Pacemaker. What is it, photos, views, how it works, how much it costs, the installation operation is set, life with him

Pacemaker - a device, the driver of an artificial heart rate, which is implanted in heart disease related to violation of the frequency of its beats. Absolute indications for its installation are diseases such as bradycardia with clinical symptoms asystole length of more than 3 sec., with bradyarrhythmias heart rate below 60 beats min.

Pacemaker - what is it?

Pacemaker - it is a device that regulates the heart rate. When the tackle it normalizes heart cardiac activity by generating electrical pulses.

It represents a unit consisting of:

• batteryPlaced in a sealed housing c titanium coating. He is sewn under the skin in the upper chest. Its dimensions of 5-10 cm, the weight of not more than '50 Titanium alloy reduces the risk of rejection of the device to a minimum.
• chipAlso built into the body, which is responsible for the analysis and control of heart rate.
• electrodes (Electro-catheters) placed in a heart chamber and coupled to the battery. They conduct electrical discharges to certain areas of the heart. The number of the electrodes ranges from 1 to 3 depending on the type of device.

Jobs battery is designed for a period of 5 to 15 years. Routine body replacement occurs in the range of from 3 to 12 years, depending on the period for which the device is intended operation. The operation is performed under local anesthesia. The procedure lasts 15-20 minutes, the patient is discharged after a maximum of 2 days.

The electrodes are placed in the chambers of the heart do not usually need to be replaced and connected to the new body. Monitoring visits to the doctor, to determine the state of human health and the quality of the device operation, performed 1 time in 2-12 months. Frequency counter depends on the type of pacemaker model and battery capacity elapsed time after the operation.

As the device interacts with the heart?

Pacemaker - it is a device that operates according to certain principles. In order to normalize the functioning of the myocardium, certain areas of the heart with the help of electro-catheters are sent electrical impulses. Early models of devices operate in a continuous mode, current pulses are sent continuously.

Upgraded types of devices in the normal heartbeat, are in standby mode, from which they come with rhythm disturbances of the heart beat. If for some time program myocardium begins to fall in the right rhythm, the device goes into active mode. Electroimpulses it restores normal heart function (work required).

On some models of pacemakers (pacemaker, pacemaker) present tracking mode.

It allows you to collect data on the functioning of the heart, to keep track of such violations as:

• ventricular fibrillation;
• atrial flutter;
• atrial fibrillation.

The collected information is sent to doctors for analysis. Charge batteries on the sensors of this type will be consumed faster.

whether the work is felt pacemaker?

Immediately after the operation a large proportion of patients experiencing an unpleasant feeling from the unit operates at its active mode.

They are perceived as a person:

• feeling the buzz in the chest;
• vibration;
• twitching and contraction of the chest;

Feelings may increase during sleep when the patient is lying on its side. Instrument operation can be felt during active physical exertion or emotional experiences. Within 2 months of gradual habituation to the sensor and the discomfort disappears.

Variety of pacemakers and special modes of operation

Pacemaker - it is a device that can have several modes of operation. C 1974 accepted coding marking devices of 3-5 letters.

Their designations:

letter 1	letter 2	letter 3	letter 4	letter 5
It indicates a heart chamber to be subjected to stimulation.	sensitivity function. It indicates which camera. analyzed stimulant.	Reaction type pacemaker to received data on the activity of the analyzed cells.	Indicates the type of pacemaker settings.	A multi-stimulation of the myocardium. Feature that allows you to stop an attack of tachyarrhythmia conduct defibrillation or cardioversion.
A - Atrium (Atrium). V - ventricle (Ventricle). D - atrium to ventricle (Dual).	A - atrium. V - ventricle. D - atrium to ventricle. About - lack of sensitivity function.	I - blocking pulse generator (Inhibition). T - start pulse generator (Triggering). D - blocking and run (Dual). O - no reaction.	R - the ability to increase or decrease the pulse frequency when changing the motor activity (Rate-adaptive).	Oh - no function in the device. A, V, D - the presence of the second electrode.

Common stimulation modes:

VVI	AAI	VVIR	AAIR	DDD	DDDR
1-chamber, ventricular, demand.	1-chamber, atrial, demand.	1-ventricular chamber, on demand, with a frequency adaptation.	1-atrial chamber, on demand, with a frequency adaptation.	2-chamber atrioventricular biocontrolled.	2-chamber atrioventricular biocontrolled with frequency adaptation.

Pacemakers constant wear separated by zones of influence.

1-chamber pacemaker

Pacemaker with electro-catheter 1, which is mounted in the atrium or ventricle. Early models were generated pulses in the asynchronous mode, the time, the programmed rate reductions. Modern 1-chamber stimulators work on demand.

Their drawback is that the atrial and ventricular contractions may occasionally coincide in this case, the blood from the ventricle falls into the atrium and in the heart of Vienna.

Implantation of devices with only one electrode is shown at constant atrial fibrillation and sick sinus syndrome (SSS). In other cases the preferred pacemaker electrode with the amount of 2 or above.

2-chamber pacemaker

When this model pacemaker to the heart is strengthened 2 electrode. When such stimulation ventricular and atrial rhythms are coordinated, preserved saline pace heartbeat, ensuring proper blood flow to the heart, blood vessels completely filled with blood and comfort patient.

Common attachment of electrodes:

• in the atrium and in the ventricle (atrioventricular stimulation);
• in the eye of the right atrium and in the coronary (coronary) heart sinus (biatrialnaya stimulation);

In the 2-chamber pacemaker may be present function of frequency adaptation. The marking is denoted by the letter R. You can change the pacing frequency, duration programmed atrioventricular delay.

Pacemakers with frequency adaptation will allow to do sports such as swimming, jogging. However, additional options the machine lead to shorter battery operation. However, additional options the machine lead to shorter battery operation.

2-chamber pacemaker implanted with:

• pathology deceleration and rapid heart rate;
• bradycardia pulse to below 40 beats / min.;
• severe disorders of the contractile function of the myocardium during physical activity;
• carotid sinus syndrome;
• atrioventricular (AV) block and from 2 degrees above;

3-chamber pacemaker

Apparatuses with 3 electrodes, stimulate cardiac card 3 (atria and two ventricles). Stimulation occurs in a certain sequence, providing natural movement of blood through the heart chambers. Instrument configuration allows operating in mode 1 or 2-chamber pacemaker.

Often, the pacemaker has a touch sensor and a frequency adjustment function. The sensors take readings of the respiratory rate, the nervous activity processes, patient temperature. Based on these data, selects the optimum mode of the pacemaker.

The sensor is implanted at:

• Heart disorders (resynchronization).
• Dyssynchrony of cardiac chambers in the background bradyarrhythmias or severe bradycardia.
• Rigidity sinus rhythm provoked depletion of reserves of the body.

A temporary pacemaker

To prevent deaths in violation of cardiac rhythm in a medical practice, a temporary pacemaker.

It is set at:

• Myocardial infarction.
• Arrhythmia.
• When right ventricular infarction and uncoordinated reduction of the atria and ventricles.
• Absolute blockade.
• In type I atrial flutter.
• Supraventricular tachycardia involving the AV node and sustained monomorphic ventricular tachycardia.
• Slow heart rate in conjunction with the faintness.
• Ventricular tachycardia, bradycardia, and against the background of other life-threatening disorders.

The device is installed physician - resuscitation. Methods for installing the device:

endocardial	The first fixed central vein catheter and has therethrough electrodes carried into heart chambers. To exclude pneumothorax (accumulation of air in the pleural cavity) is performed x-rays to a patient. Setting the electrode is time consuming and requires the presence of trained professionals, but this method is considered the most effective.
transesophageal	The electrode is inserted into the esophagus and is set therein at the level of the atria. The method is not effective for AV block.
Transkatoralny (outer)	The electrode is mounted outside the chest. The method is used as a prophylaxis for a probability proarrhythmic complication or as an emergency measure in critical situations. When this method is used a long and powerful pulses of electrical current (200 mA), which delivers to the patient severe pain. Cardiac pacing is performed after anesthesia or immersing the patient in a sedative state.

pacemaker defibrillator

Pacemakers of this type are designed to identify and eliminate ventricular fibrillation, which is 5% end-death. In normal mode, the device monitors the heartbeat and normalizes it. When an arrhythmia device generates a low energy level, restore a normal heart rhythm.

Once the attack is removed, the unit switches to monitoring mode.

Sensors implanted in the following diseases:

• Congenital heart disease.
• Heart attacks that damage the heart's electrical system.
• Long QT syndrome.
• Brugarda syndrome.
• Sudden cardiac arrest, and the risk of its recurrence.

Indications and contraindications for installation

Pacemaker - this is such a device, which may be delayed implantation in a patient in connection with:

• Acute infectious and viral diseases.
• Acute course of chronic diseases.
• A mental disorder in an acute period.

Setting strict limits pacemaker has not. Prior to implantation of the device doctor decides on the validity of this procedure.

Indications appliance sewing can be divided into:

absolute	relative
Episodes ECG asystole longer than three seconds. The recorded heart rate with exercise, in less than 40 minutes. Three-beam branch block blockade system. AV blockade II degree on the background of symptomatic bradycardia.	III degree AV block with heart rate at a load of over 40 beats. / Min., Without clinical manifestations. The presence of 2- and 3-beam blockages without ventricular tachycardias and transverse blockades accompanied syncope. AV block type 2 and II extent in the absence of clinical manifestations.

When the existence of absolute indications for pacemaker installation, contraindications no longer be taken into account. stimulator implantation procedure is carried out as planned or emergency. If the relative readings for the installation of pacemaker surgery decision is taken individually, taking into account the physical condition of the patient.

Examination before installation

Pacemaker such a device before installing that requires a thorough examination of the patient. This minimizes risks, and reduces the likelihood of postoperative complications. Patient before surgery can be assigned to the following diagnostic tests.

Compulsory:

• Ultrasound of the heart.
• ECG.
• Daily Holter monitoring.

Additional tests:

• ECG under load.
• Chest X-rays.
• Coronary angiography.
• Doppler (Doppler ultrasound) brachiocephalic arteries.
• Electrophysiological examination of the heart (EFI).

Analyzes appointed before installing a stimulator:

• Complete blood and urine analysis.
• HIV.
• Hepatitis B and C.
• Syphilis.

How is the operation of the pacemaker implantation?

The surgery is performed in the X-operating with the full consciousness of the patient. He is cauterized in the collarbone area. After incision of the skin and subclavian veins administered electrode which is then carefully advanced to the heart. spetselektroda movement is tracked by X-ray.

To find the optimal location fix electro-catheter is ECG after each possible attachment points. Further wire is fixed in one of the chambers of the heart. If there are additional electrodes all manipulations are repeated through the same incision.

In the interior of the chest muscles, forming a bed, body EX fits into it. Vessels and the skin is sewn on the cut point is superimposed aseptic bandage. The operation lasts 40 minutes to 2.5 hours. Its duration depends on the number of electro-catheter apparatus for

Features of operation at different ages

The operation to install the pacemaker is performed the same way for people of all ages.

However, due to age-related changes in the body of the elderly has several features:

• It can be increased the dosage of painkillers, because people after 55 years of reduced pain threshold.
• In view of the fragility of the tissue, the surgeon needs more attention, not to pierce through the heart wall.
• In old age, the muscles tend to fatty degeneration, sclerosis - replacement of muscle tissue in the connective and fatty. This leads to an increase in the threshold of stimulation and increase the strength of electrical impulses needed for the heart muscle contraction. If the fabric is in place securing sclerotic electrode, battery power will be consumed faster pacemaker.

The postoperative period

Recovery after surgery in a hospital takes 4 to 10 days. In the first days after surgery, in the place of the cut will be saved the pain, which analgesics are removed.

Possible postoperative complications:

• Swelling and bruising in the operated area.
• Hemorrhagic complications.
• Infectious complications.
• The air in the pleural cavity.
• Occlusion of blood vessels and consequently poor circulation.

Postoperative complications occur in less than 5% of cases.

How to determine the correct operation of the pacemaker?

The first check administered 2 days after surgery. When violations of the heart or the possibility of their development do retest after 15 days. After discharge, the stimulator is checked after 1 month. Further there are routine checks with the period of 1 to 2 times a month for 3-7 years.

Further checks are increasing up to 1 month, the remaining battery reserve is taken to control.

When the diagnosis is used:

• Electrocardiograph. On the ECG data measured by coronary blood flow and rhythm of the spontaneous contractions.
• Apparatus for programming the stimulator chip, used to adjust the settings.
• Meter pulse duration, stimulus frequency analyzer verified as occurs perception signals from the heart and a pacemaker output pulse, heart rate is analyzed.
• Using the determined radiographing position of the electrode.
• The residual capacity of the battery checked by a special magnet.

In the absence of these devices can not work accurately estimate the vehicle. doctors recommend home use wrist heart rate monitor and focus on your own well-being.

Rehabilitation

The first days after the operation you need to restrict your homework, if there is a feeling of fatigue or discomfort should stop and rest. Weight lifting 2 kg may trigger divergence postoperative sutures. The load on the upper part of the body is prohibited within 1-3 months.

Banned dramatic show of hands upward and outward. During this period permitted only therapeutic exercises recommended by your doctor. Required to comply with the recommendations of physicians for postoperative wound care. It can not be wet, ripped off the sores. If the rehabilitation proceeds without complications after 5 days after surgery, you can take a warm shower.

Complications in the long term

The risk of complications after prolonged use of the pacemaker is not more than 7%.

The list of possible complications:

• Pastoznost upper limb from the pacemaker installed.
• Fatigue under loads.
• Systemic infection.
• Offset Cardiosensor a bed.
• Inflammation and suppuration in the box.
• The displacement of the electro-catheter and inflammation at the site of their contiguity to the tissues of the heart.
• Deep vein thrombosis.

Living with a pacemaker

When implanting a permanent pacemaker is required for life to observe a number of restrictions and medical advice.

Limitations in daily life

• You can not expose to direct sunlight land area of ​​the body with the implanted device, it should be covered.
• Do not stand near an electrical substation, power lines and cables.
• It is not necessary to approach the satellite antenna, the TV tower, radar stations.
• Do not pass through metal detectors.
• Do not perform the types of work-related muscular tension of the upper body - portering, cutting firewood.
• It is necessary to avoid strikes, the pressure attributable to the operated area. Do not attempt to move the instrument by hand.

The use of household appliances, electronics, tools,

• Should become a habit that touch electrical appliances, sockets, wires hand side which is a pacemaker - can not.
• Use only grounded and insulated power tools. Phones, microwave ovens, audio players, in any mode, should be located at a distance of not less than 0.3 m from the pacemaker.
• Should refrain from working with vibrating tools - hammer, lawn mower, drill.

Physical education and sport with a pacemaker

After a rehabilitation period, patients were allowed to moderate exercise. Traumatic, contact and active sports are not allowed.

Prohibited	allowed	Limited
Trampolines.	Walking.	Ski run.
Sambo, judo and karate.	Yoga.	Volleyball.
Parachuting.	Classes in the pool.	Towns, baseball.
Weightlifting.	Pilates.	Shooting.

Restrictions on

After the surgery the patient may be assigned disability group II-III.

Prohibited activities:

• Welder (minimum distance from the welding machine 61 cm).
• heaver
• Electrician and electrical engineer.

Prohibited medical procedures

Before you perform any medical procedure should consult a doctor beforehand.

Strictly prohibited manipulation:

• electrophoresis
• Warming.
• Magnetic resonance imaging
• magnetotherapy

Lifetime of the device

Pacemaker operating time will depend on:

• battery capacity;
• modes of operation of the pacemaker;

If there defibrillation pacemaker function, removal of heart rates, body temperature, the life of the battery expires soon. The average use of the instrument is designed for 7-10 years.

Replacing components of the pacemaker or

When approaching deadline work battery device on a planned trip giving a signal. After that, the body pacemaker must be replaced. This operation in the absence of complications lasts 20-40 min. Electrodes in their normal working condition are usually left.

Replacement electrodes required in the following cases:

• Inflammatory processes in the place of the wire attachment.
• Their deployment and mechanical damage.

In this case, the doctor decides to disconnect the old mine and remove it, or leave and enter a new one. At the same time in the heart, without disrupting its function, it can be up to 5 electrodes. At operation with replacement of electro-catheters and housings requires 1.5 to 2.5 hours.

How much is the installation of the device

unit cost of pacemaker dependent on the model and manufacturer. Most budget pacemakers manufactured in Russia. The most common surgery for pacemaker implantation are carried out under the quota and under the MLA Program.

Approximate cost for vehicles of different models and their installation:

Model	Cost, rub.
EX Prospect in Russia
1-chamber without frequency adjustment, without mode on demand	10500-2500
1-chamber with a frequency adaptation function mode on demand	25000-55000
2-chamber	80000-25000
3-chamber	250,000
EX import pr-va
1-chamber with a frequency adaptation function mode on demand	80000-100000
2-chamber	160000- 450000
3-chamber	by 450000
An electrode, made in Russian	1500
Electrode imported pr-va	from 2500
Pacemaker implantation without the cost of the device and electrodes
1-chamber	20000
2-chamber	26000
3-chamber	31000
Implantation of pacing complete with electrodes and sheath
Biventricular, the delivery system	514500
DR with frequency adaptation	326000
DDD without frequency adaptation	210000

Pacemaker - a device that will improve the quality of life and prolong it. The need for such operations determines the cardiologist-arrhythmology. He picks up the model and the machine mode for each individual patient.

Useful video of pacemakers, their types and rules of operation

Indications for pacemaker implantation:

Pacemaker and Sports: