What is a Heart Battery (Pacemaker)?

What is a Heart Battery (Pacemaker)?

Heart Batterys (Pacemaker) are state-of-the-art electronic devices that can provide electrical stimulation to the heart when necessary. It consists of battery, generator and cables. The metal box containing the electronic circuits that provide energy to the battery and manage the operation of the battery is called a generator. The electrical communication between the heart and the generator is provided by cables called “lead”. The Heart Battery (Pacemaker) detects the electrical signals coming from the heart through these cables and, when necessary, stimulates the heart through these cables.

Why is a Heart Battery (Pacemaker) Fitted?

A Heart Battery (Pacemaker) is inserted because the heart’s stimulation center, namely the sinus node, cannot generate enough stimulation, the heart rate slows down, and the patient can continue to live accordingly.

In Which Situations Is a Heart Battery (Pacemaker) Fitted?

Heart Battery (Pacemaker) is generally placed in people who have heart rhythm disorder and conduction disorder in the heart. People with these problems may have a much slower or faster pulse than normal, and the person’s heart may also have trouble pumping enough blood. The pacemaker is the most effective tool used to solve these problems and significantly improves a person’s quality of life.

What is the Structure of the Pacemaker?

The Heart Battery consists of a generator that produces electrical impulses and an electrode that transmits electrical impulses. Generators carry batteries containing lithium. These batteries are placed inside the right or left chest wall or in the abdomen.

What are the Pacemaker Types?

• Temporary Heart Battery (Pacemaker)

Temporary Heart Battery are devices that are inserted to be removed when the patient’s heartbeat returns to normal. These Heart Battery (Pacemakers), which consist of a cable that reaches the heart by entering from the neck, lower part of the collarbone, arm or groin area, and a small box located on the outside of the body, can be easily removed when the general condition of the patient improves.

• Permanent Heart Battery (Pacemaker)

Generally placed under the collarbone and just under the skin, they are preferred in the treatment of:

• Permanent pacemakers,
• Atrioventricular block,
• Tachycardia,
• Bradycardia,
• Hypertrophic cardiomyopathy,
• And congestive heart failure

And other more chronic diseases.

1. Single Chamber Battery:

It is a type of Heart Battery that consists of a single cable and is used to stimulate only the right atrium or right ventricle of the heart.

2. Two-Chamber Battery:

The batteries used to stimulate both the right ventricle and the right atrium of the heart are called two-chamber Heart Battery (Pacemakers). While one of the two separate cables is placed in the right ventricle, the other is placed in the right atrium and contraction is provided in both the ventricle and the atrium when necessary.

3. Three-Chamber Battery:

This type of battery, also called a biventricular Heart Battery, is known as the Cardiac Reconstruction Therapy Battery (CRT-P) and has an important form of warning needed for the treatment of heart failure.

Thanks to three different cables placed in the right atrium, right ventricle and left ventricle regions of the heart, it is ensured that even the heart muscle, which has lost its strength, contracts correctly and that each chamber of the heart works synchronously.

How is a Heart Battery (Pacemaker) Inserted?

Heart Battery application is performed in sterile operating room conditions or in catheter laboratories. On the day before the procedure, the patient’s intervention areas such as chest, armpit and groin are shaved and each area is cleaned in detail with foam sponges.

Then, the patient is taken to a sterile environment for the procedure and the area to be intervened is cleaned by brushing with disinfectant solutions for 10 minutes just before the procedure. The patient, who is placed in a suitable position for the intervention, is covered with a dry sterile cloth and the procedure is started in the operating room environment.

Although regional anesthesia is generally preferred during heart battery implantation, heavy sedation or general anesthesia may be required in some cases. Veins located in the patient’s neck, armpit, arm or just below the collarbone are preferred for the intervention. The heart battery vein is entered through the catheter and the electrode part of the pacemaker is visualized with a fluoroscopy device and advanced to the heart.

The box-shaped part of the device, called the generator, is most likely placed inside the right or left chest muscle. Then, the incisions made in the vein and muscle tissue are closed, the procedure is terminated and the patient is taken to the recovery unit if necessary.

How is a Temporary Heart Battery (Pacemaker) Fitted?

In most cases, general anesthesia is unnecessary for pacemaker insertion. Instead, the specific area of the body is numbed with local anesthesia.

An x-ray device provides continuous imaging to monitor the surgical site and the positioning of the electrodes within the body.

In the procedure, a major vein connected to the heart is chosen, and an electrode is carefully threaded through this vein into the heart.

The selection of the vein is based on the specific condition of the patient. Commonly used veins for this procedure include the femoral vein in the groin, the subclavian vein near the shoulder, and the jugular vein located in the neck.

How Are Permanent Pacemakers and ICDs Fitted?

The implantation process for permanent pacemakers and ICD devices follows a similar method. The procedure is carried out in a fully sterilized operating room or clinic under local anesthesia, much like the implantation of a temporary pacemaker.

The use of imaging equipment is crucial during both the preparation and the operation stages of the procedure. These imaging tools allow precise monitoring of the area where the pacemaker will be placed, ensuring accurate placement and functionality.

To begin, a small incision, approximately 3 cm long, is made just below the collarbone. Through this incision, the “generator,” which is the core component of the pacemaker, is inserted.

Unlike temporary pacemakers, permanent pacemakers often have more electrodes, which are threaded into the heart’s chamber(s) via a vein situated beneath the collarbone.

Once the electrodes are properly positioned within the heart chambers, they are connected to the generator. The incision is then carefully closed, marking the conclusion of the operation.

Is Heart Battery (Pacemaker) Insertion Risky?

The implantation of a heart battery (pacemaker) is considered a minimally invasive procedure compared to other surgeries.

As such, the likelihood of serious complications arising is quite low. Any issues that may occur after the operation are typically minor and rarely pose a life–threatening risk.

In extremely rare cases, complications such as the rupture of the lung’s membrane layer during the incision or unintentional entry into an artery instead of a vein may occur during the procedure.

Post-surgery infection at the operation site is also uncommon but possible after the patient is discharged. To minimize this risk, antibiotics are often prescribed as a precautionary measure.

Occasionally, the generator or electrodes connected to the pacemaker might shift out of place and even protrude through the skin. If this happens, the surgical area must be reopened to repair and reposition the pacemaker.

Considerations After Heart Battery (Pacemaker) Surgery

Pain may occur during the first week after the procedure. Only pain relievers approved by your doctor should be used during this time.

Fever above 38°C and redness, bleeding, swelling, and discharge at the surgical site are signs of post-operative infection.

One of the most important points to consider after pacemaker surgery is the signs of infection.

Because infections that occur after heart-related procedures can lead to serious health problems.

If any of the aforementioned findings are present, a thorough medical examination is absolutely necessary.

If the pacemaker is implanted in the arm, arm movement on the side where the pacemaker is located may need to be restricted for the first 1-2 months.

And if the pacemaker is implanted in the torso, restricting arm movement is not necessary.

For the first 2 months, it is necessary to avoid lying on the side where the pacemaker is implanted and other activities that put excessive pressure on this area.

The pacemaker device is affected by many radiological radiations such as X-rays and magnetic resonance imaging.

Therefore,

Patients with pacemakers are advised to:

• Avoid passing through X-ray machines at airports,
• Shopping malls,
• Security checkpoints,
• Courthouses, and to request a manual search by showing their pacemaker card to security personnel.

And,

• Power plants,
• Base stations,
• Gun detectors,
• Police radar areas,
• High-voltage power lines

May cause changes in pacemaker function.