Implantable heart devices are electronic, battery-operated medical devices used to control the rhythm, support heart and circulation, or monitor rhythms. The devices include –
Implantable Heart Devices
Pacemakers: A pacemaker is an electronic device, to assist the heartbeat in a specific way. It has few insulated wires, battery and a circuit, programmed to regulate the electrical impulses in the heart. It is surgically placed by a cardiologist below the collarbone in the chest. Pacemakers may be implanted temporarily or permanently and may or may not be monitored by the doctor from the hospital.
Pacemakers may be of different types, depending on the area of the heart where the impulses are distributed.
Pacemaker implantation may be indicated in heart conditions, not limited to:
Biventricular pacemakers or Cardiac Resynchronization Devices (CRDs): Biventricular pacemakers work similar to pacemakers but also send electrical impulses to the heart to resynchronize ventricular contractions (pumping of lower chambers of the heart). Also known as CRDs, they are used in patients with heart failure who do not respond to medicines. This pacemaker helps to bring coordination between atria and ventricles so they both contract in synchronized heart rhythm. The device and the benefits may be monitored by the doctor sitting at the hospital.
Implantable Cardioverter Defibrillators (ICDs): Implantable cardioverter defibrillators (ICDs) devices are used to restore heart rhythm and prevent cardiac death. It is helpful in patients with abnormal heart rhythm (arrhythmias) and who are at risk of recurrent, sustained ventricular tachycardia or ventricular fibrillation.
The ICD detects abnormal rhythm and automatically shocks the heart to restore regular heartbeat and blood circulation. Many ICDs come with an inbuilt pacemaker which normalizes slower heartbeats. The ICDs may be implanted in the chest wall below the collarbone or beneath the skin (subcutaneous internal cardioverter defibrillator).
Left Ventricular Assist Devices (LVADs): An LVAD is used to support the heart in maintaining effective blood circulation by assisting left ventricles, the lower chamber that pumps blood out to the body.
LVAD is used for patients who are awaiting a heart transplant, thus it is also known as “bridge to transplant”. This device assists blood pumping and prevents further deterioration of already-weakened heart thus sustain the life of patient till a heart is available for transplantation. It is also used in end-stage heart failure when heart transplantation is not an option and thus it is also called as “Destination therapy”.
Heart rhythm monitors or Implantable Cardiac Loop Recorders (CLRs): Implantable loop recorders are wireless cardiac monitors that continuously record heart rhythm for years, usually up to 3 years. Doctors recommend implanting loop recorders in patients who have a history of unexplained heart palpitations and fainting spells that go undetected by devices such as Holter monitors. ILRs provide data much like that received from an ECG or EKG. The device finds its utility also in patients with atrial fibrillation and/stroke of undermined cause. Cardiac loop recorders are available which might either be inserted in the chest or beneath the skin of the patient.
Implantation surgery for pacemakers and ICDs:
A heart device is implanted beneath the clavicle or collarbone & bridge is formed from the device to the heart. The surgery takes about an hour or two under sedation and requires an overnight stay.
In most of the cases, the heart device is implanted in the chest wall beneath the collarbone and connected via leads to the heart. After 2 weeks from the day of surgery, the doctor checks the implantation site, confirms the working condition of the device, and looks for any arrhythmias experienced since then. The patient may then be scheduled for frequent, usually biannual doctor visits.
Subcutaneous devices, such as subcutaneous internal cardioverter defibrillator and cardiac loop recorders, are otherwise implanted under the skin beneath the collarbone (as for cardiac loop recorder) or at the side of the chest below the armpit (as for an internal cardioverter defibrillator).
The latest cardiac loop recorders are very small and can be injected under the skin. The procedure is done under local anesthesia and the patient may return home soon after. In this procedure, a small puncture is made in the skin to the left of the collarbone and the recorder is inserted via a small plastic applicator. The puncture is then sealed using solvable sutures.
Implantation surgery for LVAD:
LVAD is heart pump which is implanted just below the heart or the upper part of the abdomen. The one end of the device is connected to the left ventricle and the other end is connected to the aorta so, the device collects blood from the left ventricles and sends it to the aorta. A tube from the LVAD is brought out of the abdominal wall, through the skin, and connected to an external control device (portable options are available) and power source.
Temporary pacing: Temporary pacing may be performed either by an internal or external process. This method is opted only in reversible health conditions until a pacemaker is available for permanent pacing.
Epicardial pacing is used during surgeries.
Transvenous pacing is performed by placing a bridge (electric lead) through the vein. The bridge connects to the heart through venous access and is secured to the skin. The patient is evaluated for infections and heart conditions daily until the bridge is being used with an external pacemaker.
External pacing is performed either mechanically by percussive pacing or electrically by transcutaneous (electric pulses through the skin above chest) pacing. External pacing is usually not reliable and used only until internal pacing can be achieved.
Pacemaker: The battery of the pacemaker may last for anything between 5 to 15 years. The pacemaker’s pulse generator is replaced once the battery wears off. At the time of replacement, sometimes the leads may be left as it is and replaced only at a later date. The replacement procedure is quicker and requires less time for recovery as compared to the implantation procedure.
ICD lasts for 5 to 10 years. When the battery is nearly out, the shock generator is replaced with the new one in a minor outpatient procedure.
LVADs last for at least 7 years, and the batteries last for 14 hours.
Cardiac Loop Recorders: A CIR lasts for up to 36 months (3 years) and needs to be replaced regularly. The device is removed in a procedure similar to implantation surgery through the original incision site.
What is the average life of a pacemaker and other heart devices?
With advancements in medical technology, pacemakers are now considered as the gold standard treatment for many conditions that disrupt the heart’s electrophysiology.
Pacemaker implantation is a surgical procedure generally carried out under local anesthesia. It carries with it the risks of a surgery like, but not limited to:
Some complications may arise due to the technique of placement of the device, which include:
The patient may stay in hospital for a day or two after surgery. The device is tested before the patient is discharged. The patient may be prescribed pain medicines to manage pain in incision area that may last for a few days or weeks. The healthcare team shall advice on:
Some precautions advised by cardiologists are enlisted below:
Avoid
Inform your doctors if you are advised any medical procedures like MRI scan, electro-cauterization procedure for any surgery or shock-wave lithotripsy for treating kidney stones as it can interfere with the pulse generation.
What precautions should I take with my pacemaker or implanted heart device?
For heart device implantation surgery, it is important to ensure that the hospital has the standard infrastructure and trained team to support the pre-operative and post-operative needs of the treatment.
The most important consideration while choosing a hospital for heart device implantation surgery is the cardiothoracic surgeon and his team. The success of surgery depends on the –
Although pacemaker implantation is generally carried out under local anesthesia, factors like patient’s medical condition that may warrant an extended stay in the hospital, thus impacting the cost of the procedure in addition to the cost of the device, investigations and medications as required.
The cost of surgery depends on many factors, namely:
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