Pacemaker implantation - for Atrioventricular block

Description

• addIndications

  The major beneffit is in case of patients who have cardiac failure with low ejection fraction (<35%; the ejection fraction is the measurement of how much blood is being pumped out of the left ventricle of the heart (the percentage)), wich are at high risk for developing severe arrythmias.

  Indications for CRT -ICD include:

  •symptomatic cardiac failure

  •optimum treatment for heart failure, but still symtomatic

  •delayed electrical activation of the heart (such as intraventricular conduction delay or bundle branch block)

  •patient who have a history of cardiac arrest or are at risk for cardiac arrest

  Indications for pacemakers include:

  Absolute indications for pacemaker placement include the following:

  •Sick sinus syndrome

  •Symptomatic sinus bradycardia

  •Tachycardia-bradycardia syndrome

  •Atrial fibrillation with sinus node dysfunction

  •Complete atrioventricular block (third-degree block)

  •Chronotropic incompetence (inability to increase the heart rate to match a level of exercise)

  •Prolonged QT syndrome

  •Cardiac resynchronization therapy with biventricular pacing

  Relative indications include the following:

  •Cardiomyopathy (hypertrophic or dilated)

  • Severe refractory neurocardiogenic syncope

  Temporary emergency pacing is indicated for therapy of significant and hemodynamically unstable bradydysrhythmias and for prevention of bradycardia-dependent malignant dysrhythmias.

  Examples include:

  •refractory symptomatic sinus node dysfunction,

  •complete heart block (see the image below), alternating bundle-branch block, new bi-fascicular block, and bradycardia-dependent ventricular tachycardia.

  Examples of indications for prophylactic temporary pacing include:

  •insertion of a pulmonary artery catheter in a patient with an underlying left bundle-branch block

  •use of medications that may cause or exacerbate hemodynamically significant bradycardia

  •prophylaxis during the perioperative period surrounding cardiac valvular surgery

  •Lyme disease or other infections (Chagas disease) that cause interval changes, and prolonged PR intervals.

• addBefore procedure - Preparation

  Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

  You will be asked to sign a consent form that gives permission to do the procedure.

  In addition to a complete medical history, your doctor may perform a physical examination to ensure you are in good health before you undergo the procedure. You may also undergo blood tests and other diagnostic tests.

  You will be asked to fast for eight hours before the procedure, generally after midnight.

  If you are pregnant or suspect that you are pregnant, you should notify your health care provider.

  Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).

  Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

  Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure. If you take Sintrom, the results of your INR test (a blood test to evaluate the blood clotting) must be within a suitable range before the implant procedure can be performed. You will likely need to stop taking anticoagulant medications (Warfarin) or antiagregant medications, including aspirin or plavix, a few days before the procedure.

  Your doctor may also ask you to stop taking other medications, such as those that control your heart rate.

  Do not stop taking any of your medications without first consulting with your healthcare provider. Ask your doctor which medications you should stop taking and when to stop taking them.

  Based on your medical condition, your doctor may request other specific preparation.

  A very important element is cardiac echography. In case of cardiac failure, a special echocardiography searching differents parameters (for asyncronism) is needed before your doctor can tell you what kind of device is proper for you ( if you need a biventricular device).

• addAfter procedure - Recovery time

  This is a minimally-invasive procedure, so the recovery is usually quick. Most of the patients can leave the hospital the day after the procedure, unless the epicardial approach was used during the procedure ( in this case the hospitalization can be longer: 3-5 days). At home check out for fever, pain or alteration at the incision place.

  In the hospital : you will be connected to monitors that will constantly display your electrocardiogram tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level.

  A chest X-ray will be done after the device implant procedure to check your lungs as well as the position of the device and lead(s). Also, your doctor will repeat the ecocardiogram.

  At home : You’ll also review your home-going instructions, including incision care, activity guidelines and follow-up schedule. You should not move your arm above your shoulder. Take a pain reliever for soreness as recommended by your doctor. Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

  Long term follow-up include Holter EKG records, echocardiogram evaluations according to the follow-up schedule. You need to know that the device has a time-life between 3 and 6 years, so you need to complete the follow-up according to your doctor receommendations.

  You will receive a ID card that tells you what type of device and leads you have, the device manufacturer, the date of the device implant and the doctor’s name who implanted the device.

  Although technologic advances have greatly reduced the potential effects of EMI, patients should be advised to avoid strong electromagnetic fields because of potential interference with sensing circuitry. Examples of potential hazards include arc welders, large generators, and magnetic resonance imaging (MRI) magnets. Household appliances, microwave ovens, cell phones, and hand-held metal detectors (used for security screening) should not pose a serious threat.

  A shock from an implantable cardioverter-defibrillator (ICD) is generally painful. Patients should be advised of this in advance. Although implantable cardioverter-defibrillators (ICDs) are extremely effective in terminating life-threatening arrhythmias, many patients require adjunctive therapy to reduce the frequency of arrhythmic events that require therapy. This generally consists of pharmacologic therapy, and, particularly in cases of failure of drug therapy, radiofrequency catheter ablation. Inappropriate shocks may be delivered for atrial fibrillation, sinus tachycardia, and other types of supraventricular tachycardia, prompting ICD reprogramming or adjunctive therapy.

• addOther information

  Is it painful?

  The doctor will use local anesthesia, so the patient will not feel any pain, and after the procedure it will received pain drugs if needed (you may feel discomfort at the device implant for a few days). A medication will be given through your IV to relax you and make you feel drowsy, but you will not be asleep during the procedure.

  How long does it take?

  Usually, the device implant procedure may last from 1 to 5 hours and it takes place in a special room – the electrophysiology lab.