Most children can live a normal life after pacemaker surgery
Most children can live a normal life after pacemaker surgery

In most cases, most children can live a normal life after pacemaker surgery. An implanted pacemaker usually lasts around 10 years or more depending on the usage and the type of device implanted, after which the pacemaker would have to be replaced. 

What is a pacemaker?

A pacemaker or an implantable cardioverter-defibrillator is a small, battery-operated medical device that electrically stimulates the heart muscles. Its function is to restore the normal heart rhythm. Pacemaker surgery is a procedure in which the pacemaker is implanted. It can be performed in children (pediatric cases) and adults. The pacemaker senses the heart rhythm and paces (regulates) the heart only when needed, i.e., when the heart rhythm is abnormal (too slow, too fast, or irregular).

Why would a child need a pacemaker?

A child may require a pacemaker if the heart's natural pacemaker (the sinoatrial or SA node) is not working normally. Cases where the heart rhythm is abnormal or if the electrical pathways originating in the heart are blocked may also need a pacemaker.

The heartbeat normally originates at a part called sinus node or sinoatrial (SA) node in the right atrium (right upper chamber) of the heart. In some developmental anomalies, the sinus node may be present at a different location or there may be another focus of electrical activity. Such anomalies cause an abnormal heart rate or rhythm and need pacemaker implantation.

Pacemaker surgery helps to restore the normal heart rhythm and improve heart function and blood circulation through the body. Pacemaker implantation is indicated in the following conditions:

  • The most common indication for pacemaker surgery is SA (sinoatrial) and/or AV (atrioventricular) nodes dysfunction. In children, the cause of SA or AV node dysfunction is usually congenital heart defects (birth defects). SA or AV node dysfunction may occur following certain surgical procedures. 
  • Abnormally fast heart rates.
  • Heart valves that leak (regurgitation).
  • Abnormal thickening of the heart (hypertrophic cardiomyopathy). 
  • Poor heart function. 

How is pacemaker surgery performed?

Pacemaker implantation is performed under general anesthesia. 

A pacemaker system consists of three main parts: the pulse generator, pacing leads, and electrodes. 

  • The pulse generator contains the battery which regulates the pacemaker. It is small that measures approximately 2" × 2" × 0.25” and weighs around 20-30 g. It is placed under the skin below the left collar bone.
  • The pacing leads are flexible, insulated wires that carry electrical impulses from the pulse generator to the heart and vice versa. They are inserted through the blood vessels leading to the heart. 
  • Electrodes are found at the end of each wire and deliver the electrical impulses to the heart. 

The pacemaker stimulates the heart by suppressing all other foci of electrical activity in the vicinity. Once the surgeon sees that the pacemaker functions properly, he sutures (stitches) the incision site.

What happens after pacemaker surgery?

Postoperatively, patient is administered with pain killers and antibiotics. The patient’s vital parameters like heart rate, blood pressure, and heart functions are monitored. Most patients are discharged 24 to 72 hours after surgery. 

The pacemaker cannot be felt and does not cause pain. The generator of the pacemaker system is placed under the skin and maybe felt initially, but once the surgical incisions heal, there is usually no discomfort. 

Patients are advised to avoid close contact with devices that produce magnetic fields like MRI (magnetic resonance imaging) machines and other electrical devices such as cell phones or household appliances like microwave ovens. 

What are the complications of pacemaker surgery?

Though the risk of complications because of pacemaker surgery is low, some complications that may be encountered include:

  • infection
  • bleeding
  • displacement of leads or electrodes

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Medically Reviewed on 8/21/2020
References
https://emedicine.medscape.com/article/901397-overview

https://radiopaedia.org/cases/paediatric-pacemaker?lang=us