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 HEART DISEASE & TREATMENT

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Cardiac Implantable Devices

Cardiac Implantable Devices 
(Recommend review “Arrhythmia Clinic” and “Heart Failure Clinic”)
 
What is cardiac implantable devices?

Small electronic devices that can be inserted into the patient body to treat or support specific heart conditions.

Cardiac implantation devices
  1. Pacing/Defibrillation for specific cardiac arrhythmias
    1. Pacemaker
  1. ICD (Internal Cardioverter Defibrillator)
  2. Combine device (such as CRT+ICD)
  1. Improve/support heart pumping function
    1. CRT (Cardiac Resynchronization Therapy) or Biventricular pacemaker
    2. LVAD (Left Ventricular Assist Device).
Pacemaker


Pacemaker is a small implantable battery operate device that can discharge small direct electrical current to stimulate the heart to initiate heartbeat. It indicates in patient with potentially dangerous slow or absent heartbeat. Current pacemaker can be very sophisticated and has multiple functions to make it work as close to human heart electrical system as possible. It can record and store heart electrical activities that can accurately diagnosis the heart abnormal rhythm (arrhythmia).
                       
Pacemaker Component                                                
  1. Pulse generator
  • Size and shape
  • Pulse generator component
  • There are many types and functions. The doctor will choose the types that suit you the most.
  1. Lead
    • Conducting metal coil insulated with silicone or polyurethane, which will connect pulse generator to the specific heart position.
    • 1-3 leads are required depends on which type of pacemaker
Indication
  • Bradycardia (slow or pause heart beat)
    • Sinus node or other natural pace maker dysfunction
    • Heart electrical conducting malfunction particularly blocking the electrical impulse.
  • Indication of CRT (Cardiac resynchronization therapy) or biventricular pacing is for improving heart pumping chamber to pump blood more efficiently.
  • There are few other conditions that your doctor may recommend pacing to you. You will have to discuss the benefit for you with your doctor. 
Type of pacemaker 
  1. Type of heart chamber involve
  • Single chamber
  • Two or dual chambers
  • Three chambers in case of CRT or biventricular pacing
  1. Type or mode of function
    • Fixed rate, demand mode, rate responsive
Where is it done? 

Catheterization or electrophysiology laboratory

What to expect during pacemaker surgery?
  • Minor surgery, local anesthesia. Should be painless or only minor discomfort after local anesthesia.
  • Small incision (cut), about 2 inches. Prefer opposite side from hand preference.
  • Subcutaneous pocket creation
  • Lead (s) into a vein under the collarbone then advance into the heart position under fluoroscopic guiding.
  • Check electrical system
  • Lead connect to the generator
  • Generator insert into the pocket that has been created
  • Closing the incision
  • Procedure time 1-2 hours
What to expect after pacemaker surgery?
  • Expect to stay in the hospital overnight so your health care team can check your heartbeat and make sure your pacemaker is working well.
  • You'll likely have to arrange for a ride to and from the
  • Keep your wound clean and dry. Look at your wound every day to make sure it is healing properly. Call your doctor if you notice:
  • Increased drainage, bleeding, or oozing from the insertion site
  • Increased opening of the incision
  • Redness around the site
  • Warmth along the site
  • Increased body temperature (fever or chills)
    • For a few days to weeks after surgery, you may have mild pain, swelling, or tenderness in the area where your pacemaker was placed.
    • Most people return to their normal mild activities within a few days of having the surgery.
    • Avoid vigorous activities and heavy lifting for about a month after pacemaker surgery.
    • You should carry pace maker ID card with your pacemaker information all the time.
What Are the Risks of Pacemaker Surgery? 
 
Pacemaker surgery generally is safe. If problems do occur, they may include:
  • Swelling, bleeding, bruising, or infection in the area where the pacemaker was placed
  • Blood vessel or nerve damage
  • A collapsed lung
  • Lead dislodgement require repositioning
Talk with your doctor about the benefits and risks of pacemaker surgery.
Long term care
  • Regular pacemaker check up every 3 to 6 months
 
How Will a Pacemaker Affect My Lifestyle? - Pacemakers
Once you have a pacemaker, you have to avoid close or prolonged contact with electrical devices
or devices that have strong magnetic fields. Devices that can interfere with a pacemaker include:
• Cell phones and MP3 players (for example, iPods)
• Household appliances, such as microwave ovens
• High-tension wires
• Metal detectors
• Industrial welders
• Electrical generators
These devices can disrupt the electrical signaling of your pacemaker and stop it from working
properly. You may not be able to tell whether your pacemaker has been affected.
How likely a device is to disrupt your pacemaker depends on how long you're exposed to it and
how close it is to your pacemaker.
To be safe, some experts recommend not putting your cell phone or MP3 player in a shirt pocket
over your pacemaker (if the devices are turned on).
You may want to hold your cell phone up to the ear that's opposite the site where your pacemaker is
implanted. If you strap your MP3 player to your arm while listening to it, put it on the arm that's
farther from your pacemaker.
You can still use household appliances, but avoid close and prolonged exposure, as it may interfere
with your pacemaker.
You can walk through security system metal detectors at your normal pace. Security staff can check
you with a metal detector wand as long as it isn't held for too long over your pacemaker site. You
should avoid sitting or standing close to a security system metal detector. Notify security staff if
you have a pacemaker.
Also, stay at least 2 feet away from industrial welders and electrical generators.
Some medical procedures can disrupt your pacemaker. These procedures include:
• Magnetic resonance imaging, or MRI
• Shock-wave lithotripsy to get rid of kidney stones
• Electrocauterization to stop bleeding during surgery
Let all of your doctors, dentists, and medical technicians know that you have a pacemaker. Your
doctor can give you a card that states what kind of pacemaker you have. Carry this card in your wallet. You may want to wear a medical ID bracelet or necklace that states that you have a
pacemaker.
 
Long term
Physical Activity
In most cases, having a pacemaker won't limit you from doing sports and exercise, including
strenuous activities.
You may need to avoid full-contact sports, such as football. Such contact could damage your
pacemaker or shake loose the wires in your heart. Ask your doctor how much and what kinds of
physical activity are safe for you.
Ongoing Care
Your doctor will want to check your pacemaker regularly (about every 3 months). Over time, a
pacemaker can stop working properly because:
• Its wires get dislodged or broken
• Its battery gets weak or fails
• Your heart disease progresses
• Other devices have disrupted its electrical signaling
To check your pacemaker, your doctor may ask you to come in for an office visit several times a
year. Some pacemaker functions can be checked remotely using a phone or the Internet.
Your doctor also may ask you to have an EKG (electrocardiogram) to check for changes in your
heart's electrical activity.
Battery Replacement
Pacemaker batteries last between 5 and 15 years (average 6 to 7 years), depending on how active
the pacemaker is. Your doctor will replace the generator along with the battery before the battery
starts to run down.
Replacing the generator and battery is less-involved surgery than the original surgery to implant the
pacemaker. Your pacemaker wires also may need to be replaced eventually.
Your doctor can tell you whether your pacemaker or its wires need to be replaced when you see
him or her for followup visits.
 
 
CRT (Cardiac Resynchronization Therapy)
Pacemaker system designed to help heart failure patient weak heart (left ventricle) to pump blood more efficient. Some of the weak pumping chamber develop non uniform contraction of the chamber wall. This pacing system require additional lead to also pace the heart opposite from the standard position. The standard position is usually the right ventricular apex and the opposite site is the left ventricle from epicardial side (pacing from coronary vein).
Preparation is similar to the pacemaker system mention above. Operation usually takes longer time for placing the “left ventricular” lead.
 
ICD (Internal Cardioverter Defibrillator)
http://www.shawheart.com/illustrations/pacemaker.jpgICD
 
 
 
 
 
 
 
LVAD (Left Ventricular Assist Device)

 
http://www.epmds.info/image/93236712.jpg       Digital X-ray imaging    http://upload.wikimedia.org/wikipedia/commons/4/43/Implantable_cardioverter_defibrillator_with_lead.jpg
 
Single-chamber pacemaker     http://www.ipej.org/0404/mallela1.jpg
 
 
ICD    http://www.shawheart.com/illustrations/pacemaker.jpg   http://www.vitatron.com/images/tekening_pacemaker.gif
 
http://www.vitatron.com/images/single_chamber.gif     http://www.vitatron.com/images/dual_chamber.gif    Pacemaker Leads Placement
 

 
http://scienceillustrated.com.au/blog/wp-content/uploads/2012/02/pacemaker1.gif