Pacemaker indications. Pacemakers. What it is? Classification of pacemakers. Specifications and care of the device. Complications after installing a pacemaker

Implantation of a pacemaker (EX)

– cardiac surgery to install an artificial driver heart rate. Implantation of the pacemaker is performed when it is necessary to maintain or impose a heart rate in patients with bradycardia or atrioventricular block. Various types of pacemakers are used in cardiac surgery - single-chamber, two-chamber, three-chamber, one- and two-chamber cardioverter-defibrillators (ICD), which are selected individually, taking into account existing disorders and physical properties. Implantation of the pacemaker is performed in the myocardial or endocardial version, while the electrodes are installed outside or in the cavities of the heart, and the pacemaker block is placed in the subcutaneous bed.

The pacemaker is a high-precision software device designed to provide a physiological heart rhythm when it is disturbed. The task of the pacemaker is to maintain or impose an optimal heart rate during bradycardia or AV blockade.

Internal structure The pacemaker includes a battery, a microprocessor device and a connector. The working "stuffing" is contained in a miniature titanium case, indifferent to the tissues of the body. This unit is connected to conductors-electrodes, which are installed through the venous pathways in the atrial or ventricular chambers of the heart. The electrodes perceive the parameters of the heart, deliver information to the working unit, and initiating impulses - from the pacemaker to the heart. The pacemaker block is located outside the heart, in the subcutaneous bed.

Three-chamber pacemakers are designed to provide biventricular and right atrial pacing in CHF and ventricular dissociation. 1- or 2-chamber cardioverter-defibrillators are implanted for ventricular tachyarrhythmias and provide pacing and defibrillation in the development of life-threatening forms of arrhythmia or asystole. Cardiac surgery uses pacemakers manufactured by Medtronic, Guidant St. Jude Medical (USA), Biotronic (Germany), Elistim-Cardio Cardioelectronics (Moscow), EX-Izhevsk Mechanical Plant. The price of an imported pacemaker is higher than that of a Russian one.

Methodology

Implantation of the pacemaker is carried out in the endocardial or myocardial position. The operation is less traumatic and is performed under local anesthesia in an X-ray operating room with constant ECG monitoring. Parallel to the clavicle, a dissection of tissues 6-7 cm long is performed to bring out the outer ends of the electrodes. A cardiac surgeon dissects and catheters a vein (usually a subclavian one), through which, using an introducer, X-ray-guided electrodes are passed through the superior vena cava into the right ventricle and / or atrium.

Pacemaker electrodes can be passive (anchor) or active (screw) fixation. The tips of the electrodes of the pacemaker are coated with a special steroid coating, which reduces inflammation in the implantation zone and prolongs the life of the pacemaker.

After fixation of the cardioelectrodes, the threshold of excitability is determined - the minimum value of the impulse that causes a response contraction of the heart. Upon reaching the required ECG graphics, the outer ends of the electrodes are docked with the pacemaker block. A subcutaneous or muscular pocket (bed) is formed, where the pacemaker block is placed, followed by suturing the tissue incision. The pacemaker bed is created in the subclavian region on the right or left. The duration of the pacemaker implantation procedure is 1.5 - 2 hours.

Manufacturers of pacemakers give a long-term guarantee for their activity (on average 4-5 years), although in reality the devices can work up to 8-10 years. The lifespan of a pacemaker is determined by the state of the battery, the stimulation amplitude used, the set of additional features (for example, the presence of frequency adaptation), the condition of the electrodes, etc.

The annual control of the pacemaker allows the cardiac surgeon to assess the reserves of the device and set the timing of the planned replacement of the pacemaker. Typically, pacemakers have a reserve of several months of operation after the pacing rate is reduced. In case of malfunctions, a revision of the pacemaker may be required. The price of revision or replacement of a previously implanted pacemaker is negotiated separately.

After implantation

Patients with implanted pacemakers are advised to beware of influences that cause asynchronization of the EKS: microwave, electric, electromagnetic and magnetic fields; conducting MRI, physiotherapy procedures (magnetotherapy, UHF, etc.), electrocoagulation; chest injuries.

With an inadequate mode of electrical stimulation, dizziness, dyspnea, presyncopal and syncopal attacks may develop, requiring reprogramming of the pacemaker. Hyperemia, swelling and pain in the area of ​​the pacemaker pocket may indicate suppuration of the bed, hematoma, decubitus of the electrode or body. These conditions are eliminated by antibiotic therapy and replacement of the entire pacemaker. Candle fever, intoxication, sweating require the exclusion of septicemia and

The beginning of the 20th century was marked by the rapid development of technology in all areas of human life.

innovative medical research conducted in the 1920s showed the ability of the myocardium to contract under the influence of electric current impulses.

The essence of the research was able to revolutionize the treatment of certain heart diseases, which was proved by the external device for maintaining the rhythm created in 1927.

However, due to the large size and relatively small resource of electronic components of that time, the development of pacemakers was frozen for decades.

device in it modern understanding was created only in 1958 by Swedish scientists and was named Siemens-Elema. Since then, the design and principle of operation of pacemakers have been improved every year - the devices become more functional, reliable and durable.

Purpose and device of the device

To understand how a modern pacemaker works, you need to understand what it is. A pacemaker (EX) or, as it is also called, an artificial pacemaker (IVR), is a microprocessor-based device equipped with an independent power source and located in a sealed metal case, most often made of a titanium alloy.

The design of the device includes:

1. Frame- serves to accommodate the internal elements of the pacemaker and isolate them from body tissues.
2. Control and communication unit– necessary for coordination of modules operation, exchange of information with control and diagnostic devices.
3. memory block– stores statistical information about the operation of the device.
4. Sensor block- is able to detect changes in the work of the heart and correct the effects of the pacemaker.
5. Working block- generates and transmits electrical impulses to the heart.
6. Battery- serves as a power source for the remaining elements of the pacemaker, is equipped with mechanisms to save energy and disable non-basic functions when the charge drops below the threshold level.

The functions of the pacemaker are to perceive the heart's own rhythm, detect pauses and other failures in its work and eliminate these failures by generating impulses and transmitting them to the corresponding chambers of the heart.

If the own rhythm is stable and corresponds to the needs of the body, impulses are not generated.

An optional feature of some high-tech stimulants is the prevention of arrhythmia, tachycardia and other disorders through special work programs.

What are pacemakers?

AT this moment There are many varieties of pacemakers that differ from each other in design, functionality and other criteria. Classification of devices can be carried out according to various criteria, but the main ones are design features that characterize the specifics of stimulation.

Depending on them, there are:

• Single chamber pacemakers - affect one atrium or one ventricle;
• Two-chamber - affect the atrium and ventricle at the same time;
• Three-chamber - affect both atria and one of the ventricles;
• Cardioverter-defibrillators (ICD, IKVD) - are used in case of high risk complete cessation of circulation.

To understand in which cases a particular pacemaker model should be used, its letter code, which takes into account the design features and functionality of the device, will help.

It includes 3-5 letters of the Latin alphabet, which, depending on serial number on the label indicate:

1. Stimulated camera.
2. Camera detected by the device.
3. The nature of the response of the heart to an impulse.
4. Frequency adaptation parameters of the device.
5. Type of device response to tachycardia.

The main letters used in the labeling of the pacemaker are the first letters English words: Atrium (atrium), Ventricle (ventricle), Dual (two, both), Single (one), Inhibition (suppression), Triggering (stimulation), Rate-adaptive (rate adaptation). The final code that marks the types of pacemakers may look like this: AAI, VVIR (aka PEX), DDDR, etc.

Considering the classification of IVR, one cannot ignore the temporary pacemaker. It is an external device that is connected to the patient's heart by a resuscitator in the event of a sudden cessation of natural cardiac activity or frequent dangerous fainting.

Indications for installation

The most common heart conditions for which a pacemaker is recommended are:

• Arrhythmia;
• weakness syndrome sinus node;
• Atrioventricular block.

Arrhythmia is pathological condition, which is characterized by a change in the frequency and sequence of stages of excitation and contraction of the heart. When arrhythmia is disturbed normal functioning body and there are a number of serious complications.

Arrhythmias can be caused different reasons but the most common are:

• Ischemic heart disease;
• Heart failure;
• Cardiomyopathy and myocarditis;
• Heart defects (both congenital and acquired);
• Mitral valve prolapse;
• Toxic effects, including smoking, alcoholism, drug use;
• Mixed effects, manifested by atrial fibrillation or ventricular fibrillation (heart rate increases to 250 beats / min. or more).

A pacemaker is not implanted in all of these cases. Some violations allow you to do without surgical intervention, affecting the source of the problem. medicines or other factors.

Sick sinus syndrome (SSS) reflects disturbances in the functioning of the sinoatrial mechanism for controlling the rhythm of heart contractions.

Arrhythmias and blocks associated with SSS include:

• The drop in the minimum heart rate to 40 beats / min. and below, and heart rate under load - up to 90 beats / min. and below;
• Pauses between contractions exceeding 2.5 seconds;
• Alternating bradycardia and tachycardia;
• Severe sinus bradycardia;
• Bradysystolic mitral arrhythmia;
• "Migration" of the atrial driver;
• Sinoauricular blockade, etc.

Features of the operation

The operation to install a pacemaker refers to minor surgical interventions and is performed in an X-ray operating room. The first step is to determine the installation location.

The most common options are:

• Left subclavian region - for right-handers, left-handers with tissue damage right side chest;
• Right subclavian region - for left-handers, right-handers with tissue damage on the left side of the chest;
• Other places connected by veins to the chambers of the heart - if classic options for some reason are not possible.

Let's see how the operation goes. The algorithm usually includes the following sequence of actions:

For an experienced surgeon, 20-30 minutes is enough for all this, however, with an atypical installation site or connecting several cameras at once, the time for surgical intervention may increase.

Device installation cost

There is no definite answer to the question of how much such an operation costs - it all depends on the reputation and prices of the clinic, the features of the technologies used in it. In Moscow heart health clinics, the cost of the operation will be from 100 to 600 thousand rubles, in St. Petersburg the price fluctuates - from 60 to 300 thousand. Provincial clinics are ready to do the work for 25-100 thousand rubles.

But it is important to understand that these amounts take into account only the installation of the device. For the pacemaker itself, you will need to pay another 2,500-10,000 dollars.

Patients who are treated under the quota can receive full complex services for 3500-5000 dollars.

This amount includes:

• Accommodation and maintenance in the clinic;
• The cost of a pacemaker;
• The cost of consumables;
• Payment for the work of doctors and medical staff.

Patients with severe cardiac arrhythmias who have a general health insurance, the pacemaker is installed free of charge.

How to live with a pacemaker?

Despite the possibility of returning, in fact, to the old life, a patient with a pacemaker should still adhere to some rules.

The first and main thing is to regularly timely visit a doctor who conducts further monitoring of the patient.

The following sequence of visits is usually assigned:

1. Three months after the installation of a pacemaker.
2. Six months after the first postoperative visit.
3. Once every six to twelve months by agreement with the doctor for a scheduled examination.
4. Unscheduled - in cases of sensation of electrical discharges, the return of symptoms of the disease, the appearance of signs of inflammation at the installation site of the device.
5. After the expiration of the life of the pacemaker declared by the manufacturer (usually it is 6-15 years).

Like any implantable medical device The pacemaker has its pros and cons. A lot has already been said about the pluses, that is, the positive effect of the device on the functioning of the heart and the body as a whole. But it's important to remember that living with a pacemaker after surgery means paying attention to details that previously seemed unimportant.

You will have to refrain from such types of work and actions:

There will also be a number of restrictions in everyday life. Special care should be taken when working with electrical appliances, and especially with powerful power tools, to avoid any electric shock. Mobile phone should be kept at a distance of no closer than 20-30 cm from the place where the pacemaker is installed.

It is also recommended not to bring a camera, player and other portable electronics near the device. Otherwise, patients with a pacemaker live a full life, getting rid of the problems associated with heart rhythm disturbances.

In what cases is it necessary to replace the device and how is it carried out?

During a scheduled visit to the doctor, the pacemaker is diagnosed and, if necessary, reprogrammed. However, in some cases it may be necessary to replace the device.

Such cases include:

• End of the warranty period;
• Low remaining battery power;
• Occurrence of unrecoverable faults.

A special case is the replacement of the stimulator to install a more modern and functional model. The process of replacing a pacemaker is similar to the process of installing it, and is also performed under local anesthesia. During the operation, the condition of the electrodes is monitored and, if necessary, new ones are installed.

Video

Pathologies in the heart muscle require serious surgical intervention. One way to keep her active is to install a pacemaker. Such operations allow people to lead a normal life, even with disorders in the work of the heart.

A pacemaker is an electrical device that is implanted in the body. Its purpose is to generate electrical impulses and ensure contractions of the heart muscle.

The device consists of a pulse generator and electrodes acting as conductors. The pacemaker is powered by a battery.

For certain cardiovascular diseases, a pacemaker can be installed. Contraindications (by age incl.) - the first thing you need to know before installing the device

The device is installed through a small incision that is made in the collarbone. Wires are brought to the heart through a vein. The procedure takes place under local anesthesia. Its duration is two hours.

The pacemaker works until the heart muscle begins to contract on its own. Then the device turns off and starts functioning when necessary.

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Indications for the installation of a pacemaker

A device that supports the work of the heart is indispensable in the event of an arrhythmia, if the heart rate remains at a sufficiently low level. With rare contractions of the heart muscle, the threat of acute heart failure remains. Sharp deterioration conditions can occur at any time and lead to cardiac arrest.

Absolute indications for the installation of a pacemaker are:

• pulse less than 40 beats per minute physical activity;
• bradycardia, which manifests itself in the form of dizziness and fainting;
• AV block with severe symptoms;
• sick sinus syndrome;
• transverse heart block.

When confirming the absolute indications, the operation is carried out urgently or as planned.

Relative readings do not require urgent installation of the device. This includes the following signs:

• Asymptomatic second or third degree AV block
• loss of consciousness, cardiac arrest.

Are there contraindications, including age

The operation to install the device is performed for children, adolescents, adults and the elderly.

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Note! Complications after surgery appear in the presence of purulent inflammation. It occurs a few days after the intervention in patients of any age. In case of re-intervention, the risk of purulent inflammation increases.

If the body rejects the pacemaker, then this becomes a serious contraindication at any age.

What not to do with a pacemaker

The functioning of the device is affected by physical activity and the action of electromagnetic waves. Before carrying out any study, you should notify the specialist about the presence of this device.

After the operation, the following restrictions apply:

• examination on MRI equipment;
• intense physical activity;
• being in close proximity to electrical substations;
• wearing a cell phone or magnet in close proximity to the heart;
• staying for a long period near metal detectors;
• carrying out shock-wave procedures (requires setting up the device).

After installing a pacemaker, even if there are no contraindications for age, a number of restrictions must be observed during the week:

• give up hot bath or soul (only after 5 days if there are no complications);
• treat the intervention site according to the recommendations of a specialist;
• it is forbidden to lift heavy objects (more than 5 kg).

In the period up to one month after the installation of the device, small physical exertion is allowed. These can be walks, the duration of which the patient sets on his own. If no deviations are found in the work of the stimulator within 6 months, then sports (swimming, tennis) are allowed.

Note! The only precaution is to keep a distance of 15-20 cm from electrical equipment.

Interaction with live wires and welding machines should also be avoided.

There are no other restrictions after the installation of the device. AT Everyday life it is allowed to use household equipment and a computer. You are allowed to use your mobile phone freely.

What is the life expectancy with a pacemaker

Patients with a pacemaker, on average, live longer than people without this device. The presence of the device reduces the likelihood of developing coronary disease and other problems in the work of the heart muscle. Thus, a person is more protected from the risk of heart problems that usually accompanies the aging process.

It's important to know! Even if a pacemaker was installed, and there were no contraindications for age, there is a possibility that the device will not take root. Then it will take reoperation. However, such cases are observed quite rarely.

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Subject to the established rules, the patient can live for several decades. The device will need to be replaced after 8 years. During this period, improved versions of the device appear. At intensive work The device will need to be replaced after 4 years.

The installation of a heart pacemaker has no contraindications due to age. Due to this device, the full work of the heart muscle is ensured. If you have this device, it is important to follow the rules that will ensure its smooth operation.

What is a heart pacemaker, and what are the age-related contraindications for installing this device - you will learn from this video:

Watch also a video about the indications for the installation of a pacemaker:

Article publication date: 05/22/2017

Article last updated: 12/21/2018

From this article you will learn: for what diseases a pacemaker is installed, how it is done. Types of pacemakers. Contraindications for installation, possible complications. Life with a pacemaker: recommendations and limitations.

A pacemaker (pacemaker, artificial pacemaker, EX, IVR) is special device which, with the help of electrical impulses, sets the heart to the correct rhythm. The pacemaker saves the patient from sudden death due to either ventricular fibrillation. It maintains or imposes the correct rhythm on the heart. Some pacemakers can also stop arrhythmias as soon as they occur.

Installs and configures the EX-a qualified arrhythmologist. Further maintenance of this device is also handled by this doctor. You will need to visit him from time to time to check the operation of the pacemaker and, if necessary, to reprogram the device.

How a pacemaker works

What is a pacemaker and what are its components?

1. Generator (source) of electrical impulses, which is placed under the skin on the right or left side of the chest. This is a miniature device weighing about 50 g, equipped with its own battery.
2. Electrodes. They are carried out directly to the chambers of the heart, which must be affected. Through them, an electrical impulse is conducted from the source to the heart. Depending on the type of pacemaker, there can be from one to three electrodes.

The part of the device that is placed under the skin is covered with a titanium coating, so the risk of rejection is almost zero.

Indications and contraindications for the installation of a pacemaker

A pacemaker is implanted in patients with bradyarrhythmias (arrhythmias with a slow heartbeat), intracardiac blockades (impaired impulse conduction through the heart) and tachyarrhythmias (arrhythmias with an accelerated heartbeat).

Indications for the installation of EX:

Symptoms that indicate the installation of a pacemaker:

• With bradyarrhythmias: pulse below 40 beats per minute in daytime, pauses in the heartbeat longer than 3 seconds.
• With tachyarrhythmias: fainting and pre-syncope on the background of attacks of tachyarrhythmias, increased risk.

Absolute contraindications missing.

Postponement of the operation is possible when:

• acute inflammatory diseases;
• exacerbation peptic ulcer gastrointestinal tract;
• acute phase mental illness in which it is impossible for the patient to contact the doctors.

There are no age restrictions: a pacemaker can be installed at any age.

Examination before installing a pacemaker

To make a decision to implant a pacemaker, the arrhythmologist will need the results of the following diagnostic procedures:

Varieties of pacemakers

According to functionality, they distinguish:

• Pacemakers - have only the function of setting the heart correct rhythm.
• Implantable defibrillators-cardioverters - in addition to imposing the correct rhythm on the heart, they can also stop arrhythmias, including ventricular fibrillation.

Patients with bradyarrhythmias are fitted with conventional pacemakers, and patients with tachyarrhythmias and increased risk ventricular fibrillation - pacemakers with the function of defibrillation and cardioversion.

Depending on the zone of influence, single-chamber, two-chamber and three-chamber EKS are distinguished. Single chamber pacemakers are connected to one of the atria or one of the ventricles. Two-chamber - to one atrium and one ventricle. Three-chamber (another name for such a pacemaker is a cardioresynchronizing device) - to one of the atria and both ventricles.

pacemaker implantation surgery

This surgery is performed under local anesthesia. The implantation process takes about an hour.

The operation to install a pacemaker is as follows:

1. Anesthetize the area of ​​the chest with local anesthesia.
2. One or more electrodes are passed through the vein to the desired chambers of the heart.
3. Check the parameters of the electrodes with an external device.
4. A small incision is made in the chest. A bed is formed in the subcutaneous fatty tissue for the main part of the device.
5. Install the device, connect to it the electrodes held to the heart.
6. Sew up the incision.

In most cases, the source of electrical impulses is located on the left. However, left-handers or in the presence of extensive scars on the left side of the chest can install it on the right.

Postoperative period

After the installation of the pacemaker is over, you will be given sick leave for 3-4 weeks. Except in cases where the pacemaker was installed after a heart attack (then the sick leave may last longer).

You will stay in the hospital under the supervision of doctors for 5-9 days. During this period, pain is possible in the area of ​​​​implantation of the device.

Among the others possible complications in the first week after the installation of the device, it is possible:

• hematomas in the area of ​​the operation;
• bleeding;
• swelling at the site of implantation of the device;
• infection postoperative wound;
• damage to blood vessels;
• pneumothorax;
• thromboembolism.

The risk of complications is no more than 5%.

Your doctor may prescribe painkillers to relieve pain. You will also need to take acetylsalicylic acid(Aspirin) to prevent thrombosis. Antibiotics are prescribed to prevent or treat postoperative wound infection.

Further rehabilitation

Throughout the month, after you have already been discharged from the hospital, you will need to visit an arrhythmologist once a week to check if the device is working properly.

Within 1.5-3 months after implantation of the pacemaker, any physical activity on the arms, shoulders and pectoral muscles, lifting weights. Also, you can not sharply raise your left (or right, if the device is installed on the right) hand up and sharply take it to the side.

Within 1-3 months after the installation of the device, you can not engage in physical education. Only possible physiotherapy prescribed by the doctor.

Complications in the future

In a remote time after installing the device, you may experience:

• Swelling of the arm from the side where the pulse generator is located.
• Inflammatory process in the heart at the site of electrode attachment.
• Displacement of the device from the bed in which it was installed.
• Fatigue during physical exertion (more often develops in older people).
• Stimulation of the diaphragm or chest muscles by an electrical impulse (possible with incorrect installation device, as well as due to its malfunctions).

The risk of developing these complications is 6-7%.

Life with a pacemaker

Regularly visit an arrhythmologist to examine the pacemaker and, if necessary, reconfigure it. If there is no arrhythmologist in your city, then you will have to go to the clinic where he is, since ordinary cardiologists do not have special skills and equipment for diagnosing and reprogramming pacemakers. A consultation with an arrhythmologist lasts about 20 minutes.

There are also restrictions on daily life for people with a pacemaker, as well as in the areas of physical activity, the use of electronics, household appliances and tools, in passing medical procedures as well as in professional activities.

Limitations in daily life

Avoid putting pressure on the area where the electrical pulse generator is installed.

Don't hit the chest and fall on it. This can lead to both a breakdown of the pulse generator and a displacement of the electrodes located in the heart.

Do not stay near transformer boxes, electrical panels, power lines for a long time.

Do not stand for a long time near the "frames" at the entrance of shops and at airports.

Physical education and sports with a pacemaker

Physical activity and moderate sports activities are allowed for people with an established pacemaker (with the exception of the first 1.5–3 months after surgery).

Only sports in which there is a risk of impact to the pacemaker area, extreme sports, as well as excessive loads on the upper part body.

You can not engage in boxing, hand-to-hand combat and other martial arts, any kind of wrestling, football, rugby, basketball, hockey, parachuting, etc. It is also undesirable to engage in shooting.

AT gym exercises on the pectoral muscles using weights are prohibited.

Use of household appliances, electronics, tools

No risks have been identified for correct use the following appliances:

1. Fridge.
2. Dishwasher.
3. Electronic balance.
4. Ionizing air filters, air humidifiers, automatic fragrances.
5. Hair curlers and straighteners.
6. Calculator.
7. Battery powered flashlight, laser pointer.
8. Printer, fax, scanner, copier.
9. Barcode Scanner.

The use of other devices is also permitted. The only rule is to keep the necessary distance between the device and the pacemaker.

More about the distance in the table.

It is forbidden to use and be closer than 2.5 m from welding equipment over 160 amperes.

Restrictions in professional activity

Contraindicated professions:

• loader;
• electrician;
• electrician;
• welder.

There are no restrictions on working with a computer.

If the pacemaker was installed in connection with severe heart failure, it is possible to assign a disability of 3-2 groups.

Prohibited medical procedures

Patients with an established pacemaker should not undergo:

• MRI (however, there are some models of stimulators that allow you to undergo an MRI - check with the doctor who installed the device for you);
• Physiotherapy and cosmetic procedures using electric, magnetic and other types of radiation. These are electrophoresis, diathermy, heating, magnetic therapy, transcutaneous electrical nerve stimulation, etc. Full list you can check with your doctor.
• Ultrasound with the direction of the beam directly to the device.

Before performing any medical procedure or surgical interventions tell your doctor that you have a pacemaker installed.

Forecast: service life, efficiency

The warranty period for pacemakers is 3 to 5 years, depending on the manufacturer. The service life for which the battery of the device is designed is 8-10 years. After the battery is discharged or the device fails, the pacemaker will need to be replaced.

Often, the electrodes placed to the heart are still in good condition. In such cases, they are not touched, but only the main part of the device, the generator of electrical impulses, is replaced. If the device breaks down before the expiration of the warranty period, a free replacement under warranty is possible, unless the device breaks down through your fault.

The pacemaker is very effective in eliminating bradyarrhythmias. As for tachyarrhythmias, the device copes with seizures in almost 100% of cases, and with atrial flutter, flutter or ventricular fibrillation - in 80-99% of cases.

Indications for the installation of a pacemaker (or artificial pacemaker, IVR) are absolute and relative. The indications for installing a pacemaker are said every time there are serious interruptions in the rhythm of the heart muscle: long pauses between contractions, rare pulse, atrioventricular blockade, syndromes hypersensitivity carotid sinus or weakness of the sinus node. Patients with such diseases are those people who need to have a pacemaker installed.

The reason for the occurrence of such deviations may be a violation of the formation of an impulse in the sinus node ( congenital diseases, cardiosclerosis). Bradycardias usually occur in one of four possible causes: sinus node pathology, AV node pathology (AV blocks), pedicle pathology (fascicular blocks) and autonomic depression nervous system(manifested by neurocardial syncope).

Absolute indications for an operation to install (use) a pacemaker include the following diseases:

bradycardia with clinical symptoms(dizziness, fainting - syncope, Morgagni-Adams-Stokes syndrome, MAC); recorded decrease in heart rate (HR) to values ​​less than 40 during physical exertion; episodes of asystole on the electrocardiogram (ECG) lasting more than 3 seconds; persistent atrioventricular block II and III degree in combination with two or three-beam blockade or after myocardial infarction in the presence of clinical manifestations; any kind of bradyarrhythmia (bradycardia), life threatening or health of the patient and in which the heart rate is less than 60 beats per minute (for athletes - 54 - 56).

Indications for setting a pacemaker are rarely heart failure, in contrast to the arrhythmias of the heart that accompany it. In severe heart failure, however, we can talk about non-synchronous contractions of the left and right ventricles - in this case, only the doctor decides on the need for an operation to set up a pacemaker (pacemaker).

Relative indications for pacemaker implantation:

atrioventricular block II degree type II without clinical manifestations; atrioventricular blockade of the III degree in any anatomical area with a heart rate at a load of more than 40 beats per minute without clinical manifestations; syncopal conditions in patients with two- and three-beam blockades not associated with ventricular tachycardias or complete transverse blockade, with the inability to accurately determine the causes of syncope.

In the presence of absolute indications for the implantation of a pacemaker, the operation is performed on the patient as planned after examination and preparation, or urgently. There are no contraindications to the implantation of the pacemaker in this case. In the presence of relative indications for the implantation of a stimulator, the decision is made individually, taking into account, among other things, the age of the patient.

The following diseases are not indications for the installation of a pacemaker by age: atrioventricular blockade of the 1st degree and atrioventricular proximal blockade of the 2nd degree of type I without clinical manifestations, drug blockades.

It should be noted that each country in the world has its own recommendations for the installation of pacemakers. Russian recommendations largely repeat the recommendations of the American Heart Association.

When is a pacemaker placed on the heart?

A pacemaker is placed only in cases where there is a real risk to the life and health of the patient. Today, both single-chamber devices and two- and multi-chamber devices are used. Single-chamber "drivers" are used in the treatment of chronic atrial fibrillation(to stimulate the right ventricle) and in sick sinus syndrome, SSSU (to stimulate the right atrium). However, more and more often, a two-chamber device is also installed with SSSU.

SSSU manifests itself in one of four forms:

symptomatic - the patient has already lost consciousness or had any dizziness; asymptomatic - the patient has bradycardia on the ECG or daily monitoring(on the "holter"), but the patient does not express complaints; pharmacodependent - bradycardia is present only against the background of conventional doses of drugs with a negative chronotropic effect, (antiarrhythmic drugs and beta-blockers). With the abolition of drugs, the clinic of bradycardia completely disappears; latent - there is no clinic or bradycardia in the patient.

The last two forms are recognized initial stage sinus node dysfunction. The patient can wait up to several years with the implantation of the pacemaker, but this is only a matter of time - the operation becomes from an emergency planned one.

What other heart conditions are treated with a pacemaker?

In addition to the heart diseases described above, a pacemaker is placed to treat dangerous arrhythmias: ventricular tachycardia and ventricular fibrillation to prevent sudden cardiac death. In the presence of atrial fibrillation, indications for the installation of a pacemaker are urgent (in this case, the patient is already losing consciousness or there is a tachybradyform). And the doctor cannot prescribe drugs to increase the rhythm (risks of fibrillation attacks) and cannot prescribe antiarrhythmic drugs (the brady component increases).

The risk of sudden death in bradycardia with MAS attacks is recognized as low (according to statistics - about 3% of cases). In patients diagnosed with chronic bradycardia, the risk of syncope and sudden death is also relatively low. With such diagnoses, the installation of a pacemaker is largely preventive in nature. Such patients, due to adaptation to their heart rate, rarely complain of dizziness or fainting, however, they have a whole range of concomitant diseases, from which the installation of an IVR will no longer relieve.

Timely implantation of a pacemaker helps to avoid the development of brady-dependent heart failure, atrial fibrillation, arterial hypertension. According to experts, at present, up to 70% of operations are carried out precisely for preventive purposes.

With a transverse blockade, implantation of the pacemaker is mandatory, regardless of the cause, symptoms, nature of the blockade (transient or permanent), heart rate. Here are the risks lethal outcome for the patient are extremely high - the IVR settings allow to increase the survival of patients to values ​​close to healthy people. The operation is an emergency one.

In two cases:

complete blockade that appeared during acute myocardial infarction; complete blockade resulting from cardiac surgery

it is possible to wait up to 2 weeks (it is possible to resolve the problem without installing the EX). With congenital complete blockade, indications for implantation of a pacemaker are already in adolescent children. Congenital blockade develops in utero (the cause is mutations of 13 and 18 chromosomes). In this case, children do not have MAS attacks, because. they are fully adapted to their bradycardia.

Unfortunately, bradycardia only increases with age, by the age of 30 ( average term life of a patient with a similar disease) heart rate can be reduced to 30 beats per minute. The installation of a stimulator is mandatory, it is planned. Emergency implantation is performed in case of syncope. If the heart rate is critical, then the operation is performed even at the age of several days or months.

Treatment of blockade in a child depends on whether it is congenital or not. If it is congenital, then it is registered at the maternity hospital, and the diagnosis is known even during pregnancy. If acquired, it is considered that it was obtained as a result of the myocardium. In the second case, adolescence is not expected - the pacemaker is implanted regardless of age.

Worldwide, more than 300,000 pacemakers (ECs) are installed every year. permanent basis because patients with some severe heart conditions need artificial driver rhythm.

Varieties of pacemakers

The pacemaker is electronic device, in which electrical impulses are generated using a special circuit. In addition to the circuit, it contains a battery that supplies the device with energy and thin electrode wires.

Exist different kinds heart pacemakers:

single-chamber, which are able to stimulate only one chamber - the ventricle or atrium; dual-chamber, which can stimulate two cardiac chambers: both the ventricle and the atrium; three-chamber pacemakers are required for patients with heart failure, as well as in the presence of ventricular fibrillation, ventricular tachycardia and other types of arrhythmias that are life-threatening for the patient.

Indications for the installation of a pacemaker

Are you still wondering why you need a pacemaker? The answer is simple - an electric pacemaker is designed to impose the right heart on the heart. sinus rhythm. When is a pacemaker placed? Both relative and absolute indications can exist for its installation.

Absolute indications for a pacemaker

Absolute indications are:

bradycardia with pronounced clinical symptoms - dizziness, syncope, Morgagni-Adams-Stokes syndrome (MAS); episodes of asystole lasting more than three seconds, recorded on the ECG; if during physical activity the heart rate is below 40 per minute; when persistent atrioventricular blockade of the second or third degree is combined with two-beam or three-beam blockade; if the same blockade occurred after myocardial infarction and is manifested clinically.

In cases of absolute indications for the installation of a pacemaker, the operation can be performed both as planned, after examinations and preparation, and urgently. At absolute readings contraindications to the installation of pacemakers are not taken into account.

Relative indications for a pacemaker

The relative indications for a permanently implanted pacemaker are as follows:

if at any anatomical site there is an atrioventricular blockade of the third degree with a heart rate at a load of more than 40 beats, which is not clinically manifested; the presence of atrioventricular blockade of the second type and second degree without clinical manifestations; syncopal conditions of patients against the background of two- and three-beam blockades, not accompanied by ventricular tachycardia or transverse blockade, while it is not possible to establish other causes of syncope.

If the patient has only relative readings in order for an operation to install a pacemaker to be performed, the decision to implant it is made individually, taking into account the patient's age, physical activity, accompanying illnesses and other factors.

When is a pacemaker not justified?

In fact, the pacemaker has no contraindications for its installation, except for the case of its unreasonable implantation.

Such insufficient grounds for implantation are:

atrioventricular blockade of the first degree, which does not have clinical manifestations; proximal atrioventricular blockade of the first type of the second degree, which does not have clinical manifestations; atrioventricular blockade that can regress (for example, caused by medication).

How is a pacemaker placed?

Now let's talk about how to put a pacemaker. If you watch the video of how the pacemaker is installed, you will notice that the cardiac surgeon performs it under X-ray control, and total time procedures vary depending on the type of device being implanted:

for a single-chamber EX, it will take half an hour; for a two-chamber EX - 1 hour; a three-chamber EKS requires 2.5 hours to install.

Usually, the operation to install a pacemaker takes place under local anesthesia.

The pacemaker implantation operation consists of the following steps:

Preparation for the operation. This includes processing operating field and local anesthesia. An anesthetic drug (novocaine, trimecaine, lidocaine) is injected into the skin and underlying tissues. Installation of electrodes. The surgeon makes a small incision in the subclavian region. Next, the electrodes under X-ray control are inserted sequentially through the subclavian vein into the desired cardiac chamber. Implantation of the EX-case. The body of the device is implanted under the collarbone, while it can be installed subcutaneously or deepened under the pectoral muscle.

In our country, the device is more often implanted in right-handers on the left, and in left-handers - on the right, which makes it easier for them to use the device.

The electrodes are already connected to the implanted device. Device programming. It is produced individually according to the needs of the patient, taking into account the clinical situation and the capabilities of the device (which also determine the cost of the pacemaker). In modern devices, the doctor can set the base heart rate, as for the state physical activity and for rest.

Essentially, this is all the basic information about how a pacemaker is inserted.

Complications after installing a pacemaker

It is worth knowing that complications after the installation of a pacemaker occur in no more than 3-5% of cases, so you should not be afraid of this operation.

Early postoperative complications:

leakage pleural cavity(pneumothorax); thromboembolism; bleeding; violation of insulation, displacement, fracture of the electrode; infection of the area of ​​the surgical wound.

Long-term complications:

EKS syndrome - shortness of breath, dizziness, decreased blood pressure, episodic loss of consciousness; EKS-induced tachycardia; premature failures in the work of the EX.

The pacemaker-implanting surgery should be performed by an experienced surgeon under X-ray control, which helps to prevent most of the complications that occur on the early stage. Subsequently, the patient must undergo regular examinations and be registered with the dispensary.

In the event of complaints of deterioration in well-being, the patient should immediately consult with the attending physician.

What can and cannot be done with a pacemaker?

Living with a pacemaker has limitations regarding physical activity and electromagnetic factors that may prevent the device from working correctly. Before any examination or course of treatment, it is necessary to warn doctors about the presence of a pacemaker.

Living with a pacemaker imposes the following restrictions on a person:

undergo an MRI; engage in injury-prone sports; climb high-voltage power lines; approach the transformer booths; put a mobile phone in your breast pocket; stay close to metal detectors for a long time; undergo shock wave lithotripsy without prior adjustment of the EKS or do it during surgical operation tissue electrocoagulation.

The cost of installing a pacemaker

Basically, since the implantation of the pacemaker is paid for by the MHI fund, the cost of installing a pacemaker is usually zero.

But sometimes patients themselves pay for it and additional services (this applies to foreigners and people who do not have compulsory health insurance).

In Russia, the following rates apply:

implantation of a pacemaker - from 100 to 650 thousand rubles; implantation of electrodes - at least 2000 rubles; surgical manipulations - from 7,500 rubles; stay in the ward costs at least 2,000 rubles per day.

Most of all, the pacemaker model and the prices of the chosen clinic influence the total cost. For example, in a provincial cardiological center, a simple implantation of an outdated domestic EKS model can cost at least 25,000 rubles. In large vascular clinics, using modern imported devices and providing additional services, the cost jumps to 300 thousand rubles.

How to behave after the installation of a pacemaker?

First postoperative week

The postoperative wound should be kept clean and dry according to the recommendations of the medical staff. With a favorable course of early postoperative period five days after the operation, it is already permissible to take a shower, and a week later, most patients return to their usual work schedule. In order not to separate the seams, you can’t lift more than 5 kg at first. You can’t do hard homework, and doing lighter work, you need to listen to your well-being and immediately postpone work if there are discomfort. You can't force yourself.

One month after surgery

Going in for sports after the installation of a pacemaker is not only useful, but also necessary. Long walks are helpful. But tennis, swimming and other heavy sports will have to be postponed for a while. Over time, a doctor who monitors the patient's health may remove some restrictions on sports. The doctor should be visited according to the plan: after 3 months - the first examination, after six months - the second, and then every six months or a year.

If a person feels discomfort or anxiety about the work of the pacemaker, then you should consult a doctor immediately.

Life after pacemaker implantation

Electrical devices. Although pacemakers are equipped with protection against interference from other electrical devices, strong electric fields should still be avoided. It is allowed to use almost all household appliances: TV, radio, refrigerator, tape recorder, microwave oven, computer, electric razor, hair dryer, washing machine. In order to avoid interference, one should not approach the place of implantation of the EKS closer than 10 cm to the electrical device, lean against the front wall of the "microwave oven" (and generally avoid it) or the screen of a working TV. It is worth staying away from welding equipment, electric steel furnaces, high-voltage power lines. It is undesirable to pass through the controlling turnstiles in shops, airports, museums. In this case, upon discharge from the hospital, the patient is given a device passport and an owner card, which should be presented during the inspection, after which it can be replaced by a personal search. The COP is also not afraid of most office equipment. It is advisable to develop the habit of grasping appliance plugs and other sources of voltage with the hand further away from the pacemaker. Mobile phone. Long conversations on it are undesirable, and you need to hold the phone 30 cm or more from the COP. When talking, hold the handset to your ear opposite side from the site of implantation. Do not carry the handset in your breast pocket or around your neck. Sport. It is forbidden to engage in contact and traumatic types sports, that is, team game types, martial arts, since any blow to abdominal cavity or chest may damage the device. For the same reason, shooting from a gun is not recommended. With a pacemaker, you can return to hiking, swimming and such exercise, which allow constant monitoring of well-being and allow you to comply with safety rules.

The area of ​​the body where the pacemaker was implanted should not be exposed to direct solar radiation. It should always be kept covered with some kind of cloth. Also don't swim in cold water. It is especially important for motorists to remember that they should not touch live wires while repairing a car or changing a battery.

Validity and how long do they live with a pacemaker?

On average, the duration of the pacemaker is determined by the capacity of the battery, designed for 7-10 years of operation. When the end of battery life is approaching, the device will give a signal during the next scheduled examination. After that, replace the battery with a new one. Therefore, the question of how long they live with a pacemaker also depends on the regularity of visiting a doctor. There is an opinion that, being a foreign body, the COP can harm a person. This is not at all the case, despite the fact that often there is no alternative to installing it. In order to continue completely full life you have to put up with only minor restrictions that are worth it. In addition, it can be installed completely free of charge.

You can often hear the question of how long they live with a pacemaker, especially from those for whom such an operation is recommended. Medical practice shows that people with an implanted pacemaker, subject to all the doctor's recommendations, live no less than other people.

In other words, having a pacemaker can only prolong life, not make it shorter.

Have you already had a pacemaker installed? Or do you still have this operation? Tell your story and feelings in the comments, share your experience with others.