Pacemaker APPLICATIONS CLASSIC PACE MAKER

Our heart is an organ that works with electrical impulses it produces. The stimuli coming out of the right atrium of the normal heart, which we call the sinus node, spread to the ventricles after passing through the atrio ventricular node, which is located between the atria and ventricles of the heart. Thus, the electrical impulse produced in the sinus node is transmitted to all cardiac muscle cells, and the contraction of the heart occurs. A problem that may occur in the production of these electrical impulses in the heart or any disruption in their transmission will affect normal heart contractions and cause arrhythmia. As a result, the heart cannot pump enough blood that the body needs, and the patient experiences complaints such as palpitations, dizziness, fatigue, fainting (syncope), and stupor. Devices used to ensure the regular functioning of the heart by generating electrical impulses and producing rhythmic electrical impulses required for heart contraction in people whose electrical system is interrupted due to any disorder, such as the heart cannot generate sufficient electrical stimulation or cannot deliver sufficient electrical stimulation to the entire heart tissue. It is called pili (pace maker). While the first output of pacemakers (Pace Maker) was intended to be used in the diseases that develop as a result of slow beat of the heart (bradycardia), in recent years, in rhythm disorders (antitachycardia batteries, cardioverter-defibrillators that we call automatic shock devices (ICD) and heart failure (Bi-ventricular Pacemaker, CRT/CRT-D) has also started to be used. Pacemakers can be divided into temporary and permanent pacemakers. Temporary pacemakers are designed for use in emergencies, while Permanent pacemakers are designed for situations where continuous use is required. Temporary pacemakers are designed for emergency situations or abnormal heart It is used in cases where the condition causing the rhythm is expected to improve, for example, in cases where the heart is slow due to medication. Temporary pacemakers can also be used to provide adequate heart rate until a permanent pacemaker is placed when necessary. Temporary pacemaker is used in patients with heart attack, in patients with tachycardia, after open heart surgery and It can also be applied in other situations where necessary. The generator that provides the electrical stimulation in temporary pacemakers is quite large and is outside the body. The electrode provides the connection with the heart. Temporary pacemakers do not stay in the patient for a long time. If the event is thought to be permanent, the temporary pacemaker is removed and the permanent pacemaker is inserted into the patient. Permanent pacemaker is used in cases where the event that requires a battery to be inserted is permanent. The generator that will provide the electrical stimulation is placed in the chest or abdomen by creating a pocket under the skin. The battery is usually placed on the left side of the chest wall in practice. If the pacemaker is to be placed on the chest wall, the patient may also be asked about his preference on which side to place the pacemaker. In general, we can say that a pacemaker consists of two parts. The first of these is the generator, the part where electrical impulses are generated and can be described as the brain of the battery. The second part is the part called the Electrode, which looks like a wire or cable that transmits the electrical impulses in the heart to the destination of the impulse. The generators of the Permanent Pacemakers that produce the electrical stimulation weigh 12.5-15.5 g, and the weight varies according to the brand or the battery to be applied. Permanent pacemakers carry lithium-containing batteries. These batteries can be placed on the right or left side of the body in the chest wall or in the abdomen when necessary. One end of the electrode wire, which transmits the electrical impulse produced in the generator to the heart tissue, is connected to the generator. The other end of the lead is passed through the blood vessels and inserted into the atrium or ventricle of the heart. The operating speed of the installed Permanent Pacemaker can be adjusted externally according to the patient’s needs. Although the average life of the batteries varies depending on the patient’s disease state, the characteristics of the battery and some environmental factors, it is between 5-10 years. Thanks to the electronic system in the generator, the device shows how much life is left on average during the battery checks made at certain periods. According to the results of the controls, the generator can be changed on time. Prior to the implantation of a pacemaker, approval is obtained from the patient/patient relatives for the pacemaker application. Temporary pacemaker applications are usually performed while the patient is in the hospital due to heart disease. Temporary battery application is performed in the patient’s room or in the catheter laboratory, depending on the urgency and the circumstances. If necessary, the patient can be given a sedative, and after local anesthesia is applied to the area to be treated, a small sheath is placed in the neck or groin area, and the electrode is passed through this sheath and delivered to the heart. With X-rays called scopy, if necessary, the electrode is placed in the most suitable place in the heart. The outside generator is fixed in a suitable place. Patients should avoid touching the generator standing outside and limit their activities while the temporary battery is in use. In some cases, a temporary pacemaker can be connected to the heart with a needle through the patient’s chest wall or, rarely, through the esophagus. Permanent pacemaker application is a more invasive procedure that can be performed in the cardiac catheterization laboratory, electrophysiology laboratory, hospital operating room, or outpatient surgery department, and is considered a minor surgical procedure. By monitoring the patient. Local anesthesia is applied to the area to be treated. The application area is cleaned and shaved. If the pacemaker is to be placed in the chest wall, which we call endocardial implantation, the procedure begins with a small incision just below the collarbone to create a small surgical pocket. By placing the electrodes from the generator in the right atrium or right ventricle. The tip of the electrode is attached to the inner surface of the heart. If there is more than one electrode, the process is repeated. The generator is placed in a pocket that opens below the collarbone. The incision opened after the procedure is closed by suturing. The application time of the procedure is approximately 1 hour. After the wound is completely healed after the procedure, the pacemaker placed under the skin on the chest wall can be noticed as a swelling under the skin. However, in some patients, if the subcutaneous fat layer is high, this swelling may not be obvious, and even when the patient is viewed from the outside, it may not be understood that the battery is inserted. Epicardial placement is rarely performed in pacemaker applications and is used in some congenital heart diseases or if the patient is a child, in cases where the wire is not suitable for passing through the veins to reach the inner surface of the heart. In epicardial insertion, the electrode is placed on the outer surface of the heart. In this method, the surgeon opens the chest wall and places the electrode on the surface of the heart. The generator is placed under the skin in the upper abdomen. Shortly after insertion, a chest X-ray is taken to check that the device is properly placed for post-procedure follow-up. Short-term hospitalization is recommended after permanent pacemaker implantation. In the post-procedure period, the patient is informed about the activities that he can and cannot do. Patients should avoid contact sports, heavy lifting, sudden and violent movements of the arm on the side of the pacemaker, so that the electrode does not dislodge. After the seam in the place where the pacemaker is placed is closed, there may be stiffness at the seam for a while, and the stiffness will disappear over time as the wound heals. However, if there are any signs of infection, such as discharge, redness, fever, inflammation of the surgical wound, the doctor who performed the procedure should be notified immediately. The stitch site heals in approximately 7 to 10 days. The patient can wash and take a shower by paying attention to the seam area and drying this area. Approximately one or two weeks after the application, the patient is called for control. In the control, if necessary, sutures are removed and the suture site is examined for signs of infection. A pacemaker ID card is prepared and given to patients with permanent pacemakers on the day the pacemaker is inserted. The patient must always carry this card to be with him in case of emergency. After the patient’s 1st or 2nd week control, the next battery controls are done approximately two months later and then every 6 or 12 months. In these controls, various features such as battery operation and the remaining life of the generator are examined and evaluated. Serious complications are rare in pacemaker application. These adverse events occur in 1-2% of cases. Some of these can be said as serious bruising or bleeding, Clot formation, Tearing of the blood vessel, Stroke, Heart attack, Air leakage into the space between the chest wall and the lung, the electrode coming out of the heart, malfunction of the pacemaker and infection. Patients who have undergone pacemaker application should inform their doctor immediately if some symptoms and complaints occur. These symptoms and complaints are briefly; discharge at the wound site, with or without fever, redness at the suture site, increased warmth, tenderness or swelling, swelling of the arms, legs, wrists and ankles (oedema), Increased shortness of breath, prolonged hiccups or difficulty breathing, fainting, dizziness, blackouts , palpitations, chest pain and recurrence of any complaint that existed before the procedure.

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