Name of the Procedure:

Dual Chamber Rate-Responsive Pacemaker Implantation
Common Name(s): Pacemaker Implantation
Technical/Medical Term: Pacemaker, dual chamber, rate-responsive (C1785)

Summary

A dual chamber rate-responsive pacemaker is a small electronic device implanted in the chest to help regulate the heart's rhythm. It monitors heartbeats and sends electrical signals to stimulate the heart when it detects irregularities.

Purpose

This procedure addresses conditions such as bradycardia (slow heart rate), heart block, and other rhythm abnormalities. The goal is to maintain a regular heart rate, improve symptoms like dizziness and fatigue, and enhance overall heart function.

Indications

• Chronic or symptomatic bradycardia
• Heart block (AV block)
• Atrial fibrillation with slow ventricular response
• Syncope due to heart rhythm disturbances
• Patients with both atrial and ventricular rhythm disturbances requiring synchronized pacing

Preparation

• Fasting for at least 6 hours before the procedure.
• Adjustments or temporary discontinuation of certain medications (e.g., blood thinners).
• Pre-operative tests such as an EKG, blood tests, and imaging studies.
• Consent form signing and pre-procedure briefing.

Procedure Description

1. The patient is given local anesthesia and sometimes sedation.
2. A small incision is made near the collarbone.
3. Leads (thin wires) are inserted through a vein and guided to the heart’s chambers.
4. The pacemaker device is then connected to the leads and positioned under the skin.
5. The device is tested and programmed.
6. The incision is closed and bandaged.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital setting, usually in a specialized cardiac catheterization lab or an operating room.

Personnel

• Cardiologist or cardiac surgeon
• Anesthesiologist or nurse anesthetist
• Cardiac nurse
• Radiologic technologist

Risks and Complications

• Infection at the implant site
• Bleeding or bruising
• Lead displacement
• Pneumothorax (collapsed lung)
• Device malfunction
• Rarely, heart perforation

Benefits

• Improved heart rhythm and rate control.
• Alleviation of symptoms like dizziness, fatigue, and fainting.
• Enhanced quality of life and increased physical activity tolerance.
• Reduced risk of heart-related complications.

Recovery

• Observation in the hospital for 1-2 days.
• Monitoring of heart function and device operation.
• Avoid heavy lifting and strenuous activities for 4-6 weeks.
• Follow-up appointments to check and program the pacemaker.

Alternatives

• Medication management for heart rate control.
• Single chamber pacemaker for certain cases.
• Lifestyle changes and monitoring for mild conditions.
• Ablation therapy for specific arrhythmias.
• Each alternative has different benefits and risks; for instance, medications may not be as effective for severe conduction issues compared to a pacemaker.

Patient Experience

• Mild discomfort and soreness at the incision site.
• Device palpation under the skin.
• Immediate improvement in symptoms like steadier heart rate and reduced dizziness.
• Pain management with prescribed medication and guidance on incision care.