9 Facts you should know about pacemaker before going into surgery

Pacemakers are small, electronic devices that are implanted in the heart in order to monitor and regulate the cardiac function. They work by delivering the necessary electrical impulses. Thus, they are able to stabilize an arrhythmia or a heart rhythm which is abnormal. However, before one decides to go in for a pacemaker implant, it is better to know the bitter facts! The implantation of a pacemaker could lead to infections, cardiac muscle tears, lung collapses and bleeding along with bruising. It requires the patient to make changes in lifestyle, reduce many activities and be at risk for some for a lifetime. But when one needs a pacemaker, there is nothing that can be done about the implantation. However, knowing these facts will at least help one take action when necessary.

Infection during procedure

A 2010 research paper in “Circulation” states that the patients undergoing pacemaker implantation face the risk of infections, especially bacterial, immediately after the surgery. There is almost a general consensus on this fact. The danger of an infection at the site of implantation is high and, therefore, it is recommended that patients undergoing implantation of such devices receive antibiotics. In fact, doctors recommend antibiotics immediately after the surgery so that no infection lodges itself in the sensitive region. An infection alongside the pacemaker is very difficult to treat and takes a lot of time to heal. It could also lead to several other complications and the cardiac muscles get affected. The author of the above mentioned research papers is of the conclusion that nonstaphylococcal infections of a diverse variety are present with low virulence and mortality in all surgeries involving CIEDs (cardiac implantable electronic devices).

Heart muscle tear during surgery

The cardiac muscles are the most vital for the body because they are at work all the time. The surgery to place a pacemaker near the cardiac muscles is a delicate one. It involves threading the lead wires through a vein and inserting the wires through an incision in the chest. The pacemaker is placed above the heart, just below the skin. In this process of pacemaker implantation and testing, there are chances of tearing the cardiac muscle. Such a tear in the heart muscle leads to profuse bleeding. More serious than that is the loose blood flow that happens within the heart. These are complications that must be dealt with immediately or they can even endanger a person’s life. However, prevention is always better than cure. It would be well-advised to research before selecting a surgeon for the surgery. The experience and finesse of the surgeon go a long way in considerably reducing the risk of muscle tears.

Lung collapse during the procedure

A pneumothorax or a collapsed lung is another danger that a pacemaker implantation surgery entails. This is a serious complication that will need the assistance of a lung specialist and specialized treatment. It happens if the lungs are accidentally nicked or scratched during the surgery. Air from the lung begins to escape into the cavity of the chest and depending on the size of the escape, the lung either partially or completely collapses. The varying degrees of pneumothorax needs different treatments. If the symptoms present as mild breathlessness, then the patient is often ordered rest and sent home to recover. Slightly larger collapses require the doctor to suck air out of the chest cavity via a plastic tube under local anesthetic application. It could also be bubbled out into a bottle of water via a larger tube. However, if the lung collapse is large or near total, then there is no other option but to operate again. The surgery will take a few additional hours to complete and also cost you in finances.

Allergic response to anesthesia drug

Though this is a rare complication, if it occurs it gets pretty serious. The anesthesia drug that is administered during the surgery can trigger off an allergic response in some patients. Such a reaction can have serious consequences like an anaphylactic shock. An anaphylactic shock can be so severe that body organs stop functioning due to the impact. In worst cases, such a shock even results in death. The problem with an allergy is that the slightest trigger can result in the most unexpected reaction. It is highly recommended to discuss allergies and do the checks before the surgery. If necessary, have your personal physician or family doctor discuss at length with your surgeon before the operation gets underway.

Bruising, bleeding and swelling after surgery

The 2010 research paper “Circulation, Arrythmia and Electrophysiology” emphatically states that those who have undergone pacemaker implant are at a risk of hematoma. A hematoma is the collection of blood outside the blood vessels which leads to hemorrhage. Hematoma pockets get formed and they are pretty painful. While hematoma can happen during a surgery, the chances of it happening increase due to the use of intravenous heparin or clopidogrel before the surgery. Thus, as far as possible, it should be avoided. Apart from this, there can be swelling, blood clots, bruising and blood loss on the chest region. The chest area should be carefully monitored to keep track of any skin reactions after the surgery. If you notice any such reactions or symptoms after a pacemaker implant, it would be best to rush to the doctor.

Reduction in scope of physical activity

Usually, a few weeks after the pacemaker implant, the patient is able to resume normal activities. But, remember that care would have to be taken so that there is no exertion by the body which would result in strain on the heart. At the same time, there are some things that would have to be completely avoided. Contact sports like football, rugby and basketball are a strict no-no. Fun and entertainment in theme parks, exciting rides and adventure sports also get ruled out. This is because any physical activity that risks the disconnection of wires to the pacemaker or damage the pacemaker itself in any way should be avoided. It would be best to wear a medical alert bracelet that lets people know of the implanted pacemaker. Also, carry a detailed medical card in the wallet which lets people know what should be done in case of an emergency.

Radical changes in lifestyle are required after surgery

The pacemaker that has been implanted in the heart is sensitive to electrical and magnetic impulses, both internal and external. There is nothing to worry about the internal sensitivity because that is what makes the pacemaker capable of carrying out its task of cardiac electrical signal regulation. But, external sensitivity has to be taken care of as it may cause the pacemaker to malfunction. Certain lifestyle changes would be warranted to ensure that these external sensitivities do not affect the patient.

Cellphones should not be placed over the implant. If possible, it would be better to avoid their usage altogether. Power generators and most of the security check systems are potential hazards and must be avoided. This is a slight problem since one might wander into the radius of a security check system without even being aware of it! Even medical procedures that make use of electromagnetic fields will affect the pacemaker. Thus, the patient will have to keep off such things like MRIs and whole body scans. In the event of such scans becoming necessary for other ailments, the patient is sure to be caught in a difficult situation.

Faulty pacemakers and pacemaker failures

There has been growing concern over the number of faulty pacemakers being discovered at many US manufacturers. The worst thing about such faults is that they get discovered only after the pacemaker has been implanted in the patient. This happens because many of the manufactured pacemakers do not undergo strict quality checks. This means that at times, humans are almost the guinea pigs of the pacemaker companies! There have been reports of patients being hospitalized after their pacemaker dealt them shocks! The pacemaker is supposed to deliver these shocks only to restart the heart in case of a cardiac failure. Such malfunctioning pacemakers can cause long-term damage. Even if the fault is discovered in time and without much damage, the replacement in itself entails another elaborate surgery which puts one at risk to all the dangers discussed.

Long term risks

Getting a pacemaker implanted means signing up for a lifetime of care and precautions. Just to ensure that the device is working perfectly and fine, very regular check-ups are necessary. The battery level in the device too has to be checked. Usually, the battery lasts about 5-10 years. This means, after the 5th year, the battery will have to be carefully monitored. Changing the battery means undergoing another surgery which will carry all the risks of the first one! Though the followup surgery usually happens faster and easier than the original implantation one, it is a surgery nevertheless. Life after a pacemaker implant will never be the same again.

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