TREATMENTS
IMPLANTATION OF A PACEMAKER
PACEMAKER WITH LEADS
Why are you being offered the implantation of a pacemaker?
​Your heart condition requires the placement of a pacemaker. It is a common, reliable and effective treatment for certain heart diseases (most often resulting in a marked slowing of the heart rate) that cannot be controlled by medication. Cardiac pacing is also sometimes used in the treatment of heart failure.
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What is a pacemaker?
​A pacemaker is a small box, containing electronic circuits powered by a battery. It is connected to the heart by one, two or three leads depending on the case. It is able to constantly analyze the rhythm of the heart, especially when it is abnormal, and to stimulate it when necessary without the slightest unpleasant sensation. In addition, this stimulator. ("pacemaker") can store information about the heart rhythm as well as data relating to its functioning.
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What are the principles of implementation and monitoring?
The pacemaker is placed below the right or left collarbone, under local anesthesia with deep sedation (rarely general), during surgery. It is connected to the heart by one or two leads inserted into the atrium and/or the right ventricle. A third lead is sometimes implanted to resynchronize the left ventricle in certain forms of heart failure.
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After the operation, regular follow-ups are necessary to check that the system is working properly. A first check-up is carried out within 3 months after the implant and then regularly (every 6 months to 1 year in general) using a specific computer called a programmer, allowing you to communicate through the skin in a painless way with your pacemaker and to modify the settings if necessary. Monitoring can also, in some cases, be carried out remotely via the telephone network. You will be given a notebook indicating that you have a pacemaker. After several years (duration varies depending on the type of device and the mode of operation), a change of the case will have to be carried out due to wear and tear on the battery.
What are the risks of having a pacemaker implanted?
Like any surgical procedure, the implantation of a pacemaker exposes to a variable anesthetic risk, depending on whether it is a local or general anesthesia, as well as to possible complications in 4 to 6% of cases. These are usually benign but can sometimes be more serious and very exceptionally fatal. Early complications include the risk of bleeding (especially with anticoagulant therapy), infection, damage to a blood vessel, fluid or blood around the heart, pneumothorax (pleural breakage), heart rhythm disturbance and catheter displacement.
Some of these problems may require early reintervention. An allergy to an antibiotic or injectable iodine products should be reported prior to the procedure.
At a distance from the operation, reprogramming of the system may be necessary and reoperation may be justified in the event of system failure (failure or fragility of the pacemaker and/or one or more leads), threat of externalization of the material through the skin or infection.
What are the consequences in my daily life?
Your daily life will most often be very little changed by wearing this device. Precautions should be taken when carrying out medical examinations, in particular the performance of an MRI which is only possible under certain conditions (always indicate that you are wearing such a device because it is necessary to check the compatibility with the performance of an MRI and possibly make adjustments before and after the MRI). Metal detectors will generally be sensitive to your device. Interference (action of a magnetic field or a wave on the device) is rare, but the interferences that may concern you will be told by the implanting doctor.
There are patient associations that can also listen to you.
​er to be painlessly communicated through the skin, to interrogate the intracardiac pacemaker and possibly make changes to the basic parameters. The doctor will proceed in the same way as in the context of the interrogation of a standard pacemaker.
LEADLESS PACEMAKER
Why are you being offered the implantation of a pacemaker?
Your heart condition requires the placement of a pacemaker. It is a common, reliable and effective treatment for certain heart diseases (most often resulting in a marked slowing of the heart rate) that cannot be treated with medication.
​
What is a pacemaker?
A pacemaker is a small box containing electronic circuits powered by a battery. It is able to constantly analyze the rhythm of the heart, especially when it is abnormal, and to stimulate it when necessary without the slightest unpleasant sensation. In addition, this pacemaker can store information about the heartbeat as well as data about its functioning. In the case of a pacemaker without leads, it is a cylindrical capsule, placed directly in the right ventricle.
What are the principles of implanting and monitoring a pacemaker without leads?
A leadless pacing system eliminates the pacing lead, the creation of the pacator compartment, connectors, and some complications associated with the implantation of a conventional pacemaker. This leadless system replaces surgery with percutaneous access. This is a new technique, much more recent than conventional stimulation and for which the available data are satisfactory. Evaluations are underway to compare the results with traditional stimulation. The leadless pacemaker is placed by the right or left femoral vein at the level of the groin folds. During this procedure, the doctor will make a small incision in the groin.He will insert a catheter into the femoral vein of your leg and then move it all the way to your heart. During the procedure, the doctor may inject a contrast medium into your heart in order to take X-ray images or films.
At the end of the procedure, the leadless pacemaker will be implanted in your heart, no other part of the system will remain in your body. The doctor will close the incision made in the groin.
The operation can be done under different anesthesia modalities depending on the case. After the operation, regular follow-ups are necessary to check that the system is working properly. A first check-up is carried out within 3 months after the implantation, then regularly (every 6 months in general) using the programmer, which allows the settings to be modified if necessary. You will be given a notebook indicating that you have a pacemaker. After several years (duration varies depending on the mode of operation), a new stimulation system will have to be set up given the wear and tear of the battery. The old pacemaker will then be left in place or removed using specific equipment.
What are the risks of implanting a pacemaker without a lead?
The implantation of a pacemaker without a lead exposes you to a low anesthetic risk since it is a local anesthesia, as well as to possible complications, which are rare. These are generally benign but can sometimes be more serious and very exceptionally, life-threatening.
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Early complications include the risk of bleeding (especially with anticoagulant treatment) at the femoral puncture in the groin, damage to a blood vessel, heart rhythm disturbance, effusion of fluid or blood around the heart that can lead to emergency cardiac puncture or repair (tamponade). Some of these issues may require exceptional early reaction, such as device migration. An allergy to an antibiotic or injectable iodine products is possible.
It must be reported before the operation.
At a distance from the operation, reprogramming of the system may be necessary and reoperation may be warranted in the event of system failure (interruption of stimulation, premature depletion of the battery or any other malfunction), infection or displacement, the latter two complications being more than exceptional.
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What are the consequences in my daily life?
​Your daily life will most often be very little changed by wearing this device. Precautions should be taken when carrying out medical examinations, in particular, an MRI which is possible but requires changing the settings temporarily. Your pacemaker is immune to metal detectors. Interference (action of a magnetic field or a wave on the device) are rare but those that may concern you will be specified to you by the implanting doctor.
Then, the doctor will place the pacemaker without leads using a specific catheter and fix it in the heart muscle.
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After the pacemaker has been placed without leads, the doctor will use a programmer, which allows communication with your pacemak
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