Pacemaker implantation
Arrhythmia could be considered as a delayed-action bomb, which increases a likelihood of stroke and is the life-threatening event. Professor, habilitated Dr. Audrius Aidietis, a cardiologist working in Vilnius “Kardiolita Hospital” asserts that modern medicine provides the means to treat certain arrhythmias by implanting a cardiac pacemaker (CPM) this rather complex surgery is a lifesaving intervention, allowing further to enjoy many years of high-quality life.
After these very demanded services of cardiac pacemaker implantation have been introduced and offered at “Kardiolita Hospital” now the Clinic offers the complete range of high-quality cardiology services – from consultations to the most complex interventions and surgeries.
Implantable CPM usually are used to treat sick sinus syndrome and heart conduction disorders such as atrioventricular (AV) block and some other intraventricular conduction blocks. Professor, habilitated Dr. Audrius Aidietis, who together with the colleagues carries out CPM implantation surgeries at “Kardiolita Hospital” explains that after such surgery patient's quality of life improves significantly and he/she again feels like a healthy person. The oldest patient who underwent such surgery was 86-year-old.
There are solutions available before the surgery
Prof. hab. Dr. A. Aidietis told that Holter ECG monitoring can be applied to the patients suffering from sick sinus syndrome before the surgery; this monitoring involves electrocardiogram recording for 24 hours or longer. This examination allows detection of irregular heartbeats (extrasystoles) and shows the lowest and highest heart rate (bradycardia) and (tachycardia) episodes during the day.
A cardiac event recorder can be implanted subcutaneously for the patients who experience the episodes of unconsciousness of unclear origin; this device continuously records and saves heart activity and in case of life-threatening arrhythmia this can be done by a recorder for a couple of years. These data during the scheduled appointment can be reviewed by a physician, who can offer to take certain actions such as a surgery or any other intervention explains the physician cardiologist of “Kardiolita Hospital”.
How is the surgery performed?
Prof. hab. Dr. A. Aidietis told that during the CPM implantation a small skin incision is made few centimetres below the clavicle and a bed for the pacemaker is formed; later this bed under the skin or under the muscle is used to accommodate a pacemaker and the catheter electrodes through the veins are introduced into the heart.
A local anaesthesia is applied before the surgery, however considering patient’s condition and the underlying heart problems the general anaesthesia can be applied. In case the placement of catheter electrodes through the veins is not possible; they can be introduced applying a more complex method – through a pericardium, which is a cardiac sack covering the entire heart; this method allows access to the heart surface. A skin and pericardium incision is made and after reaching a heart surface we use this site to place special pericardial electrodes. Usually, the patient can be discharged in few days after the surgery, - said the physician cardiologist from “Kardiolita Hospital”, which employs probably the best physicians in Lithuania.
Prof. hab. Dr. A. Aidietis said that anticoagulants taken by the patient can be one of the factors that can make CPM implantation most problematic.
“When the patient is diagnosed with atrial fibrillation, he/she must take anticoagulants - blood thinning medicines; this is done to avoid stroke. During CMP implantation for such patient, we insert an additional drain and these patients are monitored carefully after the surgery; antibiotics can be prescribed, if needed. This is very important as blood can accumulate in the site of surgery around a battery of the implanted pacemaker; in such case there is a 22-fold higher risk of purulence “, – explained a physician of “Kardiolita Hospital” Cardiology Centre.
How has patient’s quality of life changed?
The cardiologist asserts that patients’ quality of life after the surgery improves significantly: “The implanted CPM is equipped with motion sensor, which automatically increases heart rate up to the predefined programmed level; this leads to significantly improved previously poor physical load tolerance. CPM allows atrial and/or ventricular stimulation; therefore, dizziness and previous fainting episodes resolve. If the patient reports certain complaints, we can react by adapting CPM settings.”
Prof. hab. Dr. A. Aidietis indicated that service time of the CPM depends on the battery capacity. Usually, a minimal stimulation energy of commonly implanted CPM varies from 0.5 to 2 mV; and is sufficient for 5-7 years of life. Depending on the daily energy consumption by the pacemaker, its service time can be extended up to 14 years.
The physician cardiologist explained that implanted CPM solves cardiac problems for many years and at the same time is resistant to the external factors.
According to Professor A. Aidietis “The CPM that were implanted in 1958 were sensitive to external factors such as powerful magnets. Exposure to such magnets resulted in increased heart rate up to 100 beats per minute. Modern CPM are completely resistant to portable telephones and other electrical devices present nearby, such as electric shavers and even magnetic resonance”.
Care is of great importance after CMP implantation
The physician of Vilnius “Kardiolita Hospital” stated that maintenance of CMP after implantation surgery is very important. First of all, a proper integration should be ensured and formation of haematoma (restricted local accumulation of blood in the tissues due to lesion of the vascular wall) should be prevented.
“Usually, patients should see their physician at least once per year after the surgery, however, if problems occur, visits every 2-3 months are recommended. Such visit frequency is recommended for the patient, who received implantable CPM because of sick sinus syndrome with atrial fibrillation. “It happens that because of CPM effect the patients do not feel the atrial fibrillation episodes, though CPM records them”, – explains Prof. hab. Dr. A. Aidietis.
According to the cardiologist because of this reason frequent patient's visits allow monitoring of data recorded by a CPM as well as assessing frequency and duration of dangerous fibrillations that were insensible to the patient. Considering this important information obtained from a CPM, physician can adjust treatment plan or pacemaker settings.
To avoid negative consequences patients with implantable CPM should remember to inform other physicians. For instance, even during a minor surgery, if electrocauterization – tissue destruction by special electrodes heated by electric current is used, a bipolar rather than unipolar electrode should be used. Otherwise, ventricular fibrillation can be triggered of CPM can be blocked resulting in life-threatening situation. Moreover, – added Prof. Hab. Dr. A. Aidietis, –some other procedures such as radiotherapy for malignant tumours or renal stone splitting procedures pose additional risk for the patients living with implantable CPM.
