Dr Swapnil Mate Cardiologist

Methods Of Pacing

The types of pacing include:-

PERCUSSIVE PACING - is the method in which a closed fist on the left lower edge of the breastbone over the right ventricle in the vena cava( two large veins that return deoxygenated blood to the heart), to induce a beat from the ventricles.
TRANSCUTANEOUS PACING - is the method that is used to stabilize bradycardias of all types bradycardia. This is a term used to describe slow heart rate, which is when the heart rate is at 60 beats per minute. Even though it does not affect the individual, it causes symptoms like weakness, fatigue, sweating, when the rate drops below 40. This method includes placing two pacing pada on the anterior/posterior position of the patient's chest. The doctor or the rescuer selects the pacing rate and increases the pacing current until electrical capture with a corresponding pulse is received.
EPICARDIAL PACING - is the method that is used, if, during open-heart surgery, an atrioventricular block occurs.
TRANSVENOUS PACING - this method is used in replacement to the transcutaneous pacing, where a pacemaker wire is placed in a vein and passed either into the right atrium or right ventricle, This is then connected to a pacemaker located outside the body.
PERMANENT TRANSVENOUS PACING - this procedure involves attaching one or more pacing electrodes within a heart chamber while the pacemaker is inserted under the left collarbone.
LEADLESS PACING - is the procedure in which attachment of pacing leads is not required. Leadless pacemakers are small, therefore, allowing generators to be placed within the heart.
BIVENTRICULAR PACING - in this method, IV lines are inserted into the major vein that feeds your heart(superior vena cava). Then, CRT wires will be inserted into the vein. If the CRT wires are in the right place and working, then the doctor will attach them to the pacemaker, which will be placed through the incision under your skin.

Types Of Permanent Pacemakers

Types of pacemakers include:-

In this device, only one pacing lead is placed either in the upper chambers or lower chambers of the heart.

In this device, two pacing leads are placed, one in the atrium and one in the ventricle. This method resembles the natural pacing of the heart.

In this device, three pacing leads are placed, one in the atrium and two in both the ventricles(lower heart chambers).

In this device, sensors are present to check the heart's physical activity.

In this device, there are no pacing leads. This makes the device small which allows the generator to be placed into the heart

Who Needs A Pacemaker?

A pacemaker is needed by those individuals who :-

Are suffering from heart failure. Congestive cardiac failure can take place when the heart has completely lost its ability to pump blood to other organs of the body. Heart failure results in developing excess fluid in and around the lungs, coughing blood, shortness of breath, swelling of the abdomen, legs, and ankles. Even though in some situations, a heart attack can be cured by restoring blood supply to the heart muscle, in the case of heart failure, the only treatment is replacing the heart or installing an artificial pacemaker which might help the heart to function well.
Are suffering from Arrhythmia. Arrhythmia is a condition referring to abnormalities in heartbeats due to issues in the electrical conduction system of the heart. When the heart beats too slow, it is known as bradycardia, and when beats too fast, it is known as tachycardia. In some cases, arrhythmia arises with no symptoms. Symptoms, if present, may include shortness of breath, palpitations, chest pain, sensing a pause between heartbeats, blackouts, etc. In a few situations, it may even lead to heart failure or sudden cardiac death.
Are suffering from cardiomyopathy. In cardiomyopathy, blood flow to the heart muscle is restricted, which makes the heart muscle work harder, to the limit where it enlarges and stiffens, causing the death of the tissues of the muscle. Cardiomyopathy is one of the main causes of a heart attack or heart failure.
Are suffering from bradycardia. This term is used to describe slow heart rate, which is when the heart rate is at 60 beats per minute. Even though it does not affect the individual, it causes symptoms like weakness, fatigue, sweating, when the rate drops below 40.
Are suffering from sick sinus syndrome, which is caused due to malfunction in the primary pacemaker of the heart, the sinus node.

What TO Expect Before The Procedure

Before the procedure :

The physician will do a thorough physical examination of you. Physical examination includes blood pressure test, triglyceride test, coronary calcium scan to check calcium deposits in the coronary arteries, checking the rhythm of the heartbeat. The examiner might ask for any unusual changes that might have occurred in your body. This helps the examiner to analyze your medical history. They also analyze the patient's condition by checking the individual's height and weight. Doctors or nurse practitioners or an assistant of a physician do certain tests to analyze the condition or disease and recommend proper instructions respectively.
You should do certain tests before you come to the physician for your treatment. Some tests include electrocardiography which detects the minute changes that take place as a result of the contraction and relaxation of the cardiac muscle, echocardiogram, where a device called a transducer is used to show the live image of the heart. Test reports of intravascular ultrasound can also be asked for, where a catheter instead of a transducer to capture the images of coronary arteries. This helps the specialists to see whether the blood flow is obstructed or not.
The physician will ask you to not take certain medicines like aspirin, anti-inflammatory drugs, or blood thinners before the procedure. You need to mention the medicines that you have been given by your doctor, to the physician.
You should not eat or drink six to eight hours before the procedure.
If you have valvular disorders or any kind of cardiovascular disease, report this to your physician.
Gather all the medicines that have been approved by the physician and make necessary arrangements for your transportation since you won't be able to drive by yourself immediately after the treatment is over.

What TO Expect During The Procedure

The pacemaker procedure is carried out in a room called Pacemaker Lab. During the procedure:-

Fluids and medicines will be given to relax your body. Anticoagulants might also be given through an intravenous catheter inserted in your arm, or hand.
The doctor will numb the area where the CRT device has to be inserted. It usually is the area that is just under your left collar bone(clavicle).
Throughout the procedure, your heart rate, blood pressure will be monitored.
The doctor will insert IV lines into the major vein that feeds your heart(superior vena cava). Then, One end of the CRT wires will be inserted into the vein. X-rays will be taken to see their appropriate position.
Once the wires are at the appropriate place, electrodes will be attached to the cardiac muscle. The other end will be connected to the pulse generator.
After the wires and the generator are connected, the generator is then implanted under the skin near the collarbone. Its mechanism will be monitored through the electrocardiography monitor.

What TO Expect After The Procedure

After the procedure

Your blood pressure and heart rate will be checked.
You should try walking slowly so that you do not face any dizziness.
Medicines like painkillers will be given if you feel any pain or swelling at the insertion site.
Ask the cardiologist or the cardiac nurses about certain restrictions and precautions that you have to maintain, like not engaging in vigorous activities or not lifting any heavy object, avoiding going near devices that function under a strong magnetic field, avoid long-term exposure to metal detectors.
After you are discharged and return home, you can resume your normal activities
Try wearing loose-fitting clothes to reduce irritation in the insertion site.
You have to visit your doctor every 6 months to check whether the device is working efficiently or not.
If you experience fever, a feeling that the generator is loose, a carcinogenic shock, palpitations, give a call to a nearby hospital.

The faculty of Dr. Swapnil Mate's Cardiology clinic includes experienced cardiologists, cardiac surgeons, cardiac imaging specialists, a preventive cardiology team, experienced pediatric cardiac surgeons and assisting surgeons, physical therapists, nutritionists, geneticists, child-life specialists, a multidisciplinary interventional cardiology team, and a group of pathologists who run by tests and give the proper cause of diseases. The cardiologists and surgeons recommend the ideal surgery to the patients. They mention the advantages and risks associated with the surgeries they plan to do on them. Together, they provide services that cater to their needs. Consult Dr. Swapnil Mate for the best medical assistance.

About Pacemaker