Artificial pacemaker

The implantation of an artificial pacemaker is a medical procedure that allows to control cardiac arrhythmias (the formation and conductivity of electrical impulses). These abnormalities cannot be managed through pharmacological treatment, or can be treated this way to a very limited degree. 

Sometimes, the implantation of a pacemaker is necessary before a planned medical procedure of the atrioventricular junction  in chronic atrial fibrillation with an excessively increased heart rate. The implantation of a pacemaker is a treatment subjected to choice. The procedure of the implantation of a pacemaker is carried out in the operating room. Before the procedure, the patient should present a set of basic medical test results, i.e. the ECG, the complete blood count, the blood type, the blood level of electrolytes and urea, the coagulation parameters (the INR, the prothrombin time, the activated partial thromboplastin time, and fibrinogen). Before the procedure, the patient has to be on an empty stomach. The procedure is carried out under a local anaesthetic in the subclavian area. After anesthetizing the patient, an incision is performed in the subclavian area, the tissues are dissected in order to expose the cephalic vein or a puncture of the subclavian vein is performed (the area of the shoulder and clavicle). 

The access to these vessels may cause unpleasant sensations; however, the patient, who is fully conscious during the procedure, can report these discomforts to the surgeon, which will allow to remove them. Then, an electrode or electrodes are introduced to the heart through the vessels mentioned above, and the pacemaker is placed in the bed between the subcutaneous tissue and the muscles below the clavicle. After the procedure, the patient has to be immobilised in bed for some time in order to prevent the displacement of the implanted electrode or electrodes.

The possible complications after the pacemaker implantation procedure include:

Complications related to the implantation of the electrode: the perforation of the heart chambers, an infection, a pneumothorax, a damage/fracture to the electrode, displacement of the electrode, venous embolism and thrombosis.

Complications related to the implantation of the pacemaker:

a hematoma of the bed, an infection, displacement of the pacemaker, pain and damage to the skin, there is a possibility of extending the stay in hospital, a surgical intervention, replacing the implanted pacemaker, increase in the stimulation threshold, sensing disorders, increase in the stimulation level, ineffective stimulation and the stimulation of the thoracic diaphragm.