Although the pacemaker can be used by everyone, physicians who recommend permanent pacemaker implantation must consider “comorbidities, surgical risks, quality of life, and patient preference” (Bains 2017). Before we begin the surgical procedure, we need to understand the difference between the 4 types of pacemakers. External (transcutaneous) pacemakers are outside of the body, but the wires are attached to the skin. This type is used for emergencies because they are only temporary. The next type is the temporary epicardial pacemaker.
This type is used during heart surgery when trying to induce cardiac simulation which was the original purpose of the pacemaker. The wires are attached to outside of the heart but inside the body. The third type is a temporary endocardial which is only used for temporary abnormality. The wires are attached to the inside the heart through the veins. The last one, most commonly known, is called the permanent (internal) pacemaker (Khan Academy 2014). The pacemaker is actually implanted in the body for a long period of time.
The pulse generator is tucked away in tissue, inside the body, near the chest. All four different types of pacemakers relatively function the same way, stimulating the heart when the heart rhythm is abnormal. The only difference is whether they are temporary or permanent which is why there exists both external and internal pacemakers. In this paper, we are going to talk thoroughly about the permanent pacemaker implantation. Before the implantation, the patient has to be treated with an antibiotic to reduce any risk of infection.
Surgeons first either make a pocket for the pulse generator or position the guide wire into the heart. The first guide wire is led through the subclavian vein, located at the first rib and clavicle using a needle. Once the wire reaches the right atrium, the guide wire is placed there until the positioning of the second wire using the same procedure. For the pulse generator, a pocket of 1. 5-2 inches is made by making a small incision near the clavicle. In this incision, the pulse generator is stored in the tissue.
Once these the generator and the wires are in correct positions, the guide wire is removed, revealing the lead under the sheath. Both leads are secured in position to the endocardium by either “passively with tines (like a grappling hook) or actively via a helical screw at the tip” (Yarlagadda 2016). The screw can be extended or retraced if necessary. Finally, the pacemaker has to be tested to ensure that the pulse generator is function properly before finishing up the rest of the surgery. Once the test is confirmed, the incision is dressed using sutures and adhesive strips (Yarlagadda 2016).
However, during recovery, the patient has to limit movement until medical professionals confirm that lead is positioned correctly and find no risk of pneumothorax which is also known as a collapsed lung or “when air leaks into the space between the lung and chest wall” (Collapsed Lung). Although there are many benefits of have a pacemaker, they can come with complications. Most common complication after implantation is lead dysfunction, pneumothorax, and infections (Bains 2017). Careful care is required after the implantation to prevent any pacemaker pocket or lead infection. Future technology
The biomedical industry has been growing as people progress with technology. The big three companies that dominate the pacemaker market are Medtronic, St. Jude Medical, and Boston Scientific (Hollmer 2014). Although there are smaller companies who are trying to break through, it is difficult since the big three have the most U. S. pacemaker approvals. These companies also produce other medical devices but since they are all dominating the same market, “lead and pacers [are] generally interchangeable between [the] companies” which result in higher safety and lower recalls (Hollmer 2014).
A new pacemaker that St. Jude Medical is testing out is its new Nanostim leadless pacemaker (Hollmer 2014). Jt. Jude Medical has already implanted it in their first patient in the UK (Hollmer 2014). With this idea out, Medtronic and Boston Scientific are trying to keep up by also developing their own leadless pacemakers. But before these new leadless pacemakers can be released in the United States, they need the FDA approval for safety. Currently, the wired pacemakers have more risks but once everyone is able to switch to the leadless pacemakers, risks would be lowered (Hollmer 2014).
Conclusion The invention of the pacemaker was the goal of many scientists and engineers and the result has greatly impacted many lives. Although there were many challenges to achieve the permanent implantable pacemaker, everyone who worked on it were extremely dedicated to make sure that that dream would come true. Nearly sixty years later, the pacemaker still plays a significant role in society and the biomedical industry, inspiring other people to continue to improve the pacemaker. Without the pacemaker, our family, friends, and everyone else wouldn’t be here standing today.