Procedures/CRM/Devices

Cath Lab Procedures

- Devices

Pacemaker implantation

These are procedures that take place in the catheter laboratory under local anaesthetic and sometimes with the addition of sedation administered into a vein. The procedure can be a day case procedure or sometimes requires an overnight stay. This procedure is performed if you have an issue with the electrical functioning of the heart.

The ablation procedure is slightly different depending on the underlying condition that is being treated.

Some examples of these procedures are described below.

A pacemaker is a device that is implanted to prevent the heart beating too slowly. It is often used for conditions such as heart block and sick sinus syndrome. The procedure is usually performed under local anaesthetic.

The natural pacemaker cells in the heart usually fire automatically to regulate your heart rate. Sometimes (usually due to ageing / wear and tear) these pacemaker cells stop working as well as they should do and your heart can have periods where the pacemaker cells do not conduct normally and your heart rate slows. This can cause symptoms such as dizziness, shortness of breath and blackouts/faints.

A pacemaker consists of a small ‘battery’ which sits under the skin of the collar bone attached to one or two wires that sit in the right-hand side of the heart. The pacemaker wires ‘watch’ the heart 24/7 and look out for your heart’s natural heartbeat. If your own natural heartbeat fails to fire, the pacemaker will detect this and provide an artificial heartbeat. You will not feel this artificial heartbeat as it mimics a natural heartbeat. In most cases, your heart provided some natural heartbeats and the pacemaker provides any beats that are missing, so is working intermittently and is on ‘standby’ most of the time.

 

In some people, the pacemaker cells of the heart are work very infrequently or not at all and the pacemaker will provide most of the heartbeats of the heart. Please note that a pacemaker will not prevent you heart beating too fast. Some patients have a heart condition (known as sick sinus syndrome) where the heart sometimes beats very fast and sometimes beats very slowly. A pacemaker will only prevent the heart beating too slowly. Cardiac medications (such as beta-blockers, Digoxin or Amiodarone) will often be required to prevent the heart beating too quickly.

Your pacemaker procedure will be performed under local anaesthetic in our catheter laboratory (operating theatre). You will lie flat on the table and will have the area under your (usually left) collar bone cleaned and drapes will be applied. Next you will be given an injection of local anaesthetic to the skin and below the skin to numb up the area and a small incision is made (around 5cm) and a small pocket for the battery will be created by the doctor under the skin. Next the doctor will place one or two wires down the vein under the collar bone under x-ray guidance and position the wires in the heart. There will always be a wire in the right ventricle (the bottom chamber of the right side of the heart). Sometimes there will also be a wire in the right atrium (the top chamber of the right side of the heart). 

Once the wires have been positioned they are attached to the battery. The battery (which is a flat disc measuring approximately 5 x 5cm) is positioned in the pocket below the collar bone and the small incision is either stitched, glued or stapled. A waterproof dressing will be applied. 

Some people will require a chest x-ray following the procedure. You may be discharged the same day or the following day. Pacemaker batteries generally last at least 5 years and may last much longer if they are not used very often and spend a long time in ‘standby’ mode. Once the pacemaker has been fitted you will be reviewed in our pacemaker clinic on a regular basis and the battery will be checked at each visit. When the battery is near to the end of its life you will be recalled for a battery change (also known as ‘pacemaker box change’).

Pacemaker implantation is usually a very safe and straightforward procedure and many such procedures are performed at Wythenshawe every year. The procedure usually takes around one hour.  Minor/common complications of pacemaker insertion include bruising, bleeding and tenderness at the wound site. Less frequent but important complications include infection (1 in 100 for new implants, 1 in 20 for battery (box) changes), collapsed lung (1 in 100), damage to the heart leading to bleeding around the heart (pericardial effusion, 1 in 500) and movement of the lead requiring a repeat procedure (lead displacement, 1 in 100). 

Main points

1.  A treatment for a slow heart rhythm 

2. Usually a day case procedure

3. A device is placed under the skin - usually below the collarbone - and one or more leads are placed inside the heart

You should always talk to your healthcare team about any procedure you're going to have and make sure it is right for you.

Pacemaker
Pacemaker x-ray.jpg