The normal electrical conducting system in the heart ensures the top chambers (the atria) contract before the bottom chambers (the ventricles). This natural sequence is mimicked by implantation of a dual chamber pacemaker, which has two leads, placed in the upper and lower chambers of the right side of the heart respectively. A simpler, single chamber pacemaker may also be appropriate:
A permanent pacing system consists of a battery and electronic circuitry in a sealed unit (the generator), and one or more leads to conduct the electricity to the heart muscle. Modern generators are small and are normally inserted in a pocket created under the skin and fat on the front of the chest. Pacemaker implantation is performed under aseptic conditions (as in an operating theatre) using local anaesthestic.
A small incision (cut) is made in the skin below the collar bone near the shoulder, to create the pocket and insert the leads. The leads are placed into a vein and then advanced to the heart under x-ray monitoring. Once a stable position, with good electrical between the leads and the heart, has been found the leads are connected to the generator, which is placed in the pocket,and the wound is closed.
The duration of a pacemaker implantation procedure varies between 45-90 minutes, with dual chamber pacemakers requiring a longer time. The patient may stay in the hospital for one night, but many patients are able to go home the same day as the procedure.
Regular follow up checks are important; they allow adjustments to the pacemaker programming that can improve quality of life, and they minimise the chance of unexpected problems with the device. The pacemaker will be checked within the first 24 hours of implantation, and two to three weeks after the procedure. Subsequently the pacemaker will be checked every 6 months. These intervals may vary slightly. In New Zealand checks are usually conducted in the public sector.
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