Assuta Medical Complex has a cardiac surgery center , which hosts a wide range of operations on the heart. One of them is the implantation of a pacemaker.
Even in 2011, MC Assuta received JCI certified to meet international standards. It offers services of highly qualified and experienced surgeons, the excellent level of service. The Center is equipped with advanced diagnostic and treatment equipment.
Pacemaker (synonyms - pacemaker, an artificial pacemaker) is a small device that is implanted into the chest or abdominal cavity with the aim to control irregularities in the heart rhythm.
A pacemaker is used to treat arrhythmia - problems with the rate or rhythm of cardiac contractions. In this state, the heart muscle beats rapidly (tachycardia), Slow (bradycardia) or irregular.
With this issue of authority is not able to function properly - to pump the required blood volume. This causes the following symptoms:
- presyncopal or fainting.
Severe form of arrhythmia is able to cause damage to organs, lead to loss of consciousness or even death.
Pacemaker facilitates a number of symptoms - fatigue and syncope. It also improves the quality of life - allows to renew a person with abnormal rhythms of a more active lifestyle.
Cardiac conduction system
human heart has its own electrical (conductive) system. Discharge originates in the upper body segment and extends to the bottom, it causes the heart to contract and pump blood.
The basis is the sinoatrial node, where an electrical signal, it synchronizes the activity of cells of the organ.
Acronym atria (the upper chambers of the heart) facilitates the movement of blood into the ventricles (lower chambers). Recent reductions pumps blood to the rest of the body. Combined reduce these chambers create a heartbeat.
The principle of operation of the pacemaker
Disruptions to electrical discharges provokes the development of arrhythmias. Pacemakers use low-energy electrical pulses to correct these problems. The device can:
- Increase the speed of the slow rhythm.
- Coordinate abnormal or accelerated rate.
- To control the transmission of signals between the lower chambers of the heart. Pacemakers that do this are known as cardiac resynchronization therapy (CRT). These devices treat heart failure.
- Notify dangerous arrhythmia induced syndrome elongate interval QT.
The apparatus includes a battery, a generator and a computerized wire cable with sensors (electrodes) at the ends. The battery powers a generator. Wires connect the generator to the heart.
How does the pacemaker of the heart?
This device helps to identify and coordinate the body rhythm. The electrodes monitor electrical activity of the heart and transmit the data over the wire to the computer in the generator.
If violations are detected, the computer sends electric shocks to the body. They go over the wire and reach the heart muscles.
Pacemakers can recognize and store information about the electrical activity and rhythm of the heart muscle. Newer models are able to control blood temperature, respiration rate, and a number of other factors. They can also regulate your heart rate when you change the type of activity.
Doctors use this information as much as possible effectively to configure the device. The process computer programming occurs through an external device without requiring direct contact with the pacemaker or the use of needles.
classification of pacemakers
The device can be temporary or permanent. Temporary pacemakers are used for short-term problems - with a slow heartbeat caused by a heart attack, surgery or excessive medication.
They are used in emergency situations. For example, when a physician can implant a permanent pacemaker until a temporary condition persists. In such cases, the patient is in the clinic until the device is placed in the body.
Permanent pacemakers are designed to address long-term problems. In this article, the focus is directed to this type of device.
Doctors also treat arrhythmia by another device implantable cardioverter-defibrillator. It is similar to an artificial pacemaker, but has the ability to create high-energy pulses for the treatment of dangerous arrhythmias.
Pacemakers - a single-chamber, two-chamber and three-chamber
This device has one to three wires, which are arranged in different chambers of the heart.
- Wires single chamber pacemaker usually carry impulses from a generator to the right ventricle.
- In a two-chamber device, the pulses are in the right atrium and right ventricle. Discharges control time reduction.
- The wires in the biventricular pacemaker transmit impulses to the atria and both ventricles. Discharges contribute to the coordination of the electrical signals between the two ventricles. This type of pacemaker is called cardiac resynchronization therapy.
Types of heart pacemakers Programming
There are two basic types of programming the device "on demand" and "partially-adaptive" pacing.
The first option monitors heart rhythm and sends a discharge in the case if the body is beating too slowly or miss a beat.
When partially adaptive elektrokadiostimulyatsii device accelerates or slows the heartbeat in accordance with the activity of a person. To do this, the device monitors the speed of sinus, respiratory, blood temperature and other factors that determine the level of activity.
A doctor at Assuta will work with the patient to determine what type of programming is optimal for a particular application.
Indications for the installation of the pacemaker
Doctors recommend this product for many reasons. The most common:
- Bradycardia - a slow heart rate, not compliance.
- Heart block - a disease in which an electric discharge reduces speed or is broken during the movement through the heart muscle.
The reason for the blockade may be:
- Organ damage due to the attack or other event that destroyed the electrical activity of body;
- nerve and muscle disorders, including muscular dystrophy.
When putting a pacemaker of the heart?
Your doctor may recommend implanting the device in the following situations:
- Aging or heart disease have damaged the ability to create the right sinus rhythm. This leads to slow heartbeat or long pauses between beats. These disorders can cause the body to shift slow or fast rhythms. This condition is called sick sinus syndrome.
- The patient did atrial fibrillation. pacemaker can restore rhythm after the procedure.
- Rights to appoint specific medications for heart health, such as beta-blockers. But they are too slow rhythm.
- The patient observed syncope, or other symptoms of bradycardia. For example, this can happen if the main artery in the neck, supply blood to the brain is sensitive to pressure. A simple twist of the neck can cause a slow heart beat. As a result, the brain does not dopoluchit desired blood volume, causing weakness and collapse.
- In humans, there are disorders of the heart, causing very slow passage of the electric signal for the body. Pacemaker provide cardiac resynchronization therapy CRT (CRT). This device coordinate electric discharges extending between the ventricles. The presence of long QT syndrome increases the risk of dangerous arrhythmias.
In some cases, put a pacemaker in the heart yet?
Doctors in Assuta can recommend this product to people who have certain types of congenital heart disease, or those who have had organ transplants. Children, teenagers and adults can use heart pacemakers - contraindications no age.
However, before you make a decision and make recommendations, your doctor will consider the arrhythmia symptoms - dizziness, unexplained fainting or shortness of breath. Explore the history of the disease, prior therapy (medication), the survey results.
Diagnostics before you install a pacemaker in Assuta
Many tests are used to detect arrhythmias. one or more surveys described below may be conducted.
The electrocardiogram records the electrical activity of the heart muscle; It shows how fast it beats; It recognizes the rhythm, strength and duration of electric discharges that pass through the heart. The test helps to identify bradycardia and heart block (the two main reasons that required pacemaker). However, it has limited functions - captures the heartbeat for only a few seconds, only to diagnose arrhythmias that occur at the time of testing.
For the coming and going of the problems with the heart rhythm using a portable ECG monitor - Holter and event monitor. Holter records for 24-48 hours while it is worn with a. event monitor expands even more possibilities - you can record 1-2 months. Many event monitors have a function - to record the electrical activity only at the symptoms, the person presses the button and starts the device. Or the monitor can be switched on automatically when detects the abnormal heart rhythm.
By using sound waves, echocardiography creates moving images body, visualizing the size and shape of the heart. It determines how chambers and valves are working well.
- the heart, where there is insufficient blood supply;
- zones that are poorly reduced;
- damaged areas of insufficient blood flow.
Electrophysiological examination of the heart (EFI)
In this test, the physician passes through a vein in the groin (the upper part of the thigh) or arm and a thin flexible wire (catheter) to the heart. He fixes the electrical discharges, as well as stimulates the body with them. This makes it possible to reveal the answer to the heart's electrical system to detect the injury.
Certain diseases are easier to find if the heart is functioning actively. During the stress test the patient is trained by forcing the body into overdrive. If the load contraindicated drugs may be used to increase the heart rate.
Installing a pacemaker - like going on?
Pacemaker placement requires a minor surgical procedure. Preoperatively dripper is installed, through which the body goes medicine. Your doctor may also introduce an anesthetic to a place where they will put the pacemaker. More likely to be prescribed antibiotics to prevent infection.
First the doctor in an artery in the shoulder area, opposite the dominant hand, puts a needle to draw the wires of the pacemaker and correctly place them in the heart. The whole procedure is performed under X-ray control. After placing wire doctor will make a small incision in the skin in the chest or abdomen. Pacemaker further comprising the battery and generator is introduced just below the skin, is connected to the wires.
The doctor then checks the operation of the device, and sutures the incision. The whole operation takes only a few hours.