• Chest X-ray.
• Electrocardiogram.
• Magnetic resonance imaging.

A week before the operation, the patient must stop taking blood thinning medications and anti-inflammatory drugs. The patient is shown a special diet of light food, which will prepare the body for surgery.

Pacemaker check

A pacemaker is a complex multi-component device that is a foreign body for the human body. Not only health and general well-being, but also life depend on the correct operation of the device. Systematic testing of the artificial pacemaker and correct adjustment are the key to its effective operation.

During the check, the doctor evaluates the correct operation of the device, the condition of the electrodes and the features of the stimulation settings. The battery condition is also checked. The initial check and adjustment are carried out immediately after implantation. If the device works correctly, the patient is assigned further scheduled checks:

• 2-3 months after installation. During this time, the body will fully adjust to the work of the pacemaker, so the cardiologist can make the final adjustment of its functions and parameters.
• After six months and a year, the doctor evaluates the correctness of the selected settings and how much the patient’s condition has improved.

Routine check-ups should be performed at least once a year. Also, as the pacemaker wears out, doctor visits become more frequent, as the device's battery begins to discharge and painful symptoms may appear.

The assessment of the condition of the artificial pacemaker begins with a patient interview by a cardiologist. The doctor asks about the general state of health, the presence of painful symptoms and the development of complications. After this, a series of tests are carried out:

1. Visual inspection of the equipment installation site. In 5% of cases, an inflammatory reaction or bedsore develops at the implantation site. Moreover, the pathological condition may make itself known several months or even years after implantation. During the examination of the chest, the doctor pays attention to the presence of such symptoms

• Change in skin color.
• Thinning of tissue.
• Deformation of the postoperative scar.
• Increased temperature of surrounding tissues.
• Discomfort when pressing on the implant.

The cardiologist identifies the first signs of the disorder and prescribes methods of treatment/prevention of inflammation.

2. Electrocardiography and stress tests. To check the correct placement of the electrodes, the patient must hold their breath and move a little. If there is significant tension and atypical movements in the chest muscles, then with increased physical activity, a person may experience severe dizziness. An X-ray examination is mandatory.
3. To check the pacemaker itself, a programmer is used. It is a special computer that is connected to the programming head of the pacemaker. The device reads all the information about the cardiac equipment and the information it collects about the heart's work. If necessary, the programmer changes the pacemaker settings. An analysis of the additional functions of the device is also carried out.
4. To check the functionality of the pacemaker, a magnetic test is prescribed. The cardiologist brings a special magnet to the implant. When interacting with it, the device should switch to the operating mode with a frequency of 99 per minute. If the results are lower, this indicates a discharged battery.

The pacemaker is checked and adjusted by a cardiologist, cardiovascular surgeon or arrhythmologist. The procedure is carried out in the clinic or hospital where the pacemaker was installed.

Pacemaker electrodes

Today, there are two types of electrodes in medical devices that maintain heart rhythm:

• Active fixation is the installation of an electrode in the heart cavity, i.e. in the chambers or ventricles. Special screw hooks are used for fixation.
• Passive fixation – the device is connected to the heart using an anchor method, that is, using special antennae at the end of the electrode.

The tips of the electrodes have a steroid coating, which reduces the risk of developing inflammatory processes at the site of implantation. Due to this, the service life of the mechanism increases, energy consumption decreases and the sensitivity threshold increases. Particular attention is paid to the classification by configuration:

• In a bipolar scheme, the cathode and anode, i.e. both poles are located in the distal part of the electrode. Bipolar electrodes are larger in size, but are less susceptible to external interference: muscle activity, electromagnetic fields. They are installed during endocardial implantation of the pacemaker.
• In a unimodal circuit, the anode function is performed by the device body, and the cathode function is performed by the tip of the electrode.

If the pacemaker is installed to treat blockades, the electrodes are placed in the right atrium and ventricle. Particular attention is paid to reliable mechanical fixation. Most often, atrial electrodes are fixed in the interatrial septum, and ventricular electrodes are fixed in the upper part of the right ventricle. In 3% of cases, electrode dislocation is observed, i.e., its displacement from the installation site. This causes a number of pathological symptoms and requires a replacement procedure.

During routine checkups, the doctor evaluates the condition of the electrodes, as there is a risk of developing an infectious complication - endocarditis. Microbial infection of intra-articular structures is manifested by a feverish condition and prolonged bacteremia. Infectious damage to the electrodes is extremely rare. Complete removal of the pacemaker with subsequent antibacterial therapy is indicated for treatment.

Pacemaker Protective Screens

All modern models of EKS have protective screens against electromagnetic and magnetic radiation. The main method of shielding the device is its protective case, which is made of metals inert to the body, usually titanium.

Thanks to this, the pacemaker is not rejected after implantation and is not sensitive to the effects of metal frames or power lines. However, metal detectors used at high-security facilities and airports can pose a potential danger. They must be bypassed by showing the pacemaker's passport and patient card.

Technique pacemaker insertion

The pacemaker installation is performed under local anesthesia and takes about 2-3 hours. The technique of the operation depends on the type of the implanted device. Single-chamber devices are installed the fastest, while three- and four-chamber models are much more difficult and take longer.

The operation consists of the following stages:

• Preparation of the surgical field and anesthesia. The chest area is treated with an antiseptic and an anesthetic is administered. As soon as the medicine has taken effect, the implantation procedure begins. The device is sewn in on the right or left side under the collarbone.
• Insertion of electrodes. The surgeon dissects the tissue and subcutaneous tissue, inserts the electrodes through the subclavian vein into the required chambers of the heart. All manipulations are performed under X-ray control.
• Installing the pacemaker body. If the electrodes are installed correctly, the cardiologist proceeds to fixing the device itself under the chest muscle or in the tissue. For right-handed people, the device is placed on the left, and for left-handed people, on the right.
• Programming the device, suturing and wound treatment. At this stage, the required impulse stimulation frequency is set and sutures are applied.

After the expiration of the ECS service life, both the housing itself and the entire electrostimulation system can be reinstalled.

Surgery to install a cardiac pacemaker

The implantation of an artificial pacemaker is considered minimally invasive. The operation is performed under local anesthesia, in a special operating room with an X-ray machine. The doctor punctures the subclavian vein and inserts an introducer with an electrode into it. All movements are performed under X-ray control.

The most difficult stage is the installation and fixation of electrodes in the atrium or ventricle for good contact. The surgeon measures the excitability threshold several times to select the optimal, highly sensitive localization of the electrodes.

The next step involves sewing in the device body. The pacemaker is installed under the skin or in a special pocket under the muscle. The doctor then sutures the wound and tests the device again. As a rule, the operation lasts about 2 hours. In rare cases, when using special implantation methods, the surgical intervention can take up to 3-4 hours.

Duration of the pacemaker surgery

The time it takes to install an artificial pacemaker depends on its type. On average, the operation takes 2-3 hours.

The implantation of a single-chamber pacemaker takes about 30 minutes, plus time for suturing the wound. Two-chamber devices are installed within an hour, and three- and four-chamber devices - up to 3-4 hours. The surgical intervention is performed under local anesthesia, so the patient does not experience discomfort.

Where is a pacemaker placed?

The installation of the medical device for maintaining the heart rhythm is carried out under the collarbone. The choice of this area is explained by the fact that the wires coming out of the pacemaker are placed through the subclavian vein into the heart.

The electrodes may be inserted through a vein at the base of the neck or in the shoulder. The surgeon inserts the electrode into the correct chamber, then checks its position with an X-ray machine and secures it in place.

At the next stage, the installed wire is connected to the pacemaker body and the device is sewn into the prepared space between the skin and the chest muscle. At the final stage, the stimulation of heart contractions is checked and the wound is sutured.

Contraindications to the procedure

The absence of justified indications for pacemaker implantation is the main contraindication to pacemaker installation. In medical practice, there are several controversial cases when implantation of the device may be unnecessary:

• First degree atrioventricular block without clinical manifestations.
• Atrioventricular proximal block of the second degree type I without clinical symptoms.
• Regressive atrioventricular block. May develop due to medications.

In order to minimize the risk of an unnecessary operation, the patient is prescribed Holter monitoring. Round-the-clock monitoring of the heart rate and analysis of the data obtained allow us to make a final conclusion about the need for an artificial pacemaker.

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Contraindications by age

The pacemaker implantation surgery has no age contraindications. The device can be implanted at any age, i.e. both in infants and in the elderly. Restrictions arise when there is a high risk of rejection of the device.

Poor survival of the pacemaker is possible with an autoimmune reaction of the body. In this case, our immune system perceives the implant as a foreign body and begins to attack it. Such reactions occur in 2-8% of cases, but more often in elderly patients.

As for the possibility of developing purulent, infectious and other complications. Their occurrence is in no way related to the age or gender of the patient. Such consequences occur with a weakened immune system or violation of safety precautions during the installation of the device.

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Contraindications after installation

As with any surgical intervention, after the installation of the pacemaker, the patient will face a number of restrictions. Most contraindications are temporary, let's consider them:

• Excessive physical activity.
• Any hazardous activities.
• Magnetic resonance imaging.
• Staying close to metal detectors and power lines for a long time.
• Undergoing shock wave lithotripsy without adjusting pacemaker settings.
• Electrocoagulation of tissues during operations without changing the pacemaker stimulation mode.
• Carrying a mobile phone close to the heart.

Compliance with the above recommendations allows you to avoid premature failure of the device or the development of complications due to incorrect operation of the implant.

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Consequences after the procedure

Consequences and treatment after the installation of a pacemaker read here

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Complications after the procedure

Implantation of an artificial pacemaker is the only chance to maintain cardiac activity in some diseases. But in rare cases, the installation of an ECS results in serious complications. The main causes of postoperative problems include:

• Asynchronous ventricular function.
• Loss of connection between contractions and excitations of the heart sections.
• Lack of coordination between blood ejection into the aorta and peripheral resistance.
• Development of arrhythmia.
• Conduction of impulses from the ventricle to the atrium.

Most often, patients encounter the following complications after implantation of a pacemaker:

1. Hemorrhagic complications. Subcutaneous hemorrhages can develop into serious hematomas. A tense hematoma requires urgent removal. Minimally invasive surgery is performed to remove the thrombus. To prevent further thrombus formation, the patient is given a pressure bandage on the postoperative scar.
2. Electrode displacement is one of the most common complications of surgery. Problems may arise during subclavian vein puncture. Patients often encounter damage to the brachial plexus and puncture of the subclavian artery, pneumothorax, air embolism, and hemothorax.
3. Infectious complications develop in 2% of cases and are usually caused by staphylococcus. To prevent infection, the patient is given intravenous antibiotics. If the infectious process has affected the entire body, then removal of the cardiac pacing system and complex antibiotic therapy are indicated.
4. Ulceration of the skin over the implant. This is a late complication that develops due to a violation of the surgical technique. The problem occurs in the following cases:

• Formation of a tight bed for installation of the pacemaker body.
• Close proximity of the device to the skin surface.
• Body with sharp edges.
• The patient has a thin build.

Thinning and redness of tissue is a sign of a bedsore, and may also indicate secondary infection. Treatment requires changing the location of the device or removing it completely.

5. Venous thrombus – this complication is rare. Subclavian vein thrombosis or pulmonary embolism are possible. Anticoagulant therapy is used for treatment.

To minimize the risk of developing the above-mentioned postoperative complications, comprehensive preparation for surgery is indicated, as well as monitoring the results of implantation during the first year.

Pacemaker rejection

Implantable pacemakers are made of a material that is inert to the human body. This is due to the fact that the immune system perceives the implanted device as a threat to health and begins to attack it. The immune system produces specific autoantibodies against foreign bodies, which leads to rejection of the pacemaker.

To prevent the rejection process, the patient is prepared for implantation and observed in a hospital setting for 10-14 days after the operation. The patient is also prescribed medications that reduce the risk of an unfavorable outcome of treatment.

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Cardiac arrest with a pacemaker

In cases of increased risk of sudden cardiac arrest or serious disturbance of its rhythm, patients are given a pacemaker with a defibrillator function. The device is implanted in case of tachycardia or problems with fibrillation. In this case, the device monitors the heart and, if necessary, stimulates it by sending electrical charges.

An artificial pacemaker is a guarantee that a person will not die from cardiac arrest or the consequences of organ dysfunction. Cardiac arrest with an ECS is possible if the device fails or life-threatening complications arise. That is, the pacemaker itself does not prolong life, but improves its quality.

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Care after the procedure

After the pacemaker implantation surgery, the patient undergoes a rehabilitation course aimed at restoring the normal functioning of the heart muscle and the entire body. Recovery begins from the moment of leaving the intensive care unit, where everyone who has had a pacemaker implanted is placed.

• The patient spends the first 24 hours in a lying position, and the arm on the side where the device was sewn in is immobilized. Painkillers and a number of other medications are prescribed.
• After a day or two, you are allowed to get up and gradually walk around, the arm is still immobilized. If necessary, an anesthetic is administered and the bandage over the wound is changed.
• On the 4th-5th day, the pacemaker's work is checked, and a set of tests is also prescribed to assess the body's condition.
• After 1-2 weeks, the patient is discharged home for further rehabilitation. Before discharge, the bandage and stitches are removed. The postoperative scar should not be wet for 3-5 days. If the wound does not heal well, antibiotics and anti-inflammatory drugs are prescribed.

During discharge, the cardiologist talks to the patient, gives a passport for the installed device, talks about the nuances of its operation and service life. Upon returning home, it is necessary to maintain physical activity, but not to overload the body. A balanced diet rich in vitamins is also recommended.

Rehabilitation after a pacemaker

After implantation of an artificial pacemaker, the patient will undergo a long rehabilitation. Recovery takes from 2 to 8 months. Conventionally, this period is divided into several stages:

1. Postoperative wound care and monitoring of pacemaker function. The patient spends 7-14 days in the hospital, and the first days in intensive care.
2. 2-4 months after the implantation of the device, special exercises, diet and, if necessary, drug therapy are prescribed.
3. After 6 months, the operated area is completely scarred, so restrictions regarding physical activity are lifted.

Patients are also given the same health recommendations that apply to all people with heart disease: diet, moderate activity, and regular check-ups with a cardiologist.

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Service life of a pacemaker

On average, the work of an artificial pacemaker is designed for 7-10 years of work. The exact service life of the pacemaker depends on its model, operating mode, and the functions used. Before the end of work, the device gives a specific signal, which is recorded by a cardiologist during a routine check.

The failed device is replaced with a new one with repeated surgical intervention, since recharging the battery is impossible. The device's battery discharges gradually and is accompanied by the following symptoms:

• Slowing of the heart rate.
• Dizziness and fainting.
• Respiratory failure and shortness of breath.
• Increased fatigue.

In some cases, the pacemaker fails long before the battery runs out. This is possible with the rejection of the pacemaker, infectious and other life-threatening complications.

Pacemaker replacement

The main indication for replacing an artificial pacemaker is the depletion of its battery. However, there are also emergency cases that require the device to be removed:

• Device failure.
• Suppuration of the pacemaker bed.
• Infectious processes near the electrodes or housing.
• Rejection.

The replacement is performed under local anesthesia. The doctor makes an incision and removes the pacemaker body. Then the condition of the electrodes is checked and a new device is connected. After that, the surgeon stitches the wound and sends the patient to the postoperative ward. If the electrodes were replaced, the patient is placed in intensive care for 24 hours.

The cost of replacing a pacemaker is the same as for its initial installation. In some cases, re-implantation is carried out under a quota.

Reviews

Numerous positive reviews about the pacemaker confirm not only the effectiveness, but also the necessity of this device, especially when other treatment methods are unable to restore normal heart function.

Despite the long rehabilitation period, the risk of complications and a number of restrictions that must be followed throughout life, ECS allows you to feel like you are in your body again and enjoy life.

Alternative to a pacemaker

To date, there are no methods for replacing the procedure of implanting an artificial pacemaker. In some diseases, the patient may be offered lifelong drug therapy instead of an ECS. But it is necessary to take into account the health risk, since the pills are toxic.

That is, there is no worthy alternative to a pacemaker that would pass clinical trials and be safe for the body. But despite this, American scientists are developing drugs whose action is aimed at simulating the heart rhythm. If the effectiveness of this project is confirmed, then in the near future gene therapy will make it possible to abandon the surgical implantation of an ECS.