A biventricular pacemaker is a special form of pacemaker that is used in cardiac resynchronization therapy (CRT) to help the ventricles contract more regularly. This implantable medical device is often used by people with severe heart failure brought on by abnormal heart rhythms and function. This treatment has been proven to enhance heart failure symptoms and overall quality of life.
The upper chambers (atria) and lower chambers (ventricles) of the heart pump in a coordinated manner in a healthy heart. With heart failure, the right and left ventricles do not pump in unison. The left ventricle cannot pump enough blood to the body when the heart’s contractions are out of rhythm. The right upper chamber of the heart (the atria) may also be out of sync.
With a biventricular pacemaker, tiny electrical impulses are delivered through the leads, which keeps the right and left ventricles pumping in tandem. The device comprises of a pulse generator, which contains a battery and a tiny computer, and three wire leads.
A biventricular pacemaker is inserted into the chest by creating a small chest incision. There are two methods for positioning the wire leads:
Biventricular pacemakers can enhance the well-being of approximately half of individuals who, despite receiving medication, continue to experience severe or moderately severe heart failure symptoms.
Individuals at a high risk of experiencing cardiac arrest or those with heart failure who are already on heart failure medications but are experiencing worsening symptoms may be eligible candidates for a biventricular pacemaker. It may be also recommended to those who have:
Biventricular pacemakers, like any heart failure treatment, carry potential complications, including bleeding, cardiac tamponade with blood accumulation around the heart, collapsed lung, infection, lead dislodgement from heart tissue or the pulse generator, mechanical failure leading to improper device function, and the risk of nerve damage.
With biventricular pacemakers, most individuals do not experience the sensation of their heart pacing. The device emits painless electrical impulses that traverse the leads, coordinating the contractions of the heart’s chambers to facilitate synchronized pumping, when an irregular heart rhythm occurs.
A few days before the treatment, the healthcare provider might ask patients to stop using a particular medication. After midnight, the night before the surgery, avoid eating or drinking anything. If one must take medication, only sip water briefly to aid with pill swallowing.
Generally, one’s experience may vary depending on the lead placement strategy:
At the start of the procedure, an antibiotic will be injected into the IV to help prevent infection. It usually takes two to five hours to implant a pacemaker. The healthcare provider will determine the most suitable method for the case.
Generally, the procedure include:
After placing the leads in their proper positions, the healthcare provider carries out tests to validate their accurate positioning, ensure effective sensing and pacing, and synchronize the right and left ventricles. This process is known as pacing. It involves the controlled transmission of low levels of energy through the leads into the heart muscle causing the heart to contract.
Once the leads have been tested, it will then be connected to the patient’s pacemaker. The healthcare provider will then establish the pacing rate and configure other settings for the pacemaker. The final fine-tuning of the pacemaker’s parameters is carried out post-implantation using a specialized device known as a programmer.
After checking the pacemaker, an echocardiogram is done to assess the heart’s function and see if there’s any improvement from the new pacemaker. The pacemaker will continue to operate at the settings that best show the health of the heart.
Biventricular pacemakers have been shown to enhance the well-being of approximately half of the individuals who undergo the procedure for heart failure.
The improvement brings a range of advantages, including an enhanced quality of life and the ability to lead an active, independent lifestyle. Additionally, patients with this device experience a reduction in heart-related hospitalizations, improved heart function, and an extended lifespan.
Recovery for individuals undergoing these procedures typically begins in the hospital. Most cases of endocardial approach can expect to return home within a day following the procedure. However, for those opting for the epicardial approach, longer hospital stay of up to five days may be necessary to ensure a smooth recovery process.
The recovery period may span a few months. It is important to rest and refrain from engaging in strenuous upper-body activities, particularly on the side where the pacemaker was implanted, during this time. Additionally, anticipate scheduled follow-up appointments with your healthcare provider to:
Consult a healthcare provider if any of the following is experienced:
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