Definition and Overview

A cardiac pacemaker replacement is a minor surgical procedure that involves changing an old or defective pacemaker with a new one.

In certain cases, a person's heartbeat can become irregular due to old age or a heart disease or condition like scarring and blockages. These are often treated with other options such as medications and change of lifestyle. But if the problem is severe or does not respond to other conservative treatment approaches, a pacemaker is considered. This is a small implantable device placed just underneath the skin. It sits close to the heart since it helps regulate the electrical activity and thus the heartbeat.

The pacemaker’s main task is to synchronise the heartbeat in case it slows down, goes fast, or follows an irregular pattern. It is composed of leads that are connected to the walls of the heart and a generator that includes the battery. In most cases, only the battery is replaced.

Who Should Undergo and Expected Results

Just like any device, the pacemaker has its own shelf life. In general, the battery can last up to 8 years. However, there are cases when they may have to be changed earlier, depending on the workload, the number of leads used, and other diseases or conditions that affect the performance of the heart. If arrhythmia or the irregular heartbeat happens more often, the pacemaker may have to be replaced within four years.

To know if the pacemaker requires changing, the cardiologist, a specialist of the heart, conducts a heart exam twice each year, more often if a new heart condition diagnosed is diagnosed. However, it is important to note that not all problems concerning the pacemaker would need changing. In certain cases, the settings may only have to be adjusted using a programming device.

How Does the Procedure Work?

The procedure is performed by a cardiologist. It is a minor surgery that involves only local anesthesia to numb the pain and sedative for patient comfort. Before the surgery, the patient goes through different physical tests while women of childbearing age may be examined for possible pregnancy. All patients are advised to fast a night before the procedure.

The first step is to remove the pacemaker. To do this, the doctor makes a tiny incision on the spot where the old pacemaker is set to access it. The old pacemaker is then disconnected from the leads, and a new one is implanted. Throughout the procedure, the patient’s vital signs, such as blood pressure, are monitored. Depending on the condition of the leads, they may also have to be changed. If it’s the latter, they are directly attached to the new pacemaker, which is then tested before its settings are adjusted according to the ideal heart rhythm and activity of the patient.

The procedure is normally performed on an outpatient basis, but certain cases require the patient to spend overnight in the hospital for monitoring.

Possible Risks and Complications

The risks and complications associated with pacemaker replacement are often minor. The patient may feel discomfort and a heavy feeling especially in the upper section of the chest, but this will go away over time. Also, because of the incision, an infection may occur, but this can be minimised or prevented with antibiotics.

The patient may also experience bleeding and bruising and may not be able to exercise or engage in strenuous activity for a few weeks.

References:

  • Tracy CM, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities — A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. The Journal of Thoracic and Cardiovascular Surgery. 2012;144:e27.

  • What is a pacemaker? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/pace/. Accessed Jan. 29, 2013.

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