Artificially Keeping The Pace—Advances in Cardiac Pacemakers
Imagine suffering from shortness of breath, dizziness, fainting spells or chest pain that could suggest arrhythmias, or changes from the normal sequence of electrical impulses that coordinate your heartbeat. Each year, 3 million Americans are diagnosed with heart arrhythmias. Many more suffer in silence, unaware of the medical anomaly deep within their chest that may or may not surface in the future causing physical symptoms needing therapeutic intervention.
While not all types of arrhythmias are serious, some can be deadly. In fact, ventricular fibrillation that occurs when the heart beats rapidly with erratic electrical impulses (without pumping blood) can be fatal within minutes. Blood pressure drops suddenly, starving vital organs, a pulse and respiration are no longer detectable or possible, and the body will collapse within seconds of this cardiac event.
The Advent of The Pacemaker
Fortunately, some 60+ years ago, one University of Buffalo professor’s happy accident lead to the discovery of the first pacing device, designed to stimulate the heart muscle to contract and pump blood.
The heart muscle is comprised of four chambers, two atria (upper chambers) and two ventricles (lower chambers). The muscle is divided into a right and left side, and is responsible for pumping some 2000 gallons of blood throughout the body each day. This is necessary to irrigate every organ and bring oxygen to tissues. So that the blood is collected and pumped, the heart depends on electrical pulses, passed from high to low cavities.
These pulses start with the sinus node, which is also known as the natural pacemaker. Then, the sinus node coordinates contractions and gives rhythm to the heart. The pulses pass from the high to low cavities in a specific order, which then contract. This contraction is called the beating of the heart. At rest, a healthy heart beats between 60 and 80 strokes per minute, 100,000 times a day. During physical exercise or stress, the body has a greater need for oxygen and strokes per minute change.
There are many reasons a physician may see the need for an artificial pacemaker in some individuals. The most common involve bradycardia and heart block, however. Bradycardia occurs when the heart beats slower than normal. Heart block involves a disrupted or slow electrical signal as it moves through the heart. Both cause dysregulation of the heart’s natural pace, causing insufficient blood flow and oxygen to the body.
How The Pacemaker Works
A pacemaker works to monitor and control an individual’s heart beat through a battery operated, computerized generator connected to sensors and leads, placed within the heart. These sensors detect abnormal heart rhythms and communicate with the computer, which then directs the generator to release the correct electrical pulses (through the leads) that the heart needs for specific activities and stress levels. Newer pacemakers also monitor blood pressure, breathing, and other physical functions that can be recorded and reported to physicians later.
Advanced Technology in Pacing Devices
Newer pacemakers can be programmed to respond to an individual’s specific needs, can be surgically implanted in as little as 1 hour and weigh about 1 ounce. A minor medical procedure will allow for placement of the leads into specific areas of the heart, and the stitching of the actual pacemaker under a flap of skin on the left side of the body. This is done while conscious, under local anesthesia.
Recently the U.S. Food and Drug Administration (FDA) approved what may be the smallest, most advanced pacing system to date, at just one-tenth the size of a traditional pacemaker. The University of Utah Health Care implanted the first “leadless pacemaker” directly into the heart via catheter just this last June 2016. The Micra Transcatheter Pacing System (TPS) is no bigger than a standard vitamin capsule, does not require leads of any kind, and is cosmetically invisible, as it does not require surgical placement through a skin pocket below the collarbone, like most pacemakers.
Important Safety Concerns
After the placement of a pacemaker it is important to always tell your doctor if:
The incision becomes red, warm, swollen, or purulent.
You have a fever, dizziness, chest pain, and prolonged fatigue.
In addition, during the first 5 days of implantation, you should avoid sudden and large movements with the shoulder.
After the operation, you will have a first meeting to follow up with your doctor.
The electrical functions of your pacemaker will be tested.
The stimulation parameters will be adjusted according to your needs.
Programming is done with an external programmer only.
You will have an average of one every 6 months exam.
At each visit, the state of the battery and pacing thresholds will be tested.
Living with a pacemaker
Gradually, you will return to normal life.
But follow these instructions:
Take medications prescribed by your doctor
Check your pulse regularly
Go to appointments check your pacemaker
Keep on your pacemaker identification card as well at home and in travel
With a pacemaker, you will live normally
You can continue your usual activities, such as gardening, cleaning, driving
You may shower, bathe or swim
After consultation with your doctor, you can resume your hobbies, do sports, and have a normal sexual activity
If you do not feel well, contact your doctor
Pacemakers are of course protected against the influences of electrical devices. If you are next to an electric system and you experience symptoms such as rapid heart rate, irregular stimulations or discomfort, move away from the system and switch off immediately
You can still use:
- TV, hairdryer radio, electric shavers
- washing machines, vacuum cleaners, microwave ovens
- office equipment, computers, telex, electrical appliances in the kitchen.
- Caution: Ensure that all electrical appliances are in good working condition.
- The phone is not restricted. For mobile phone, talk to your doctor. To prevent possible interference, place the handset against the ear that is opposite to the location of your pacemaker.
- It is very important to check with your doctor the following activities:
- working with heavy equipment with strong vibrations (pneumatic drill, for example)
- use of firearms (hunting, for example)
- electrical systems to significant electromagnetic field or high voltage lines electric welding (welding machine)
In general, travel by plane, train or car is not a problem for pacemakers. You can travel by car, by boat, but check with your doctor if there are constraints related to remoteness.
Tell your doctor when you travel. It will give you the address clinics and hospitals close to your final destination.
If you go by plane, inform the security staff and show your pacemakers book. The staff will give you the necessary instructions to security check.
Traveling by car is not a problem. For your own safety, buckle up, your pacemaker will not be disturbed.
Appointment with your doctor
Before any treatment, tell your doctor, dentist and other specialist you have a pacemaker.
The following interventions are inconsequential:
Mammography or sonography
Warning: In the case of special procedures such as radiation, lithotripsy, transcutaneous electrical nerve stimulation (TENS), MRI or electrical cauterization, a prior detailed analysis will be performed in the presence of your cardiologist.
Hundreds of thousands of people throughout the world live longer, happier, more active lives with the support of cardiac pacing devices. Hidden from view, always at work, these medical miracles regulate the heart when our bodies fail to do so naturally.
1″About Arrhythmia”. Heart.Org, 2017, http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/About-Arrhythmia_UCM_002010_Article.jsp#.WPqat2U4mb-.
2″How Does A Pacemaker Work? – NHLBI, NIH”. Nhlbi.Nih.Gov, 2017, https://www.nhlbi.nih.gov/health/health-topics/topics/pace/howdoes.
3″Internal Pacemaker – Jacobs School Of Medicine And Biomedical Sciences – University At Buffalo”. Medicine.Buffalo.Edu, 2017, https://medicine.buffalo.edu/research/research_highlights.host.html/content/shared/smbs/research_highlights/pacemaker.detail.html.
4″Heart Pacemaker: Medlineplus Medical Encyclopedia”. Medlineplus.Gov, 2017, https://medlineplus.gov/ency/article/007369.htm.
5″University Of Utah Health Care Offers World’s Smallest Pacemaker”. Healthcare.Utah.Edu, 2017, https://healthcare.utah.edu/publicaffairs/news/2016/07/micra.release.php.
6″Ventricular Fibrillation – Mayo Clinic”. Mayo Clinic, 2017, http://www.mayoclinic.org/diseases-conditions/ventricular-fibrillation/basics/definition/con-20034473.
7″Who Needs A Pacemaker? – NHLBI, NIH”. Nhlbi.Nih.Gov, 2017, https://www.nhlbi.nih.gov/health/health-topics/topics/pace/whoneeds.