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Pacemaker – an overview

We often come across the word pacemaker and we know that it is a “something” that is placed in the heart when a person has a heart problem. Now have you ever wondered that what is that “something” or what exactly is the heart problem for which a pacemaker is placed inside the heart? Here we will have all our questions answered. Basically, a pacemaker is a small medical device that produces electrical impulses to regulate the beating of the heart. The pacemaker uses low-energy electrical pulses to prompt the heart to beat at a normal rate. They are either placed on the chest or the abdomen, depending on the condition or requirement of the patient.

Why are pacemakers required?

  • Speed up a slow heart rhythm or control an abnormal or fast heart rhythm (arrhythmia).
  • Make the ventricles contract normally if the atria don’t beat with a normal rhythm (atrial fibrillation).
  • Coordinate electrical signalling between the upper and lower chambers of the heart.
  • Coordinate electrical signalling between the ventricles. Such pacemakers are called cardiac resynchronization therapy (CRT) devices and are used to treat heart failure.
  • Prevent a disorder called long QT syndrome (form of arrhythmia).

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Even though pacemakers help in many cardiac conditions but they also produce some side effects. The most common side effects are infection or blood clot within the heart.

The heart itself has a natural pacemaker that maintains the electrical conduction system of the heart. The natural pacemaker of the heart is the SA node or sinoatrial node which is situated in the right atrium. The electrical impulse generated by the SA node travels to the AV node or atrioventricular node along the Bundle of His through the bundle branches (both left and right) and finally to the Purkinje fibres to produce contraction of the heart. In this process, the blood is pumped throughout the body.

How pacemakers functions?

A pacemaker consists of Lithium-Iodide battery, electrodes or sensors connected with wires and a computerized generator. The electrodes or sensors detect the heart’s electrical activities and sends it to the generator. If any abnormality of heart beat is detected by the electrodes, then the generator is directed by the computer to modulate or send electrical pulse to the heart through the wires connected. The pacemaker can be accessed from the external environment through the computer of the pacemaker which enables a doctor to program the electrical impulses generated and also to set the type of pacing.

Which tests are used to diagnose arrhythmia?

  • Electrocardiography or ECG
  • Echocardiography
  • Holter monitors
  • Electrophysiology study
  • Stress test

What are the most common side effects of placing a pacemaker?

  • Infection – Even though antibiotics are administered prior to placing a pacemaker, infections can still be caused. Strong antibiotics are prescribed in such conditions.
  • Damage of blood vessels – Placing a pacemaker needs surgery. Piercing a blood vessel can lead to internal bleeding.
  • Damage of heart – The heart can structurally be damaged during its implantation.
  • Induced arrhythmia – Abnormally functioning pacemaker can produce abnormal heart rhythms.

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