pacemaker information

My Dr. has suggested that I see a Cardiac Physician regarding a pacemake because my heart rate is too low to suit her. If the Cardiac Dr. says I need one, what is the cooperation period involved with this procedure?

4 Comments

Possible pacemaker

by Swedeheart - 2008-04-29 07:04:59

Hello,

I am a pacemaker patient and have mine a grand total of 65 days today! So please bear in mind my thoughts are those of a "newbie"...

First of all I am not sure what you mean by "cooperation" period. The length of the surgery? The length of recovery?

Just a few things I would suggest. I am not sure where "home" is for you... as we have folks from many different countries post here. I live in the US and had my procedure done here. It appears there are some differences depending on where you live, but nothing drastic.

Before you have a pacemaker if it is decided you need one... be sure you see a EP doctor (a Cardiologist who specializes in electrophysiology) and make sure they have done lots and lots of successful implants. It is a little bit of a tricky business and you don't want someone doing surgery in your heart that hasn't had a lot of experience! Here is a link that provides some good basic information from a reliable source on pacemakers and the procedure:
tp://www.clevelandclinic.org/heartcenter/pub/guide/tests/procedures/pacemaker.htm

One of the things that I haven't seen on any of the medical sites is a discussion on placement. Most pacemakers and ICD's are placed under the left collar bone under the skin. Some under muscle. There are other places that they can be placed but some surgeons don't like to go there for whatever reason. The reason I bring this up is that it is a problem for some ~ the placement. For women it sits right under our bra straps and is uncomfortable. For younger folks that are fit and healthy, you can *see* the device under the skin and it does really bother some people as people might look when you are swimming and wonder what it is.... Mine is under the collar bone and is barely visible, my scar even though only 65 days old isn't much either. But I have a little extra padding... and that might account for it.

Recovery time seems to be hugely different for many. So many variables. Age, condition before surgery, any problems during, etc. For me (I am 60) it took me a full 8 weeks before I stopped feeling pretty icky. I still have bouts, but it is getting better. Some folks are very lucky and feel great within a day or two!

The big thing about the pacemaker is the restrictions on lifting your arm for 6 to 8 weeks. You can't lift your arm over your shoulder and you have to be careful of lifting any weight with that arm as well. The doctors will give you a run down on that, but follow it to the letter! If you are a young parent with toddlers, it means you might not be able to pick them up except with the opposite arm. If you are athletic, you may have restrictions on weight lifting, or sporting activities for awhile.

I have "babbled" on about a lot of different things, post again and give us more details of what you are curious about! This is a great forum and very nice folks here. Very helpful.

Good luck, and let us know how you are doing.

Swedeheart

Getting A Pacemaker

by Nim Rod - 2008-04-29 09:04:24

This may provide you with a little additional information on what is involved in getting a pacemaker.

A pacemaker is most often treatment for slow (usually less than 60 bpm) heart beats. Without treatment, a slow heart beat can lead to weakness, confusion, dizziness, fainting, shortness of breath and death.

Slow heart beats can be the result of metabolic abnormalities or occur as a result of blocked arteries to the heart's conduction system. These conditions can often be treated and a normal heart beat will resume. Slow heart beats can also be a side effect of certain medications in which case discontinuation of the medicine or a reduction in dose may correct the problem.

But sometimes, the conduction system of the heart becomes irreversibly damaged for any one of a number of reasons. And some people require medications that cause slow heart beats as a side effect in order to prevent other serious problems. Since there is no medication that one can take on chronic basis to speed up the heart rate, a pacemaker is the only solution.

Fortunately, having a pacemaker implanted is only a minor surgical procedure. This is not open heart surgery. After a pacemaker is implanted, most people resume their previous lifestyle with little or no limitations.

The procedure is performed with mild sedation and a local anesthetic. Patients are usually not put to sleep. An 2 inch incision is made parallel to and just below a collar bone. Pacer wires are then inserted into a vein that lies just under the collarbone and advanced through that vein under fluoroscopic guidance into the heart. The other end of the pacer wires are connected to a "generator" that is implanted under the skin beneath the collar bone. This generator is about half an inch deep and one and a half inches wide. The skin is then sutured closed and the patient leaves the hospital later than same day or the following day. Incisional pain is mild and transient and usually responds to Tylenol. It is possible to feel the pacer generator under the skin and a slight deformaty of the skin can be visually noticed.

Patients may not shower for a week after the procedure to keep the incision dry and should avoid excessively exerting the arm on the side the pacer was placed for that week.

After a week, the patient may resume their prior lifestyle without limitation. Household appliances do not interfere with modern day pacemakers. However, cellular phones may-especially digital cell phones. These should be kept 12 inches away from the pacemaker when on-preferably at the ear on the opposite side of the pacemaker. Never leave the cell phone in a pocket overlying the pacemaker.

Patients with pacemakers should avoid powerful electromagnetic fields which may reprogram the pacemaker. MRI (magnetic resonance imaging) scans cannot be performed on patients with pacemakers for that reason.

The pacemaker generator contains a lithium battery and what is, essentially, a little computer. The generator can communicate with an external device placed on the skin overlying the pacemaker. Through this device, a physician can change the programming of the pacemaker to best suit the individual patient's needs and investigate the status of the pacemaker. Some pacemakers also report on the performance of the patient's heart.

Pacemakers can also be checked over the telephone. The patient places a device and a magnet over the pacemaker and the pacemaker transmits a signal over phone line that is analyzed in the physicians office.

Pacemaker batteries give off warning signals when they are running low on power many months before they actually fail. This can be detected either by a telephone check or by a formal interrogation by the external device mentioned above. Pacemakers are generally checked at least every 3 months to allow plenty of time to change the generator when it is running low on power. Changing the generator simply means remaking the same incision, removing the old generator, and plugging the existing wires into the new generator. The patient goes home the same day. Most batteries last at least 5 years.

Pacemakers sense every heart beat the patient has and only pace the heart when the patient's heart rate falls below a predetermined limit. Patients are usually completely unaware of when the pacer is pacing their heart. In some patients, the pacemaker only needs to fire very rarely because the slow heart beat only occurs intermittently. In other patients, the heart beat is always too slow and the pacemaker has to pace the heart all of the time. Such patients are said to be pacemaker dependent.

Another use of pacemakers is for a disease called hypertrophic obstructive cardiomyopathy. This is a disease where overgrown heart muscle blocks the egress of blood out of the heart. By altering the electrical activation pattern of the heart's muscle, pacemakers can help alleviate this problem.

A special type of pacemaker that stimulates both the left and right ventricles of the heart simultaneously ( a biventricular pacemaker) can reduce symptoms and the need to be rehospitalized in heart failure patients with weak heart muscle who demonstrate slow electrical conduction through the ventricles on their ECG. This is known as cardiac resynchronization therapy. Thses pacemakers are usually combined with implantable defibrillators. Because these pacemakers are specifically designed for patients with heart failure, they may also come with a monitor to detect the amount of fluid in the lungs or the strength of contraction of the heart muscle.

It depends

by ElectricFrank - 2008-04-30 01:04:37

Part of the decision process and recovery depends on your nature. If you are the worrisome type you will want one if there is any chance you might need it. Recovery will take longer because you will be constantly worried that you will damage it.

On the other hand if you are more the "go for it type" you may hold off longer because you aren't having any problems and it is only the cardiologist that is concerned. You will probably get active much faster.
These observations are not to put anyone down for either approach. It is important to honor our nature.

So as far as recovery time as an example I spent one night in the hospital (only because my implant was late in the afternoon), came home the next morning and walked 2 miles, followed by 3 miles/day after that. The cardio said to limit my arm lift for 3-6 weeks so I went back to normal activity around 3 weeks and just didn't do any heaviy stretches. I've had no physical problems with leads or the site, only programming issues.

I would say that this is nearly the feasible recovery time, and it can range on up to years if a person either has a poor job of surgery or has an underlying heart problem that would limit them pacer or not.

Hope this helps,

frank

SEE EP!

by sweetkozy - 2008-04-30 03:04:55

All I have to add is....

See an EP doc FIRST!!!!..... If one is available...... Then go from there. Good Luck and keep us informed!

Cheers :)
Jenny

You know you're wired when...

Your device makes you win at the slot machines.

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