PERMANENT PACEMAKER INSERTION (PPI)

A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles). A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure and hypertrophic cardiomyopathy.

2 PARTS: the pacemaker box (also known as the pulse generator) a battery, and wire (also called leads). Three basic types of permanent pacemakers: Single-chamber pacemaker Dual-chamber pacemaker. Rate-responsive pacemaker.

What to expect? You will need to stay in hospital for 3 to 4 days for the pacemaker implantation. The implant procedure usually lasts about one hour, and is performed under local anaesthesia with sedation.

Before the procedure: Some routine blood tests and electrocardiograms may be performed You will be required to sign a consent form. A small needle is inserted in one of the veins on your hand to facilitate injection of medication. You will be asked to fast on the night before the procedure. Just before the implantation, you will be given an injection of an antibiotic

During the procedure: The implantation is performed in the Invasive Cardiac Laboratory. After injection of local anaesthetic, a small incision (cut) is made in the upper left chest (if you are right-handed) and a small "pocket" is created under the skin to accommodate the pacemaker box. An insulated lead is then inserted through a vein in the upper chest and, guided by X-ray, is threaded until its tip lies snugly within the heart. The other end of the lead is then connected to the pacemaker. The incision wound is closed with stitches, cleaned and bandaged

HOME CARE: You can resume most daily activities within a few days Take care to keep the wound dry. The waterproof dressing should be changed daily for a week to 10 days after which it should have healed. The stitches need not be removed as they are absorbable. Your doctor will arrange a schedule of periodic checks, and will electronically program the pacemaker's behavior to suit your requirements. WOF: fever, excessive pain, redness or swelling over the wound. Inform your doctor immediately if you have these symptoms.

 On the side of the pacemaker, avoid excessive movement of the arm. Complete the course of antibiotic medication prescribed on discharge. avoid magnetic resonance imaging, a medical diagnostic imaging technique. Avoid using mobile handphones on the side of the pacemaker 6. Ensure that you return for regular check-up at the appointed dates.

COMPLICATIONS:

Local infection Pneumothorax Bleeding and hematoma Hemothorax Ventriculaer ectopy and tachycardia Cardiac perforation Twiddler syndrome Pacemaker syndrome