It can correct this rhythm. Because it has a pacemaker built into it, a defibrillator also has the capability of stimulating the heart like a pacemaker, to help stop fast rhythms, at times, and to prevent the heart from getting too slow. These devices are highly reliable.
The device often has to be programmed to the patient's needs, the medical condition and the situation.
Cost is an issue. Some people must have a device implanted at any cost, as they most certainly would not survive without that device. In those cases, devices are placed without question. There are other situations where a device implantation may not be completely clear, necessary, or allowed by the present billing structure. Currently a high quality of battery — a lithium battery — that wears out slowly is used. There is a point before the battery fails when we have several months to decide what to do.
The battery's energy supply does wear out, and it can vary depending on the kind of device--some devices will last maybe five years, maybe ten years, and some people get more life out of it and some get less, depending on the situation and how much they use it.
What we do when the battery reaches its end of life is we open up the pocket where the device is located, which is under the skin, and we unscrew the leads. Then we plug in a new device and close up the skin. We put in a brand new device, often a higher quality, more technologically advanced device. A pacemaker implant can be done under local anesthesia, but most patients prefer to have sedation, so we use conscious sedation, where the patient can respond to us. We do not generally place a tube down the throat for most people unless we use general anesthesia.
For defibrillator implants we have to use larger amounts of conscious sedation because we need to test the device. We put the patient into a cardiac arrest and use the defibrillator to shock the patient to normal rhythm. That may sound scary, but in fact that is a very safe procedure. We are prepared for all consequences, and it is something necessary. It requires a deeper sedation during the time of the testing of the device. For biventricular devices, in which we place leads into the left side of the heart through a vein, the devices and the leads are more complicated to put in.
The implants are more challenging and they take longer. For most people, the device will be needed for the rest of their life. There are specific individuals who may get a device for prophylactic purposes, or for some reason the condition resolves.
That does not happen very often. If it can be determined for a fact that the problem has resolved, then occasionally we remove devices. We often use devices in conjunction with medications. We do not look at devices in general as a substitute for medication.
On the other hand, no medication can substitute completely for an implanted defibrillator. What some people are hoping for is when they get a device put in they can come off all of their medications--this is not the case. In fact, devices usually work with medications much better than they work by themselves.
For some people we try to treat life-threatening rhythm disturbances with medication first before we place a defibrillator in. As time has gone by, we have learned more and more about the safety and effectiveness of implanted defibrillators.
We have moved toward using devices more than anti-arrhythmic drugs, specifically, to try to lower the risk of an arrhythmia and its consequences. This is because many of the anti-arrhythmic drugs have side effects and some toxicity.
But that does not mean that we stop the other drugs used--such as drugs used to lower cholesterol, or drugs to help the heart condition. For pacemakers, occasionally we do use medication to keep the heart going faster, but that generally is not the best approach.
There are some cases when we use medications to prevent fast rhythms in conjunction with a pacemaker or a defibrillator. For biventricular pacemakers, if the heart function improves enough, we can stop some of the medications that appeared to be necessary before. For each person there often is some judgment as to what the right thing is to do. Based on those guidelines then there is no way you can tell everyone what the right thing is, it requires some judgment.
If there is any concern, consider getting another opinion. You'll likely be awake during the surgery to implant the pacemaker, which typically takes a few hours. A specialist will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax.
Your chest is cleaned with special soap. Most pacemaker implantations are done using local anesthesia to numb the area of the incisions. However, the amount of sedation needed for the procedure depends on your specific health conditions. You may be fully awake or lightly sedated, or you may be given general anesthesia fully asleep.
One or more wires are inserted into a major vein under or near your collarbone and guided to your heart using X-ray images. One end of each wire is secured at the appropriate position in your heart, while the other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone. A leadless pacemaker is smaller and typically requires a less invasive surgery to implant the device. The pulse generator and other pacemaker parts are contained in a single capsule.
The doctor inserts a flexible sheath catheter in a vein in the groin and then guides the single component pacemaker through the catheter to the proper position in the heart. You'll likely stay in the hospital for a day after having a pacemaker implanted.
Your pacemaker will be programmed to fit your heart rhythm needs. You'll need to arrange to have someone drive you home from the hospital. Your doctor might recommend that you avoid vigorous exercise or heavy lifting for about a month.
Avoid putting pressure on the area where the pacemaker was implanted. If you have pain in that area, ask your doctor about taking medicines available without a prescription, such as acetaminophen Tylenol, others or ibuprofen Advil, Motrin IB, others.
It's unlikely that your pacemaker would stop working properly because of electrical interference. Still, you'll need to take a few precautions:. Security systems. Passing through an airport metal detector won't interfere with your pacemaker, although the metal in the pacemaker could sound the alarm.
But avoid lingering near or leaning against a metal-detection system. Devices that are unlikely to interfere with your pacemaker include microwave ovens, televisions and remote controls, radios, toasters, electric blankets, electric shavers, and electric drills.
Having a pacemaker should improve symptoms caused by a slow heartbeat such as fatigue, lightheadedness and fainting. Because most of today's pacemakers automatically adjust the heart rate to match the level of physical activity, they may can allow you to resume a more active lifestyle.
Your doctor should check your pacemaker every 3 to 6 months. Tell your doctor if you gain weight, if your legs or ankles get puffy, or if you faint or get dizzy. Most pacemakers can be checked by your doctor remotely, which means you don't have to go into the doctor's office.
Your pacemaker sends information to your doctor, including your heart rate and rhythm, how your pacemaker is working, and how much battery life is left. Your pacemaker's battery should last 5 to 15 years. When the battery stops working, you'll need surgery to replace it. The procedure to change your pacemaker's battery is often quicker and requires less recovery time than the procedure to implant your pacemaker.
If you have a pacemaker and become terminally ill with a condition unrelated to your heart, such as cancer, it's possible that your pacemaker could prolong your life. Doctors and researchers vary in their opinions about turning off a pacemaker in end-of-life situations.
This is controlled by your heart's electrical conduction system. A pacemaker is sometimes used to correct slow or irregular heartbeats called arrhythmias. These arrhythmias may cause you to feel light-headed, breathless or even experience black-outs. If your heart rate is too slow, the pacemaker will send an electrical signal to the heart muscle to start a heartbeat.
You are unlikely to feel your pacemaker when it activates so don't let this worry you. When your heart is beating normally, the pacemaker will not be activated. Pacemakers are made up of a long-lasting battery and an electronic circuit in a metal case that sits under your skin. The pacemaker is connected to your heart muscle by one or two leads. Modern pacemakers can be very reliable and comfortable. Having a pacemaker can greatly improve your quality of life and for some people it can be life-saving.
A pacemaker can relieve some arrhythmia symptoms, such as fatigue and fainting. A pacemaker may help a person with abnormal heart rhythms to resume a more active lifestyle. There are several types of pacemaker available. Together with your doctor, ask about the options and talk about what may work best for you. The entire procedure usually takes about one hour, although this can vary.
You may experience some discomfort and bruising around your pacemaker site, but serious complications from pacemakers are very unusual. You will need an assessment by a specialist to check on your condition before you return to driving.
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