PACEMAKER and ICD TREATMENTS

• The heart is different from other organs with its natural pacemaker (sinus node), which has the ability to generate its own electrical impulses, and its unique conduction system (AV node and his purkinje system), which carries the impulses from it to all cells of the heart. With this unique electrical structure, the contraction of the heart muscle is ensured, the blood needed by the whole body is pumped and the oxygen needs of the organs are met. In case of problems in any part of this unique structure, the electrical impulse sufficient for the contraction of the heart muscle cannot be generated, and the contraction of the heart muscle will be disrupted and cause serious health problems. Pacemakers are used in the treatment of problems that occur in the heart’s stimulus system or the electrical transmission system that transmits the stimulus. Pacemakers consist of two main parts, the “generator” and the “electrode”. The generator is the main casing of the pacemaker and while providing the energy needed; electrodes or cables provide interaction and communication between the pacemaker generator and the heart. Pacemakers may have one or more electrodes depending on the type of battery. Some pacemakers have a special shock delivery feature to treat rhythm disorders. There are 3 different types of pacemakers according to the disease and patient groups they are used for.Pacemaker Implantable Cardioverter Defibrillators (ICD- pluggable defibrillators )

  Cardiac Resynchronization Therapy or Implantable Cardioverter Defibrillators (CRT-P, CRT-D)

  Why Is a Permanent Pacemaker Needed?

  When the heart cannot produce enough stimulation due to a problem that occurs in the sinus node, which is the natural pacemaker of the heart, or due to disruptions in the station (AV node) between the atria and ventricles responsible for the transmission of the stimulus, or due to interruptions in the conduction system (his purkinje system), the heartbeat slows down and becomes unable to meet the body’s needs. income. As a result, patients present with weakness, fatigue, dizziness and sometimes fainting. Pacemakers are devices that are inserted to correct these problems. By both creating a stimulus and transmitting the stimulus to the heart cavities, it prevents the heart rate from falling and ensures that the needs of the body are met.

   

  Why Is a Implantable Cardioverter Defibrillator (ICD) Needed?

   

  Disturbances in the heart’s electrical system do not always cause the heart to slow down. Sometimes, damage to the electrical system can cause dangerous and deadly rhythm problems. By causing the heart to work very fast, they prevent the heart from functioning and can progress to cardiac arrest within minutes. In this case, if the patient is lucky, if he can reach a health institution or an ambulance, he is brought back to life by applying electroshock. But unfortunately, not everyone can be so lucky and some patients die because of these rhythm problems. These wearable Implantable Cardioverter Defibrillators (ICD) have the feature of recognizing the rhythm problem and giving shock when the patients have this dangerous rhythm problem at home, and they save the lives of the patients. Since the probability of seeing these dangerous rhythm problems is higher in patients with previous heart failure and heart attack, these Implantable Cardioverter Defibrillators (ICD) can be inserted for precautionary purposes without any rhythm problems as a precaution when certain criteria are met. Implantable Cardioverter Defibrillators also treat low heart rate because they act as a pacemaker.

   

  Why Is a Cardiac Resynchronization Therapy (CRT) Needed?

   

  Pacemakers with this feature are used in patients with heart failure and who have lost the synchronized movement of their heart muscles due to damage to the electrical system of the heart. (The patient group with cardiac functions, EF <35%, left bundle branch block LBBB detected in electrography and conduction time >150 msec benefit most). In these patients, apart from the normal pacemaker cables attached to the right ventricle and right atrium of the heart, a third cable is placed on the outer surface of the left ventricle of the heart through a venous system called the coronary sinus through the right ventricle of the heart, allowing the right and left ventricles of the heart to move simultaneously. After a successful application in this way, heart muscle functions of heart failure patients recover over time and their functional capacities also increase.

   

  How is a Pacemaker Implants?

   

  Pacemakers are inserted by heart rhythm specialists (cardiac electrophysiologists) all over the world in angio-catheter laboratories, under operating room conditions, in accordance with operating room rules, sometimes under local anesthesia and sometimes under sedation (sleep state). Unfortunately, since there are not enough heart rhythm specialists in our country, it is also worn by experienced cardiologists. Usually, a small incision is made in the left chest area (the left side is preferred unless there is a special situation), and a pocket is created in which the generator of the pacemaker can be placed. The size of the pocket varies according to the type of pacemaker. Afterwards, long tubes are placed in the venous system (subclavian vein), which takes the dirty blood from the left side through this pocket to the heart. Cables are placed in the chambers of the heart through these tubes. When a single-cable battery is inserted, only the right ventricle is placed, while in two-cable batteries, the right auricle is placed, and in three-cable batteries, both the right atrium and left ventricle are placed. Afterwards, the cable or cables are connected to the generator of the battery and the whole system is placed in the pocket opened in the left chest area and the process is terminated.

   

  What Are the Risks That May Occur During the Implatation of a Pacemaker?

   

  There are some risks during the insertion of a pacemaker, as with any operation. These risks are minimized when performed by experienced centers and experienced rhythm experts. Major risks:

   

  Injury of lung tissue and accumulation of air around the pleura (pneumothorax)

   

  Accumulation of blood around the heart (pericardial effusion-tamponad)

   

  Disconnection of attached cables

   

  Infection

  Blood Clot

   

  The occurrence of a life-threatening situation is almost negligible during the insertion of a pacemaker. The most feared complication is infection. Because even in the slightest suspicion of infection, the entire system should be removed and a new pacemaker should be inserted after 4-6 weeks of antibiotic treatment. For this reason, it is necessary to provide operating room conditions and antibiotic treatment before and after the procedure when a pacemaker is inserted.

   

  What should be considered after a pacemaker treatment?

   

  Wound control is performed in the first week after the pacemaker is inserted. Afterwards, the pacemaker and its cables are checked in the first month, and then the patient is called every 6 months. Depending on the type of pacemaker and how much the patient uses the pacemaker, the lifespan of pacemakers varies between 6-12 years.

   

  Things to consider immediately after the pacemaker is inserted and within the first 3-6 months;

   

  Healing of the incision site where the battery is inserted and returning to our daily life is actually within 10-15 days in most cases. But we need to pay attention to the things mentioned so that the cables of the battery, which is installed in the first month, are not dislodged. In the first 10 days, care should be taken to make the wound dressing regularly and to keep the procedure area sterile. In particular, we need to stay away from activities that will make us sweat. Since the wound is stitched aesthetically, there will be no need to take stitches and the stitches will dissolve on their own.

   

  In the first 4-6 weeks, large movements will not be made and weight will not be lifted with the arm on the side that is attached.

   

  Do not lie on the side where the battery is inserted for a month.

   

  There are a lot of people wondering about the effect of mobile phone carrying, driving and the effects of detectors after the pacemaker is inserted:

   

  Patients with a pacemaker can use a mobile phone, but it is recommended not to carry it closer than 15 cm and to talk to the ear on the side where the pacemaker is not installed.

  Driving is not recommended within 15 days – 1 month after the battery is inserted. However, after the healing process is completed, the car can be used again with the approval of the doctor.

   

  Hand-held metal detectors and x-rays may very rarely cause changes in pacemaker settings. For this reason, they should ensure that the patients are manually checked by telling the officer that they have a pacemaker while passing through places with security units such as airports and shopping centers. Metal detectors should be kept at least 15 cm from the pacemaker. However, the latest batteries are quite safe in this regard. There is little to no interaction. Therefore, even if our patients pass through metal detectors absentmindedly, they should not panic, the interaction is less than one in a million. In such cases, our patients are recommended to come for control and have their battery settings checked again.

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