Arrhythmology and Pacemaker Clinic

A pacemaker is a medical device that generates electrical impulses delivered by electrodes to one or more heart chambers. Each impulse causes the respective heart muscle to contract and pump blood, thereby regulating the function of the heart’s electrical conduction system. The primary purpose of a pacemaker is to maintain a steady heart rate when the heart’s natural conduction system fails to provide sufficient heart impulses or when there is a significant blockage in the heart’s electrical conduction system. Patient symptoms can vary, ranging from increased fatigue, shortness of breath during exertion, weakness, unsteady gait, and dizziness to short-term loss of consciousness, usually accompanied by a fall. Since similar symptoms can be caused by other conditions, an ECG recording is required to confirm bradyarrhythmia.

Transcutaneous external pacing is recommended for the initial stabilization of hemodynamically significant bradycardias. The procedure is performed by placing two large pacing electrodes on the patient’s chest in an anterior/lateral or anterior/posterior position. This is an emergency procedure that serves as a bridge until transvenous temporary pacing or permanent pacing can be applied (if the cause of the significant bradycardia is irreversible). In transvenous temporary pacing, a temporary pacemaker electrode is inserted under sterile conditions through venous access into the right ventricle and subsequently connected to an external pacemaker outside the body. Permanent pacing is performed by implanting a permanent pacemaker. Every permanent pacemaker consists of two main parts: the pacemaker itself, i.e., a battery with electrical circuits, and an electrode system that delivers electrical impulses to the heart. Modern pacemakers are externally programmable and allow for the selection of optimal pacing modes for individual patients. The underlying condition determines the type of pacemaker that will be implanted in the patient. A single-chamber pacemaker uses only one pacing electrode, either in the right atrium or, more commonly, in the right ventricle. A dual-chamber pacemaker has two pacing electrodes, one in the right atrium and the second in the right ventricle. Most pacemakers today operate in “on-demand” pacing modes with rate adaptation, where heart pacing is based on the dynamic requirements of the circulatory system. The surgery lasts one to two hours. The surgical procedure varies from patient to patient. Most patients undergo the procedure while conscious, using only a local anesthetic to numb the area where the pacemaker is placed. Most commonly, a permanent pacemaker is implanted transvenously, with the pacing electrode inserted through the venous system into the appropriate part of the heart. After creating a subcutaneous pocket for the pacemaker, usually in the area below the collarbone, the electrode is inserted directly into the heart under X-ray guidance, which allows for its correct placement to be monitored. After testing the pacing parameters, the pacemaker is connected to the electrodes and placed into the prepared subcutaneous pocket. Before being discharged home, the patient’s pacemaker is checked to verify its proper functionality.

A small number of patients experience complications related to the implantation of the pacemaker and electrodes. Complications may include local infection, a reaction to the medication used during the procedure, or damage to a blood vessel, the heart wall, or another organ (most commonly the pleura of the lungs). These complications are usually easily correctable and treatable.

Monitoring of pacemaker activity is carried out through visits to a specialized pacemaker clinic, most often at the facility where the implantation was performed. A pacemaker check-up includes recording the heart’s electrical activity via ECG, evaluating the pacemaker’s functions, and checking its battery status. The intervals between individual check-ups may be shortened as the time for pacemaker replacement approaches. It is important to adhere to the dates of all examinations and check-ups.

In most cases, a pacemaker will not restrict patients in recreational and other activities. However, it is necessary to avoid hard contact sports and strenuous or repetitive physical activities focused on the upper body. It is also necessary to avoid carrying or holding magnets or magnetized material near the pacemaker. It is advisable to use mobile phones on the opposite side of the implanted pacemaker at a distance of about 20 cm. Certain types of electrical or magnetic energy can interfere with some pacemaker functions. In their own interest, patients should avoid major sources of EMI (electromagnetic interference) caused by electrical appliances in poor technical condition or improperly grounded, electrical equipment producing large amounts of energy, e.g., industrial generators, arc welders, medical devices (magnetic resonance imaging, therapeutic radiation, transcutaneous nerve stimulation), metal detectors, and security systems in stores and airports. At airports, patients should present an identification card so that they do not need to pass through a metal detector. Before undergoing a medical procedure or examination (electrosurgery, electrocautery, cardioversion, lithotripsy, radiation therapy), the patient should inform the doctor that they have an implanted pacemaker. The pacemaker will operate safely during chest X-rays, ultrasound examinations, CT scans, mammography, and X-ray fluoroscopy.