Pacemaker (cont.)
What are possible complications of
pacemaker implantation?
Pacemaker implantation is a safe procedure in experienced hands.
The death rate due to a direct complication from pacemaker
implantation is less than one in 10,000 implantations. Complications
occur less than 1% of the time and include bleeding, bruising, and
infection at the implantation site, introduction of air into the
space between the lung and chest wall (necessitating chest tube
placement), perforation of the heart (requiring urgent drainage of
the blood from the sac surrounding the heart), stroke, heart attack,
and damage to blood vessels.
What are the types of pacemakers?
Pacemakers may contain one or multiple leads. A single-chamber
pacemaker has one lead while a dual-chamber has two leads.
When the lead from a single-chamber pacemaker is placed in the
ventricle, the pacemaker is able to receive signals from and pace
only the ventricle. If the lead is placed in the atrium, the
pacemaker will be able to receive signals from and pace only the
atrium. Depending on the cause and the nature of the bradycardia, the
doctor decides where to place the single lead.
Dual chamber pacemakers have two leads: one in the atrium and one
in the ventricle. Dual-chamber pacemakers are more complex and
sophisticated than single-chamber pacemakers. A dual chamber
pacemaker can receive signal from and pace both the ventricle and the
atrium. It can also coordinate the signals and contractions of the
atria and the ventricles to help the heart beat more efficiently.
In a normal contraction cycle in a normal heart, the atria
contract first to deliver blood into the ventricles. The ventricles
then contract after a short time interval. Dual-chamber pacemakers
can coordinate the electrical signals to the atrium and the ventricle
so that this natural sequence of contractions is followed. Following
the natural sequence of contractions improves the pumping efficiency
of the heart.
Dual-chamber pacemakers are more susceptible to problems because
of their greater degree of sophistication. These pacemakers can cause
the heart to race inappropriately if confused by the heart's own
electrical activity. Also, additional leads mean that more equipment
can potentially fail. Thus, not all patients are good candidates for
dual-chamber pacemakers. Some patients are better served with a
single-chamber pacemaker. A qualified cardiologist or
electrophysiologist is ideal to decide which pacemaker is most
appropriate.
Next: Can some pacemakers automatically adjust the heart rate? »
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