The pacemaker to the right of the sternum feel impulses. Indications for the installation of a cardiac pacemaker and possible contraindications. What are the types of pacemakers

Pacemakers. What it is? Classification of pacemakers. Specifications and care of the device

Thanks

What is a pacemaker and why is it needed?

When is a patient given a pacemaker?

Most often, a pacemaker is implanted for the following problems:

• Bradycardia. Bradycardia is a decrease in heart rate that can occur for various reasons. It should be noted that in this case all parts of the heart muscle contract in the correct order. It's just less likely to produce an impulse that stimulates contraction. Because of this, the blood is generally worse pumped through the body. If the cause of bradycardia cannot be identified and eliminated, the patient is implanted with a pacemaker that will constantly maintain the heart rate within the normal range.
• Asystole. Asystole is the absence of heart contractions for a certain amount of time. If an electrocardiographic study ( ECG) found episodes of asystole lasting 3 seconds or more, this is an indication for the installation of a pacemaker.
• Low heart rate ( heart rate) under load. important research in cardiology is the removal of the ECG during exercise. Normally, the heart rate increases in response to exercise. If this does not happen, it is believed that the heart is not able to cover the body's increasing needs for oxygen, and the patient is better off with a pacemaker.
• Atrioventricular block. Atrioventricular block is called complete or partial blocking of impulses in the node between the atria and ventricles. As a result, the chambers of the heart lose the rhythm of contractions, and the volume of pumped blood decreases. Not all atrioventricular blockades are an indication for the installation of a pacemaker. The decision in each individual case is made by the attending physician.

The use of pacemakers at different ages ( in children, adolescents, etc.)

Parents of children with an implanted pacemaker need to pay attention to the following features:

• Full bathing of the child is possible only after complete healing postoperative scar. Prior to this, only rubbing or washing is possible without water entering the implantation area of ​​the body.
• A small child must be constantly monitored, as the body can slightly lift the skin. Children, out of curiosity, often begin to move the device under the skin, which may cause malfunctions.
• The presence of a pacemaker in a child excludes contact sports. The possibility of visiting various sections should be discussed with the attending physician. In any case, section leaders and coaches must be informed that the child has a pacemaker.
• The implanted device is not a contraindication for visiting kindergarten or schools. However, educators and teachers should be aware of this and look after the child.
• Also, the presence of a pacemaker is not absolute contraindication for routine vaccination. However, for the first time after the implantation of the device, it is better not to vaccinate. This is not due to the presence of a pacemaker, but to the surgical intervention itself, after which the body must recover. If necessary, children make an individual calendar for vaccination.
• Psycho-emotional upbringing of a child is also a very responsible task. Many children develop complexes as they get older. It is important to teach the child all the precautions and develop the right habits. After that, the children are explained that they can live a full life and are no different from other children.

Currently, new, more compact models of pacemakers are being developed, which will greatly facilitate operations in childhood.

What are the pros and cons of installing a permanent pacemaker?

Pros and cons of a permanent pacemaker

How to choose the best pacemaker?

In general, when choosing a pacemaker, pay attention to the following features of the device:

• device type ( single chamber, double chamber, etc.);
• electrode configurations;
• electrode fixation mechanism;
• type of insulating material;
• the place of implantation of the body;
• battery capacity;
• device cost, etc.

Types and types of pacemakers

Most often, pacemakers are classified according to the area of ​​stimulation. AT this case The patient himself cannot choose the device, and the attending physician helps him in this. The most convenient devices with a long service life ( good battery) and the possibility of non-contact setting of the operating mode. In most pacemaker clinics, the patient can familiarize himself with the differences between different models and consult a specialist.

Classification of pacemakers

According to the principle of use, pacemakers can be divided into the following categories:

• Temporary. Temporary pacemakers are commonly used in intensive care units. The electrodes are brought to the heart, but the body of the device is not implanted. Thus, the rhythm is maintained for a relatively short time until the doctors fix the problem.
• Permanent. Permanent pacemakers are implanted for a long time ( 5 - 10 years or more). They, in turn, have their own classification.
• Other types of pacing. Other types include, for example, transesophageal pacemakers, when using which the electrode is inserted into the esophagus for a while, and not brought to the heart muscle through the vessels. External pacing through the chest wall is also possible. According to the mechanism, such devices are close to defibrillators and are rarely used in practice.

According to the number of electrodes, models of permanent pacemakers are classified as follows:

• Single chamber. They have one electrode in one chamber of the heart, where rhythm disturbances are noted.
• Two-chamber. Two electrodes are applied to two sections of the heart muscle ( usually in two chambers of the heart). These devices provide a more efficient pumping of blood.
• Three-chamber. Three electrodes are brought to the heart, capable of fully regulating the rhythm of contractions. These models are usually equipped with a large number of additional features.
• Four-chamber. Models with four electrodes are rarely used and only for special indications.

Temporary and permanent pacemakers

Differences between temporary and permanent pacemakers

Single chamber

Single chamber pacemakers are sometimes used in patients with persistent atrial fibrillation. Also, this type can be implanted in case of weakness syndrome. sinus node (SSSU). The best option there will be a frequency adapted model that is able to regulate the frequency itself. A fixed frequency imposes serious restrictions on physical activity and creates certain threats of complications.

Double chamber

A dual chamber pacemaker is indicated for the following disorders:

• bradycardia with Morgagni-Adams-Stokes syndrome;
• incomplete atrioventricular block ( 2 or 3 degrees);
• lack of an adequate response of the heart to physical activity;
• carotid sinus syndrome;
• sick sinus syndrome not always);
• some other violations of the rhythm and conduction function of the myocardium.

Three-chamber

Three-chamber pacemakers are considered the most functional options for patients. Modern models not only have frequency adaptation, but also a number of special sensors that respond to changes vital signs. So the device can regulate the heart rate depending on body temperature, respiratory rate or natural nervous regulation ( for example, in a state of psycho-emotional arousal). In addition, a three-chamber pacemaker can be equipped with a cardioverter-defibrillator. The wide range of features of three-chamber models increases their cost compared to dual-chamber or single-chamber pacemakers.

Four-chamber

Cardioverter-defibrillator ( resynchronization therapy)

As a rule, cardioverter-defibrillators need to be changed more often, as their battery drains faster. Their average service life is 5-7 years. Precautions in Everyday life almost identical to those in patients with a conventional pacemaker. It should also be noted that a person with an implanted defibrillator does not “shock”. Even at the moment of discharge, you can touch it, and the other person will practically not feel anything.

transesophageal

The use of a transesophageal pacemaker has the following advantages:

• the procedure is non-invasive, that is, unlike other internal or external pacemakers, no surgery is required;
• the risk of complications is minimal, since the procedure is not traumatic and does not take much time;
• the effectiveness of myocardial stimulation with the correct insertion of the probe-electrode into the esophagus is practically the same as with other methods of pacing;
• the procedure can be used both to eliminate acute arrhythmias and for diagnostic purposes;
• after the procedure, the natural rhythm of the heart quickly returns to normal;
• the cost of transesophageal pacing is lower than with conventional pacing.

epicardial

An epicardial pacemaker has the following advantages:

• The device is installed through a small incision in the intercostal space, that is, injuries during the operation are minimized.
• The body is attached inside the chest, and not under the skin, therefore it is less susceptible to mechanical stress ( displacement, shock, etc.).
• The absence of electrodes supplied through the vessels reduces the risk of blood clots and maintains full blood flow.
• The device is convenient to use in pediatric cardiology, since in small children the diameter of the vessels is smaller, and the supply of electrodes of conventional pacemakers can block their lumen.

Wireless pacemaker

So far, the implantation of wireless models has been approved only for certain types of conduction disorders ( for example, some patients with atrial fibrillation). In addition, it is still very difficult to find clinics that perform such operations. However, as this technology advances, wireless pacemakers will gradually replace obsolete models.

What is a rate adaptive pacemaker?

Outdoor ( temporary) pacemakers

External pacing has the following features:

• requires special equipment;
• cannot be held for a long time;
• the muscles of the heart contract together with the muscles of the trunk ( chest wall) between the electrodes;
• associated with quite strong pain sensations;
• it is desirable to give the patient sedatives or painkillers before the procedure;
• has less efficiency in restoring heart rate);
• usually performed outside the hospital when absolutely necessary.

A more common version of an external pacemaker is a temporary device, which, in principle, does not differ much from an implanted one in terms of the mechanism of action. Electrodes are also placed in the heart ( through the central veins), stimulating certain parts of the heart muscle. However, the body of an external pacemaker is not implanted under the skin, but remains outside.

A patient with such a device is in the intensive care unit. The heart rate is artificially regulated until the normal functioning of the heart is restored. For example, after a heart attack, the heart muscle is damaged due to temporary interruptions in blood circulation in the coronary vessels ( vessels of the heart). Until the damage is repaired, serious rhythm disturbances can occur. The patient is fitted with an external pacemaker, which will eliminate this symptom. As blood circulation is restored, muscle work returns to normal, and the need for artificial stimulation disappears. If the damage does not repair, the external pacemaker is simply replaced with a permanent implanted device.

The use of an external pacemaker carries certain risks. An open wound constantly remains in the skin, through which the electrode in the heart is connected to the body from the outside. In this way, the infection can get directly into the bloodstream, which is fraught with very serious complications. In addition, there is a high risk of accidental displacement of the electrodes. That is why patients with temporary external pacemakers are in intensive care, where the catheter insertion site is looked after daily and the heart function is checked using an ECG.

Technical parameters, characteristics and care of pacemakers

Any model of an implantable pacemaker has standard modes of operation, which can go astray under certain conditions.
If necessary, the operating mode of the device can be changed. In modern devices, this is done remotely using special equipment.

When setting a specific pacer mode highest value have the following specifications:

• Frequency of impulse generation. Models without frequency response work in rhythm, prescribed by doctors when installing. This is an important characteristic, since the speed of pumping blood through the body depends on the heart rate. It should not be too high so as not to give an extra load on the heart muscle, but at the same time, it should cover the needs of the body. Frequency adaptive models change the frequency as needed, but also within predetermined limits.
• The strength of the generated impulse. For effective excitation of the heart muscle and its full contraction, the optimal strength of the generated impulse must be selected. It is largely individual and depends on the sensitivity of muscle cells ( excitability). Too weak an impulse will result in the pacemaker not stabilizing the heart. In some patients, as the underlying disease progresses, changes in the structure of the heart muscle may occur. Because of this, the susceptibility to impulses decreases, and you have to turn to a specialist who reprograms the device and increases the strength of the supplied discharges.
• frequency adaptation. With frequency adaptation, the pacemaker is equipped with special detectors that record the work of the heart and the needs of the body. Models with this function are much more convenient to use. The pacemaker can, for example, be turned on only when needed, which saves battery power and increases the life of the device.
• Possibility of cardioversion. Some models are equipped with a built-in defibrillator that can start the heart automatically in case of a stop or stabilize the rhythm in case of severe failures.

How pacemakers work

The heart is a hollow muscular organ that pumps blood around the body. Due to the consistent contraction of muscles in the walls of the four sections ( cameras) of the heart and the coordinated work of the valves, the blood flow is constantly directed to the necessary vessels. Proper muscle contraction is provided by the so-called conduction system. These are special cells in the walls of the heart that are able to quickly spread an electrical impulse. There are also a number of cells responsible for generating this impulse.

Normally, the work of the heart is reduced to the following phenomena:

• The bioelectric impulse arises in special nodes - sinoatrial and atrioventricular.
• The impulse propagates along the bundles and fibers of the conducting system located in the walls of the heart.
• Under the action of an impulse, the sections of the heart muscle contract sequentially, distilling blood from one chamber to another.
• After the contraction, the so-called repolarization phase begins. The muscle cells relax and the chamber refills with blood.
• The reverse flow of blood is prevented by valves located at the border of the transition from one cavity to another.

The principle of operation of the pacemaker of any model is as follows. The device generates electrical impulses with a given frequency and a certain strength, which suppress the natural bioelectrical activity of the heart. These impulses control the contraction of the heart muscle, making it work properly. Thus, the heart functions normally in various pathologies. A pacemaker is simply indispensable for people who have problems with the development and distribution of impulses in a natural way.

What are the modes of operation of the pacemaker?

At the moment, there is a special mode encoding, which is used mainly by specialists in this field. It consists of three, four or five letters ( depending on the model of the device and the system adopted in the country).

The mode code contains the following information:

• the chamber or chambers of the heart that the machine stimulates;
• the chamber or chambers of the heart that the machine detects;
• availability of frequency adaptation;
• muscle response to an incoming impulse;
• parameters of the cardioverter-defibrillator ( if provided).

Service life of pacemakers how often should the battery be changed)

The life of a pacemaker depends on the following factors:

• Device type. The type of device and its mode of operation largely determine the rate of battery depletion. If the pacemaker is continuously running after surgery, the battery will drain evenly and relatively quickly. "Smart" devices turn on only when necessary, as they themselves monitor the rhythm of the heart. Thus, in sleep mode, the battery is almost not discharged, and the overall service life of the device is greatly increased. In addition, some pacemakers "record" the heart's rhythm and store it. This also increases energy costs and can generally shorten the life of the instrument.
• Battery Type. Various models of pacemakers use different sources nutrition. Each type of battery has its own estimated service life, "energy reserve", due to its design and technical characteristics. Of course, models with more powerful batteries will last longer.
• Patient's diagnosis. The patient's diseases also have a certain influence on the life of the pacemaker. If pacing of multiple heart chambers is needed, the machine will work harder and the battery will run out faster. If there is no need for continuous stimulation, and problems occur only occasionally, energy consumption is slower.
• Complications. The reason for the urgent replacement of the pacemaker can be various complications. Sometimes they appear in the first days or weeks after implantation, and sometimes after a few years. Quite often, an inflammatory process develops in the subcutaneous bed, where the body of the device is installed. AT severe cases this forces doctors to urgently remove or replace the pacemaker, even though its useful life has not actually expired. The cause of such a complication may be infection during surgery or displacement of the body under the skin.
• Unforeseen disruptions. Some external factors can affect pacemaker performance ( e.g. strong magnetic field). In rare cases, this leads to serious malfunctions, and the device has to be replaced or reconfigured.
• some critical conditions. As a result of injury or exacerbation various diseases The patient may need emergency medical care. If the pacemaker complicates access during surgery or interferes with the provision of assistance, it will be removed ( Of course, with all the precautions).

Do I need to repeat the operation to replace the battery ( battery) pacemaker?

Do electrodes need to be replaced over time?

Is it possible to program and reprogram a pacemaker at home?

Checking and reprogramming the pacemaker is not done at home for the following reasons:

• Special equipment. In principle, equipment for checking and adjusting pacemakers is not too bulky and can be delivered to the patient's home. However, the entire set of devices for all possible cases transport still fails. The hospital will also have equipment if necessary to check the position of the electrodes ( x-ray, echocardiograph, etc.) or other additional options.
• Lack of specialists. Not all clinics and cardiology departments have specialists and equipment for testing and adjusting pacemakers. home visit ( even though it is theoretically possible) is done extremely rarely, as it does not allow to cover a large number of patients.
• risk of complications. In principle, checking and reprogramming are not dangerous manipulations. However, in rare cases, the machine or the patient's heart may not respond adequately to external influences (for example, checking the battery charge is done using a special magnet). Rhythm failures in this case would theoretically endanger the life of the patient if this happens at home. The hospital always has doctors and equipment to provide first aid and reduce the risk of any complications.

Does the pacemaker make any sounds during operation?

The number of operations to install a pacemaker is steadily growing every year, and the technique of surgical interventions is also being improved. If even 10 years ago pacemakers had rather impressive dimensions and thickness, today models no larger than the cap of a ballpoint pen have been developed. More than 3,000,000 people live on the globe after the installation of the EX-, and not just live, but enjoy the newly opened opportunities: ride a bike, lead an active lifestyle, walk without shortness of breath and heartbeat.

The pacemaker in many cases saves the lives of patients, and also returns its meaning, opening up possibilities that people with severe heart damage have forgotten to think about. The article is devoted detailed analysis, what is a pacemaker, who is indicated for its implantation, how is the operation to install the device, and also what contraindications does the installation of a pacemaker have.

1 Excursion in history

In less than 70 years since the development of the first portable pacemaker, the pacing industry has made a huge leap in its development. The end of the 1950s and the beginning of the 1960s were the “golden years” in pacing, since during these years a portable pacemaker was developed and the first implantation of a pacemaker was made. The first portable device was large and also dependent on external electricity. This was his huge minus - he was connected to the outlet, and if there were power outages, the device immediately turned off.

In 1957, a 3-hour power outage led to the death of a child with a pacemaker. It was obvious that the device needed improvement, and within a few years, scientists developed a fully portable portable stimulator that was attached to the human body. In 1958, a pacemaker was implanted for the first time, the device itself was located in the abdominal wall, and the electrodes directly in the heart muscle.

Every decade, the electrodes and the "stuffing" of the devices, their appearance was improved: in the 70s, a lithium battery was created, due to which the service life of the devices increased significantly, two-chamber EKS were created, which made it possible to stimulate all the heart chambers - both the atria and the ventricles . In the 1990s, pacemakers with a microprocessor were created. It became possible to store information about the rhythm and frequency of contractions of the patient's heart, the stimulator not only “set” the rhythm itself, but could adapt to the human body, only correcting cardiac work.

The 2000s were marked by a new discovery - biventricular pacing became possible in severe heart failure. Thanks to this discovery, the contractility of the heart has significantly improved, as well as the survival of patients. In a word, the pacemaker from the middle of the twentieth century to the present day has gone through many stages in its development, thanks to the discoveries of doctors, scientists, and physicists. Thanks to their discoveries, millions of people today live more fulfilling and happier lives.

2 The device of a modern device

The pacemaker is also called an artificial pacemaker, because it is he who "sets" the pace of the heart. How does a modern heart pacemaker work? The main elements of the device:

3 Who is shown the installation?

When does a person need to install an artificial pacemaker? In cases where the patient's heart is not capable of independently generating impulses at the desired frequency, in order to ensure full contractile activity and normal heart rate. Indications for the installation of a pacemaker are the following conditions:

1. Decreased heart rate to 40 or less with clinical symptoms: dizziness, loss of consciousness.
2. Severe heart block and conduction disorders
3. Attacks of paroxysmal tachycardia, which are not subject to medical treatment
4. Episodes of asystole more than 3 seconds recorded on the cardiogram
5. Ventricular tachycardias are severe, life-threatening fibrillations refractory to drug therapy
6. Severe manifestations of heart failure.

Most often, the stimulator is installed for bradyarrhythmias, when the patient has low heart rate blockades develop - conduction disturbances. Such conditions are often accompanied by a clinic - episodes of Morgani-Adams-Stokes. With such an attack, the patient suddenly turns pale and loses consciousness, he is unconscious from 2 seconds to 1 minute, less often 2 minutes. Fainting is associated with a sharp decrease in blood flow due to disruption of the heart. Usually, consciousness after an attack is completely restored, the neurological status does not suffer, the patient after the resolution of the attack feels a slight weakness, fatigue. Any arrhythmia accompanied by such a clinic is an indication for the installation of a pacemaker.

4 Operation and life after it

Currently, the operation is performed under local anesthesia. An anesthetic is injected into the skin and underlying tissues, a small incision is made in the subclavian region, and the doctor inserts electrodes through the subclavian vein into the heart chamber. The device itself is implanted under the collarbone. The electrodes are connected to the device, the required mode is set. Today there are many stimulation modes, the device can work constantly and “impose” its fixed rhythm on the heart, or turn on “on demand”.

Demand mode is popular for frequently recurring blackouts. The pacemaker works when the spontaneous heart rate falls below the level set by the program, if the "native" heart rate is above this heart rate level, the pacemaker turns off. Complications after surgery are rare, they occur in 3-4% of cases. Thrombosis, infection in the wound, fractures of the electrodes, disturbances in their work, as well as malfunctions of the device can be observed.

In order to prevent the development of complications after pacemaker implantation, patients should be observed by a cardiologist, as well as 1-2 times a year by a cardiac surgeon, ECG monitoring is necessary. About 1.5 months are required for reliable encapsulation of the electrode head in the tissue, about 2 months are required for the patient's psychological adaptation to the device.

It is allowed to start work after the operation in 5-8 weeks, not earlier. Patients with a heart pacemaker are contraindicated in work with exposure to magnetic fields, microwave fields, work with electrolytes, in vibration conditions, and significant physical exertion. Such patients should not undergo MRI, use physiotherapeutic methods of treatment so as not to disrupt the operation of the device, linger for a long time near metal detectors, and place a mobile phone in the immediate vicinity of the stimulator.

You can talk on a mobile phone, but place it near your ear on the side opposite to the one on which the stimulator is implanted. Watching TV, using an electric shaver, a microwave oven is not forbidden, but you must be at a distance of 15-30 cm from the source. In general, apart from minor limitations, life with a pacemaker is not much different from life ordinary person.

5 When is a pacemaker banned?

There are no absolute contraindications to the installation of EKS. To date, there are no age restrictions during the operation, as well as some diseases in which the setting of the pacemaker is not possible, for patients even with acute infarction, according to the indications, a pacemaker can be installed. Sometimes implantation of the device can be delayed if necessary. For example, during exacerbation chronic diseases(asthma, bronchitis, gastric ulcer), acute infectious diseases, fever. Under such conditions, the risk of complications after surgery increases.

Pacemakers. Lifestyle after pacemaker implantation. Where to install a pacemaker?

Thanks

Lifestyle of a patient with a pacemaker

The attending physician introduces the patient with the basic restrictions and rules of life with a pacemaker.
Many clinics where implantation is performed also give out special brochures and leaflets that contain the most important information. In practice, the patient gradually gets used to and lives normal life. The risk of serious complications with any impact on a modern pacemaker is extremely small. The devices are equipped with multi-stage protection, and even the magnetic field that knocked down the mode in older models is more of a theoretical danger these days. In most cases, negligence can lead to material costs - a second operation, replacement of the apparatus or a short course of treatment.

Does a pacemaker affect the course of pregnancy and is it possible to give birth with it?

In general, women with an implanted pacemaker should do the following:

• Before implanting the device, it is better to notify the doctors that the patient would like to have children in the future. This may affect the choice of machine model.
• Before conceiving a child, it is better to consult with the attending cardiologist, who will check the condition of the device and conduct necessary examinations. In some cases, it may be necessary to first replace the batteries or the entire device ( not to do it during pregnancy).
• To monitor the course of pregnancy, you should choose a competent specialist who agrees to manage such a difficult patient. In practice, many doctors simply do not want to take risks and refer patients to other specialists.
• If you experience any unusual symptoms ( not only from the heart) it is better to contact your doctor immediately, as complications can be very diverse.
• Before giving birth, additional examinations should be taken, and a cardiologist is often invited to the birth itself, which helps to monitor the patient's condition.

Of particular difficulty are situations when a patient needs to install a permanent pacemaker during pregnancy. In these cases, the body is implanted higher ( so that it does not move as the fetus grows). During the operation itself, the abdomen must be covered with a special lead blanket, since the control of the position of the electrodes is usually performed using x-rays.

However, even with all these features and precautions, the risk to the mother and to the child is very small. In the vast majority of cases, due attention of specialists ensures normal pregnancy and childbirth.

What physical activity is allowed for patients with a pacemaker ( sports, household loads, sex, etc.)?

However, extremely heavy loads are not recommended for patients. Together they affect not only the heart, but also increase blood pressure and in rare cases, the pacemaker may not be able to cope with the developed problem. Because of this, such patients are not allowed to professionally engage in many sports.

With regard to physical activity, patients with a pacemaker should adhere to the following recommendations:

• allowed to play most sports at the amateur level ( without wear loads);
• contact sports are prohibited martial arts, fencing, etc.), since there is a high risk of getting hit in the area of ​​​​implantation of the pacemaker;
• football, volleyball, basketball and similar games should be played with caution, as a blow to the danger zone can be obtained by contact with a player or ball;
• active exercises on horizontal bars, uneven bars, gymnastics are prohibited, as they are associated with a sharp change in body position, and the electrodes in the heart may shift;
• swimming allowed;
• any household loads are allowed ( including sex, but without pressure on the implantation area of ​​the device).

Is a disability group given after pacemaker implantation?

At the meeting of the commission, the following factors will be important:

• initial diagnosis;
• type of pacemaker;
• type and volume of medical services provided;
• the degree of dependence of the patient on the pacemaker;
• the presence of other acute and chronic diseases;
• education and working conditions;
• social status ( family, living conditions);
• age, etc.

Together, the commission assesses whether a person retains his ability to work after the installation of a pacemaker, and to what extent. FROM medical point vision of a patient with an artificial pacemaker is equated to a patient with coronary heart disease and should receive a disability group. Therefore, there are legal prerequisites for this. However, if there are no factors in the workplace that may pose a danger to the operation of the device, and the patient is not completely dependent on a pacemaker, a disability group is usually not given.

In any case, the first step for patients after surgery should be to consult with their doctor on this issue ( usually the doctors themselves do not offer to undergo a commission). The doctor can tell you where to go next, how realistic the assignment of a disability group is and what documents may be needed. He must also submit an appropriate medical report.

One of the options for the decision of the commission may be the assignment of a temporary disability group. The patient could lose his ability to work only in the postoperative period, or he would be given time ( up to several years) for other education and retraining. In any case, this issue is resolved with the involvement of not only doctors, but also other specialists ( lawyers, medical and social experts, etc.).

Where and by whom can you work with a pacemaker?

The following jobs and professions may pose a certain risk for patients with implanted pacemakers:

• Law enforcement and military forces. The police and military must have a good physical training. In addition, their training and work is associated with physical contact, during which you can get hit in the area of ​​the implanted body.
• Welder and some construction specialties. Work on a construction site can be associated not only with serious physical exertion, but also with the use of powerful tools. For example, a welding machine creates a fairly powerful electromagnetic field that can affect the operation of a pacemaker. Working with a jackhammer due to strong vibration sometimes leads to displacement of the electrodes.
• Manufacturing engineers. Factories usually use powerful electrical equipment, magnets and other devices that are dangerous for a patient with a pacemaker. A safety engineer can clarify the presence of physical hazards.
• Electricians and electricians. Working with electrical equipment, one way or another, is associated with the danger of electric shocks. Weak shocks that won't hurt healthy person may interfere with the operation of the pacemaker and endanger the life of the patient.
• Power plant workers. At power plants, despite all types of protection, there is a chance to get into the zone of influence of powerful electromagnetic radiation. They are located around equipment and high voltage power lines.
• Miners. Dive into the mine itself, although associated with certain changes in the physical parameters of the environment, does not pose a serious threat to patients with a pacemaker. However, powerful equipment that is commonly used in mining operations can generate electromagnetic fields.
• Some doctors. A number of doctors especially in the field of diagnostics) is often located near powerful electrical equipment.

Can I give massage to patients with a pacemaker?

Some risk is the following techniques massage:

• direct massage of the area on which the pacemaker is fixed;
• deep massage of the muscles of the body ( belly, chest, back);
• a number of techniques manual therapy, in which strong turns of the body are necessary;
• massage associated with the use of hot lotions and body heating.

Can you fly on an airplane with a pacemaker?

Is it possible to pass through a metal detector in stores, at the airport and at customs?

The main places where metal detectors can be found are:

• Large shops and supermarkets. Devices that work on the principle of metal detectors are sometimes installed at the exits of stores. There they are designed to prevent petty theft. However, such devices are safe for pacemaker patients. They are configured to search for other metals, and do not react to the body of the device.
• Airports. At the airport, metal detectors are installed for security purposes, and all passengers ( as well as employees) to get into the so-called "sterile zone" pass through the frame of a fairly powerful metal detector. Such devices pose the greatest danger to pacemaker patients. Airport staff are aware of this, and the patient may not pass through the frame if he presents a special patient passport. This document is issued after the implantation of a pacemaker. In such cases, security personnel are required to replace the passage of the metal detector with a thorough physical search or other methods that are safe for the passenger. At international airports in other countries, a pacemaker identification card may be required international standard. This should be taken care of in advance, before the start of the trip.
• Customs control zones at the borders. Customs offices also sometimes install metal detectors through which luggage is passed or passengers pass. People with a pacemaker should notify workers about the implanted device and present the appropriate document.

How do I know that the passage with a pacemaker is prohibited?

Is it possible to visit a bath or sauna, sunbathe on the beach or in the solarium?

An exception may be patients in whom heart damage occurred against the background of systemic diseases. For them, visiting the bath is dangerous because of possible complications, but not from the side of the pacemaker, but due to the presence of a systemic disease.

Tanning on the beach is also not a contraindication, since most of the sun's rays are absorbed by the skin, and the pacemaker is implanted much deeper. However, infrared rays are able to heat the metal, as they penetrate deep enough. That is why patients with a pacemaker are not recommended to visit solariums or infrared saunas.

Can a cell phone interfere with a pacemaker?

Can I exercise at home with an implanted pacemaker?

There are certain restrictions on physical activity in the first months after implantation. This is due to the normal fixation of the body and electrodes, as well as the normal healing of the postoperative wound. When exercising on the simulator, you should avoid sudden movements and any pressure on the implantation area of ​​the body. More detailed instructions can be obtained from your doctor after surgery.

Does alcohol affect pacemaker function?

Alcoholic beverages in the presence of a pacemaker are dangerous for the following reasons:

• a large amount of alcohol affects the conduction of impulses by the heart muscle and can provoke an arrhythmia;
• alcohol leads to vasodilation, which changes blood pressure, and this, in turn, affects the work of the heart;
• long-term use of alcohol, even in small doses, can in the long run affect the size of the heart muscle ( hypertrophy of certain departments).

Do microwaves, refrigerators, and other household electrical appliances affect pacemaker performance?

Using household appliances Patients with a pacemaker should pay attention to the following points:

• do not lean against the switched on electrical appliances with the part of the skin under which the pacemaker is fixed;
• turned on hand-held devices should not be brought closer than 10 cm to the implantation site;
• Do not touch the TV screen while the TV is on ( especially older models with kinescope);
• do not touch the metal case of switched on electrical appliances ( washing machine, microwave oven, heaters, etc.), because sometimes they are shocked;
• you need to check the grounding of household appliances and install modern sockets to prevent accidental electric shocks.

Does the laser affect laser radiation) to the work of the pacemaker?

Can I use a pacemaker and a hearing aid at the same time?

What medications and drugs should not be taken by patients with a pacemaker?

In some cases, patients are prescribed aspirin or other drugs for a long time after implantation. These drugs reduce the risk of blood clots and reduce the chance of complications. Self-refusal to take them or change the dose is not recommended. It is better to consult on this matter with the attending cardiologist, who is not only familiar with the principle of operation of the pacemaker, but also knows the patient's diagnosis in detail and can take into account the general condition of the body.

Do patients with a pacemaker need a specific diet and diet?

In most cases, the diet in cardiac patients is aimed at "unloading" the heart and reducing the risk of atherosclerosis. It is recommended to monitor salt intake, the amount of potassium and sodium, the content of "harmful" lipids in food. The exact diet for any disease can be clarified with your doctor. Also, at the consultation of a nutritionist, you can draw up a detailed menu, taking into account the tastes of the patient and medical recommendations.

Patients with most heart conditions should adhere to the following guidelines:

• reduce salt intake throughout the day ( including as part of other dishes);
• reduce the intake of fatty foods;
• exclude concentrated animal fats;
• give preference to fish and seafood;
• try not to overeat during the day;
• eat fresh fruits and vegetables more often;
• reduce coffee and energy drinks;
• try to avoid fatty dairy products.

In addition, cases should be taken into account when heart damage developed against the background of other pathologies. This is possible, for example, with a number of autoimmune diseases, diabetes, thyroid problems. Such patients may need a more strict diet.

Do I need to warn doctors about a pacemaker during dental treatment and other medical interventions?

The presence of a pacemaker can make adjustments to the conduct of therapeutic and diagnostic procedures the following reasons:

• The use of certain medications. In the presence of a pacemaker, the use of certain medications during procedures may be limited. This is due to their effect on the work of the heart. For the correct appointment of treatment and in order to avoid complications, it is necessary to warn the doctor about the implanted pacemaker before choosing the drug and dose.
• The impact of the electromagnetic field. Physiotherapeutic treatment and a number of diagnostic studies are based on the influence of a strong electromagnetic field. For patients with a pacemaker, such procedures are contraindicated. The doctor should be warned to choose alternative tactics for treatment or diagnosis.
• Impact of ultrasonic waves. Ultrasonic waves are used in ultrasound, crushing kidney or gallstones, and in some other procedures. These manipulations are not a categorical contraindication for patients with a pacemaker, but doctors should be warned in advance. Then they will be more attentive during the procedure and the examination or treatment will not affect the operation of the device.
• The impact of electric current. With a number surgical interventions doctors use special scalpels with electrocoagulators. This is convenient because it avoids

The human body invariably gets older, many internal organs age and wear out. That is why pain signals come in, which warn that some organ is malfunctioning. However, a person pays special attention to the heart. With heart pain or heaviness in the chest, anxiety is created about one's health. After all, as you know, healthy heart- long life.

At the present time, medicine is making new breakthroughs in the field of medicine, so now everyone can check their heart and identify certain pathologies. High-precision research instruments will detect the mechanism that has failed, so the doctor will select the optimal and correct treatment. One of the best correction options that helps restore lost heart function is a heart pacemaker. The operation, the reviews of which are the most positive, allows former patients to forget what heart pain is. They live full lives. Cardiology in Moscow is at the highest level. Tens of thousands of adults and children are treated annually, and the best doctors give the inhabitants of the country a new full life.

But, before you figure out what a pacemaker is (the cost of the operation may vary) and how it works, you need to know the anatomy and physiology of such an organ as the heart.

Heart: its structure and functions

The heart is a muscular organ that is capable of pumping blood throughout the body. It contains a partition muscle tissue, which divides the heart into right and left parts. These two parts are also separated by a septum, the upper halves are called the atria, and the lower halves are called the ventricles. The atria and ventricles are connected by physiological valves through which blood moves due to muscle contraction.

Blood, being in the right half of the atrium, enters the lungs, where it is actively saturated with oxygen. Further, this blood enters and then flows into the aorta, which divides into arteries. Thanks to this mechanism, oxygenated blood flows throughout the body through the arteries and thereby enriches all tissues and organs with oxygen. After the oxygen release function is completed, the blood is collected in the veins and flows back to the heart, first entering the right atrium and then into the right ventricle. Arterial blood, which is saturated with oxygen, will be lighter than venous blood.

Due to the fact that the human heart works smoothly, the blood is able to constantly enrich all tissues and organs with useful substances and oxygen. The natural mechanism that winds up the heart and makes it pump blood is based on the work of supplying special electrical impulses. In medicine, this function is called the sinus node, or the natural driver of the heart. It is located in the heart, namely in the right half of its part, in the atrium.

sinus node plays important role in the work of the heart. It controls the heart rate, and depending on the situation and various conditions speeds up the heart rate or vice versa, slows them down. For example, during physical exertion, the heart beats faster than when the body is in a passive state. The heart's natural driver senses that there is a need to pump blood faster, so it rewires the heart muscle to work faster.

The path of transmission of electrical impulses

The propagation of electrical impulses is carried out due to the fact that conductive fibers are located in the heart, and it is they that cause the atria and ventricles to contract until the next impulse. Due to the pause between contractions, which the heart can withstand, the “rest” of the heart muscle occurs.

In some physiological and pathological conditions, a slowing of the heart rate is observed. Reasons for a slow heartbeat:

• dizziness;
• hypertension;
• headache;
• fatigue, apathy;
• fainting;
• violation of the frequency of breathing.

In medicine, this condition is called bradycardia. The reason for its appearance is that the sinus node is damaged, followed by changes in the conduction system. This condition leads to a decrease in the heart rate, which adversely affects the cardiovascular system and the body as a whole, as the supply of oxygen to tissues and organs decreases. Further develops oxygen starvation, and this condition leads to the failure of many vital important organs. First of all, the heart itself begins to suffer. The patient may feel pain in the chest, as well as heaviness in the region of the heart. If a person does not pay attention to the symptoms and does not treat the disease, then the brain begins to suffer, more precisely the brain cells that constantly require optimal oxygen saturation.

With development, the impulses that the sinus node gives do not always reach the ventricles, and sometimes they do not reach at all, which leads to a violation of the synchrony of the work of the atria and ventricles.

Pathology of the heart rhythm

Congenital cardiac arrhythmia is associated with the pathology of the child's cardiovascular system, that is, irreversible changes occurred at the time of laying the organ. Very often, such a violation is determined by ultrasound examination of the fetus, but sometimes the disease is detected only after the birth of the baby.

Pediatric cardiology deals with the treatment of babies who have heart defects, sometimes it is necessary to introduce a pacemaker into the body to save a child's life.

Acquired palpitations can occur for many reasons:

• age-related changes;
• after myocardial infarction;
• infectious diseases that give complications to the heart;
• hereditary predisposition;
• obesity;
• smoking and alcohol abuse.

Restoration of the heart rhythm

Such a disease is not treated with medication, only the symptoms are relieved with drugs, but the patient's health is still in danger. In this condition, it is advisable to use an artificial pacemaker.

It is a special device - a pacemaker that continuously stimulates cardiac impulses, causing the ventricles and atria to contract synchronously. In order to install a pacemaker, the cost of the operation will be higher and will be more complicated recovery period if the disease is not treated on time, but let it take its course.

Composition of the electrical pacemaker system

The structure of the device is very complex, it is located in a sealed case and consists of a pulse generator and an electrode. The case consists of a special medical alloy (titanium), due to which the survival rate of the stimulator in the human body increases.

The operation of the device is carried out only at those moments when the slowing of the heart rate begins, or there are pauses in the work of the heart. In this case, the device triggers a mechanism that sends its own electrical impulses to the heart muscle, bringing it to a normal state. This is an approximate diagram of how a pacemaker works. The operation reviews of patients with cardiac pathology were positive. They boil down to the fact that patients no longer suffer from heart rhythm disturbances, returning to a full life.

Kinds

At the moment, there are three types of devices that are artificial pacemakers.

1. Single chamber pacemaker. It has only one electrode, which is located in the ventricle, that is, in only one heart chamber. At the same time, atrial contraction is carried out in a natural way. This type of device has serious drawbacks, since it controls only one heart compartment. Sometimes it happens that because of this, the rhythm of the work of the ventricle and atria coincides, which leads to pathology of the outflow of blood from the heart. Due to the malfunction of the atria, the blood will not be able to fully circulate from the ventricle to the atrium, which means it will not enter further into the bloodstream.
2. Dual chamber pacemaker. It has two electrodes, one is located in the ventricle, and the second - in the atrium. This device has advantages over a single-chamber pacemaker. In this case, there is complete control over the correct operation and complete synchronization of the atrium and ventricle. Thanks to this, the outflow of blood from the heart will occur without any disturbances, while the blood will flow into the bloodstream according to the same rules as it was with healthy cardiac activity.
3. Triple chamber pacemaker. This device is the most modern artificial pacemaker. It has three electrodes, which are located in three heart compartments: atrium, left and right ventricle. Thanks to such a good arrangement, the blood physiologically correctly passes all the stages of flow from one heart compartment to another, getting smoothly into the blood vessels. The rhythm is the same as that of a healthy heart.

What is an electrode and how it works in a pacemaker

Due to the high flexibility of the electrode, it can be easily bent and twisted, which is very important for such a device, since various physical movements of a person occur, as well as heart contractions.

The conductor is able to transmit impulses to the myocardium, thanks to which it generates information about the heart rhythm. The electrode has a special ultra-sensitive head that makes contact with the heart muscle.

Heart pacemaker: operation, reviews

At the moment, the operation to implant a pacemaker is a simple and affordable procedure. It lasts no more than two hours, is carried out by experienced doctors, the department is cardiology. Feedback from patients in the postoperative period is good, since recovery is relatively fast, and patients are soon discharged home. The pacemaker is sewn into the chest area in the subclavian area so that it is located between the skin and muscle tissue.

The electrode, before entering the cavity of the heart, passes through a vein. The whole process of electrode placement is carried out under ultrasound supervision. The device itself is fixed to the outer part of the cardiac segment - the heart pacemaker. The operation reviews of patients who have an artificial pacemaker are positive. Thanks to the implantation, they will soon be able to return to their former way of life. However, inconveniences and limitations remain. Nevertheless, a very serious device is being introduced into the body - a heart pacemaker. The cost of the operation depends on the manufacturer of the device and the material of the electrode.

Operating rules

To avoid a failure in the automatic pacemaker system, you must adhere to the following rules:

• do not be near high-voltage electrical lines;
• it is forbidden to be near various power translators, towers for transmitting television and radio signals;
• in no case should you pass an inspection with a metal detector (at the airport, in stores).

In the presence of an implanted pacemaker, it is forbidden to undergo some medical studies:

• chest ultrasound;
• MRI (research);
• treatment in the physiotherapy room with a different range of waves: magnetotherapy, electrotherapy;
• electrocoagulation only with the permission of the attending physician.

In everyday life, you should also follow certain rules:

• avoid touching sources of electricity;
• do not move the device on your own, do not hit it;
• talking on mobile phone, apply it to the right ear;
• when using a hammer drill, a drill must be extremely careful;
• do not strain the pectoral muscles;
• in the gym to limit the load on this muscle group.

The cost of surgery and the price of a pacemaker

Usually, the price includes the pacemaker itself. As a result, the final price adds up whole complex procedures and activities. These include:

• open heart surgery;
• the cost of a pacemaker;
• price of electrodes;
• period of stay in cardiology, rehabilitation.

It is important to determine what type of pacemaker, how many electrodes it has, which manufacturer. Depending on this, when performing a heart operation, the cost can range from the very minimum to definitely high. Pricing policy for pacemakers:

• single-chamber view of the device ( domestic production) from 10,500 to 55,000 rubles, imported - 80,000 rubles;
• two-chamber - from 80,000 to 250,000 rubles; imported analogue - from 250,000 rubles;
• three-chamber - from 300,000 rubles and more, and imported production on average from 450,000 rubles.

However, it should be clarified that this does not include the price of electrodes. The price for a domestic electrode will be from 2,000 to 4,500 rubles, for an imported one - from 6,000 rubles. Therefore, it is easy to calculate how much a heart pacemaker will cost, the cost of the operation will be from 15,000 to 500,000.

Installing a pacemaker

The Cardiology Center is located in the capital, so residents of different cities of the country are treated there.

This center treats adults and children. It is noteworthy that it also has specialized pediatric cardiology. In the treatment of patients and diagnosis, modern equipment is used. The cardiology department is also equipped with various advanced devices. Diagnosis is made by qualified specialists. Treatment can be carried out medically and instrumentally. After recovery, patients are provided with rehabilitation. Cardiology in Moscow is at the highest level, so you can not be afraid for your health.

The cost of treatment in the cardiology center

Depending on how critical the diagnosis is, prices may vary. If a patient meets the quota, he can count on free services in any field of medicine: surgery, cardiology. Prices in this case will no longer worry you, which is very profitable and at the same time reliable.

A person is alive as long as his heart beats. The sinus node sets the rhythm, from which impulses are supplied along the nerve fibers, muscle contraction occurs. The frequency of contractions directly depends on the physical, emotional stress and other circumstances.

Various age-related degenerative-dystrophic processes also entail physiological and pathological changes contributing to a slowing of the heart rate, or the appearance of pauses in its work.

When medications do not have the desired effect, or their use is excluded due to medical indicators, the situation can be corrected with the help of an artificial cardiac pacemaker.

The device is a complex electronic device with a microchip, a generator and electrodes in a hermetically sealed case made of medical alloys.

How much a pacemaker costs depends on its functionality

A kind of small computer that can perceive changes in the work of the heart muscle, and, if necessary, correct myocardial contractions with electrical impulses.

The purpose of the pacemaker is to identify and correct rhythm disturbances in a timely manner in order to prevent cardiac arrest. That is, it takes over the function of the sinus node and becomes an artificial driver of the heart.

The indication for surgery is the presence of any type of arrhythmia, namely bradycardia or tachycardia. These pathologies can cause severe health complications, up to the complete cessation of cardiac activity. To avoid severe consequences and implantation of a pacemaker.

It's important to know! When choosing a device, the main thing is not how much the pacemaker costs, but only the individual characteristics of the patient and the specifics of the disease, confirmed by medical research.

Types of pacemakers and how much they cost

There are devices for temporary and permanent use, working with or without taking into account the natural activity of the patient's heart: synchronized and asynchronous. Each of them provides a transceiver for interaction with the mechanism for checking and setting the EKS (programmer) without surgical intervention.

In any case, without detailed surveys and clarification complete picture diseases, it is impossible to decide on the choice of the desired device.

EX cost

How much the pacemaker costs depends on the additional required options in the content of the software.

How many parts of the heart is it capable of:

• synchronize,
• read,
• save and
• process information about cardiac activity, etc.

Dear models

Modern expensive devices are equipped with special elements that can control changes in body temperature, breathing rate, and reactions of the nervous system. There are models equipped with built-in automatic defibrillation.

They are indicated for patients with severe depletion of the heart and body. Typically, the warranty period for multifunctional devices is 4-5 years.

Do not miss helpful tips doctors: How to quickly cure jams in the corners of the lips. Effective ways and means.

Average in price

Dual-chamber pacemakers can be classified as devices of the middle price category. Due to the consistent supply of impulses to the heart departments, myocardial contraction occurs in the most natural and familiar mode.

Service life of 3 years.

Cheap models

Cheap models include devices with 1 electrode, simplified devices without additional functions and the ability to control other departments. For this reason, lately they are used only in cases of a permanent form of atrial fibrillation.

Note! For temporary pacing, simplified devices are sufficient, which are removed after the patient is removed from a dangerous state. If it is impossible to use the intracardiac method of administration, an external method can be used by attaching adhesive electrodes to the patient's skin.

In general terms, the price limit for pacemakers runs from 10,000 - 15,000 to 600,000 - 800,000 rubles. Accordingly, devices with 3-4 electrodes are more expensive, but they are also able to provide maximum stability of the heart.

Significant influence on the price also has:

• manufacturer, imported devices are more expensive than domestic counterparts;
• the material of manufacture is, as a rule, titanium or alloys based on it;
• the existence of additional functions, for example: the presence of a memory device, a set of sensors, an automatic set for switching the stimulation mode, etc.;
• life time;
• The more features, the more battery consumption.

Does quality depend on price?

You need to know how functional the pacemaker is, in the list of manufacturers you can always choose the most acceptable cost.

Imported devices often meet modern requirements and desires, and are more relevant in the light of medical trends. Domestic devices are absolutely not inferior, and even surpass imported ones, in particular, in terms of service life, reliability and ease of operation.

Doctors' advice about What to do and how to treat noise in the ears and head. The main causes of noise in the head.

Are there any benefits when buying a pacemaker

Pacemaker implantation operations can be performed on a quota basis at the expense of budget funds in institutions providing high-tech medical care, in accordance with the relevant order.

Under the compulsory health insurance policy, this is possible in emergency cases, and is applicable only in relation to devices of domestic production.

As soon as the choice has fallen in favor of an imported heart pacemaker, the costs can be partially compensated in the amount of the cost of the Russian analogue, according to a certificate from the hospital and a statement from the patient.

Such an operation has long been a simple and affordable procedure. And life with the device practically does not limit the usual life activity.

In some cases, temporary use of a pacemaker can already bring life back to normal.

Be careful! After the implantation of the pacemaker, it is imperative to observe certain safety measures when in contact with electricity and electronic devices.

The body's engine runs smoothly as long as it is helped favorable conditions. This is not always feasible, but the tasks are completely solvable.

The capabilities of the pacemaker are aimed at stopping problems, normalizing the work of the heart, and returning a person to an active life. And this is the most precious thing a person has.

How much does a heart pacemaker cost, what are its functions and who needs it - you will find answers to these questions in the video below:

The following video is about diseases in which a person needs to install a pacemaker: