Pacemaker – small device with a big impact

Pacemaker – small device with a big impact

We are now so used to many medical advances that we take their existence for granted: Artificial hip or knee joints, hearing aids or visual aids, and even pacemakers are standard for us today. Here, you can find out exactly what a pacemaker is and when it is used.

What is a pacemaker?

A cardiac pacemaker helps the heart beat in its normal rhythm, i.e., situation-adapted. A modern pacemaker is a little larger than a matchbox, consists of a lithium iodide battery and sophisticated electronics, and is encased in titanium. A pacemaker typically weighs between 20 and 30 grams. It delivers electrical impulses to the heart tissue via one or more thin electrodes that are anchored in the heart to support the heart’s rhythm.

 

What is the heart rhythm?

The heart comprises muscle tissue that sequentially contracts (contracts) in a specific order causing blood to move. We usually feel every regularly occurring contraction as a heartbeat. The forwarding can be felt on the wrist as a pulse. The contraction and heartbeat are usually controlled from a nerve point in the heart called the sinus node. From there, nerve fibres lead to all regions of the heart.

As soon as the sinus node emits a nerve impulse, the nerve fibres cause the various chambers of the heart to contract and relax, allowing the heart to perform its pumping function. However, this pumping function can only be regulated if the nerves that influence the muscle tissue are functioning and react to stress, such as climbing stairs or excitement.

heartbeat irregularities

As people get older, many people develop irregular heartbeats. For example, if the sinus node gives off too few impulses in sick sinus syndrome, the heart rate decreases  ( bradycardia ). But even if the impulse transmission in the nerve tracts is disturbed – for example, due to circulatory disorders or nerve damage – the heart beats irregularly or too infrequently.

For those affected, this can manifest itself in unpleasant palpitations or dizzy spells, which in their most extreme form can lead to unconsciousness (Morgagni-Stokes seizure). Often, however, it “only” leads to an increasingly lower resilience: Every effort, no matter how small, is complex, and you become increasingly flabby and quickly get out of breath.

 

When is a pacemaker used?

A cardiac pacemaker is always needed when the regulation of the patient’s heart rhythm is disrupted, the person affected shows the symptoms mentioned above, or it is to be expected that the irregular heartbeat could result in a life-threatening situation.

Dabei muss geklärt werden, weshalb genau der Herzrhythmus unregelmäßig ist: Arbeitet der Sinusknoten nicht mehr richtig, an welcher Stelle stimmt die Überleitung zu den Nervenfasern nicht oder liegt etwa eine andere Grunderkrankung vor (beispielsweise eine Schilddrüsenfehlfunktion), die den Herzschlag beeinträchtigt?

Auch Medikamente gegen zu hohen Blutdruck oder gegen Herzinsuffizienz können für die Rhythmusstörung verantwortlich sein. Mit dem Langzeit-EKG und verschiedenen anderen Testmethoden können die Nervenfasern stimuliert und ihre Funktion überprüft werden. Sobald die Ursache feststeht, wird der passende Schrittmacher ausgewählt.

Welche Arten von Herzschrittmachern gibt es?

Die Art des Herzschrittmachers, der eingesetzt wird, hängt von der Art der Erkrankung ab. Je nach Rhythmusstörung werden Elektroden eingesetzt, die in einer, zwei oder sogar drei Kammern Impulse abgeben.

Folgende Typen von Herzschrittmachern sind üblich:

  • Einkammerschrittmacher: Hierbei wird eine Elektrode in die rechte Haupt- oder in die Vorkammer des Herzens geführt.
  • Zweikammerschrittmacher: Eine Elektrode führt in die rechte Vorkammer und eine in die rechte Hauptkammer.
  • Dreikammerschrittmacher: Eine Elektrode führt in die rechte Vorkammer, eine in die rechte Hauptkammer sowie eine in die linke Hauptkammer.

There is also a fairly new type of pacemaker, namely so-called  mini pacemakers.  They are significantly smaller and weigh less than other pacemakers, namely only around two grams. They are wireless, but only stimulate one heart chamber. These “single-chamber systems” are therefore used less frequently than other pacemakers, for example in those affected by permanent  atrial fibrillation .

New functions of modern pacemakers

In addition, modern pacemakers use sensors to adapt their frequency to the wearer’s activity: climbing stairs, running, working, and even excitement lead to an increase in the heart rate. Today, every pacemaker can transmit its data telemetrically to a data interface located outside the body, making maintenance and control of the pacemaker relatively easy.

So-called “home monitoring”, which sends data to a terminal outside of check-up appointments and notifies the doctor if there are deviations from normal function, is already possible with some implants today.

 

How is a pacemaker used?

Today, a pacemaker is usually inserted in a short  operation  under local anesthesia. A pocket is prepared in the subcutaneous fatty tissue below the left or right clavicle and the pacemaker unit is placed there. A larger vein runs under the collarbone in which the thin electrode can be advanced to the heart.

Depending on the make, the electrode is screwed into the appropriate place in the heart with a twisting movement or anchored using small barbs. It is then connected to the pacemaker. You can test immediately whether the pacemaker is working properly and sending impulses to the heart. If the model requires two or three electrodes, the same procedure is used with the other electrodes.

How long does a pacemaker last?

While the first implanted pacemaker stopped working after just one day in 1958, the average lifespan of the batteries in modern pacemakers today is six to ten years. Unfortunately, it is not possible to just replace the batteries as they are permanently connected to the device.

Thanks to technical advances, it is possible to check how long the lithium iodide batteries will last during every pacemaker check. Even if the device signals that the power will soon be exhausted, this does not mean that a new device must be used immediately as an emergency. Today’s devices usually continue to work for months without any problems, so that an operation can be well planned.

What does a pacemaker patient have to pay attention to?

After the operation, the pacemaker is programmed to best suit the patient’s needs. The data will be entered into the  pacemaker card  that you will receive after the implantation. Always carry it with you – this way, if there are unclear arrhythmias, you can check exactly whether your little helper is the trigger.

Regardless of whether the pacemaker is inserted, patients with  atrial fibrillation should ideally limit  their  alcohol consumption  . Regular or excessive alcohol consumption has been proven to promote atrial fibrillation.

 

Increase in performance

Many patients notice an improvement in their performance. While you will be physically limited in the first few weeks after the operation due to some pain from the wound, you will later be able to do almost any sport again – although you should avoid martial arts and archery.

Be careful with electronic devices

Since pacemakers do not make any noise, your little additional device will eventually become more and more a matter of course for you. Nevertheless, you should not forget it completely, especially when you are near certain other electronic devices:  magnetic resonance imaging scanners,  which generate a strong electromagnetic field, can influence the function of your pacemaker.

Pacemaker patients should continue to exercise caution when handling the following devices:

  • Cell phones:  Cell phones are generally no longer a problem for pacemaker patients. However, a safe distance of around 15 to 20 centimeters from the pacemaker should always be maintained with a cell phone.
  • Kitchen and household appliances:  Those affected should not be less than 15 to 30 centimeters away from machines such as toasters, stoves or washing machines. If in doubt, you can obtain information about the influence on your pacemaker from the manufacturer’s instructions.
  • Article security systems:  Article security systems that are located in the entrance and exit areas of department stores can also temporarily disrupt the pacemaker. However, this phenomenon rarely occurs.

On the other hand, personal hygiene devices such as shavers, hair dryers or electric toothbrushes are safe for people with pacemakers.

Sources of danger with cardiac pacemakers

Let your doctor inform you about possible sources of danger. Holidays and even plane trips are possible without any problems, but remember your pacemaker ID. In airports, your pacemaker can alert the metal detectors, and your ID will help solve the problem.

Worries about a sudden failure of the device are unnecessary with today’s models. The function of the small but mighty helper is checked during regular follow-up examinations. Enjoy your electronic marvel!

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