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Pacemakers-Restoring Healthy Heart Rhythm

Restoring and Regulating Heart Rhythm with Advanced Cardiac Pacing

Pacemakers are implantable electronic devices used to treat bradyarrhythmias (abnormally slow heart rhythms) and certain types of heart block. These devices help maintain a regular heart rate and ensure optimal cardiac output, significantly improving quality of life and reducing symptoms like fatigue, dizziness, and syncope.

Clinical Indications for Pacemaker Implantation

According to current ACC/AHA/HRS guidelines, pacemakers are indicated in patients with:

  1. Symptomatic bradycardia

  2. Sinus node dysfunction (e.g., sick sinus syndrome)

  3. High-grade AV block (e.g., Mobitz type II, complete heart block)

  4. Chronotropic incompetence

  5. Post-AV nodal ablation for rate control in atrial fibrillation

  6. Certain congenital heart diseases

  7. Bifascicular block with syncope (select cases)

Types of Pacemakers

1. Single-Chamber Pacemaker

  • Typically stimulates either the right atrium or right ventricle.

  • Often used in patients with chronic atrial fibrillation and bradycardia.

2. Dual-Chamber Pacemaker

  • Coordinates electrical impulses between the atrium and ventricle.

  • Maintains AV synchrony; preferred in sinus node disease with AV block.

3. Biventricular Pacemaker (CRT-P)

  • Used in cardiac resynchronization therapy (CRT) for patients with heart failure and intraventricular conduction delay (e.g., LBBB).

  • Improves systolic function, exercise tolerance, and survival in selected heart failure patients.

4. Leadless Pacemakers

  • Minimally invasive, catheter-delivered device implanted directly into the right ventricle.

  • Ideal for patients without need for atrial pacing or with vascular access challenges.

Implantation Procedure Overview

  1. Performed under local anesthesia with conscious sedation.

  2. Leads are guided through the venous system into the heart chambers (except leadless models).

  3. The generator is implanted subcutaneously, usually in the pectoral region.

  4. Post-procedural monitoring includes telemetry, wound assessment, and pacing threshold testing.

Post-Implantation Follow-Up

  1.   Regular device checks (in-person or remote) to assess:

    • Battery life

    • Lead integrity

    • Pacing thresholds and sensing

  3. Remote monitoring reduces hospital visits and improves early detection of issues.

  4. MRI compatibility should be considered when selecting the device.

Risks and Complications

While generally safe, potential complications include:

  1. Pocket hematoma or infection

  2. Lead dislodgement or fracture

  3. Pneumothorax (rare)

  4. Venous thrombosis

  5. Pacemaker syndrome (in cases of loss of AV synchrony)

  6. Electromagnetic interference (e.g., from MRI, certain tools or equipment)

Pacemakers vs. ICDs

A pacemaker treats bradyarrhythmias by stimulating the heart when it beats too slowly, whereas an Implantable Cardioverter Defibrillator (ICD) monitors for and treats life-threatening tachyarrhythmias (e.g., ventricular tachycardia/fibrillation).

Heart Interventions

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