Rehabilitation after installation of a pacemaker in Assuta

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Details

A pacemaker (pacemaker) is a small device, weighing approximately 30-50 grams, capable of creating electrical impulses that regulate heart rate. It is installed when it is necessary to maintain rhythm in patients with bradycardia or atrioventricular block, when the heart works intermittently.

A pacemaker, as a rule, consists of two parts: a metal case containing a battery designed for 7-10 years of operation and a microprocessor unit that provides heart rate setting and other parameters; the second part is the electrodes, through which electrical impulses propagate from the pacemaker into the chambers of the heart. Pacemakers are the best treatment for bradyarrhythmias. The first pacemaker was implanted in 1958.

There are three types of pacemaker (this depends on the location of the electrodes):

• Single-chamber: installed in only one chamber of the heart - the right ventricle or atrium,
• Two-chamber: installed in the atrium and ventricle of the heart,
• Three-chamber: contains a device for the treatment of heart failure, installed on the right atrium and both ventricles.

ECS is also divided into temporary (an external stimulator is installed for a period of several hours to 2 weeks) and permanent (an implanted stimulator is installed).

How is the treatment carried out?

• The pacemaker is installed under local anesthesia and under X-ray control in a specially equipped operating room.
• Electrodes connected to a stimulator, which is sewn into the muscle bed in the subclavian region, are inserted into the heart through the subclavian vein.
• The most difficult part of the procedure is positioning and securing the lead tip into the atrium or ventricle to ensure good contact.
• A bed for a pacemaker is created in the subclavian region on the left or right under the skin through a small skin incision.

Life expectancy with a pacemaker

So, from a medical point of view, life expectancy with a pacemaker is determined primarily by the general health of the patient and does not depend on the presence of IVR.

Only in the first time after the operation, the patient is advised to limit his activity: he should not lift heavy objects, work in an inclined position, etc. If you subtract these two or three months after the operation to install (implant) the device, then the pacemaker and the duration of active life also do not depend much on each other.

Recommendations for increasing life expectancy with a pacemaker are general:

• worrying less, resting more and being calmer about everything is, of course, difficult to implement, but this will help maintain the heart rhythm in a normal state;
• drink less alcoholic beverages, and definitely don’t get drunk - alcohol, again, disrupts the heart rhythm, which can lead to the development of tachycardia (the stimulator will skip beats when an impulse is needed, and send an impulse to the heart when it is already beating normally) ;
• lead a moderately active lifestyle, i.e. It’s no longer possible to lift “iron” (including because the electrical impulse sent to the contracting pectoral muscle can interfere with the work of the pacemaker), but walking and running, swimming is fine.

In general, the life expectancy of people with a pacemaker has no correlation with the very fact of having a pacemaker installed, subject to restrictions. It is necessary to remember the prohibitions, undergo timely examinations, not violate contraindications, avoid heavy physical work (including monotonous work - in order to avoid the electrode coming off) - and you can lead a full life!

Does a pacemaker have a greater effect on life expectancy? How much does a pacemaker prolong life and does it prolong it at all? No doctor can predict how much ECS can extend life expectancy. The task of IVR is to prevent death in the event of an attack of arrhythmia or blockade.

More discussion:

What is the life expectancy after pacemaker installation?

Throughout life, a medical history is maintained with the pacemaker. The medical history of a pacemaker begins with an anemnesis (a record of information about the patient's condition obtained from the patient himself or his relatives).

Possible complications

The risks of the procedure are generally around 1%, including bleeding, pneumothorax (air entering the pleural space), cardiac perforation, risk of suppuration and device malfunction.

Possible complications include displacement and disruption of electrode insulation, pacemaker syndrome (dizziness and shortness of breath when the pacemaker is not working properly) and infectious complications.

In fact, such complications are very rare and are not comparable to the benefits of a pacemaker installed according to indications.

How long can you live with a pacemaker?

So, with one pacemaker between two operations you can live from 3 – 4 to 30 or more years. Personally, for my device the manufacturer sets a service life of 7-8 years. How long is it or not? It takes approximately 6 – 8 months for a scar to form and about a year for the final implantation of the device (in general, the terms vary – from 3 to 12 months).

How long do they live with a pacemaker after this? Approximately 6 – 7 years before replacement (and if you are lucky and the device does not “spun” without stopping, then 13 – 14). Of course, there are unpleasant situations when the pacemaker does not take root, and it has to be changed every 1 - 2 years, but such cases are not frequent.

How long do people with pacemakers live in general? As long as the restrictions are observed and the patient monitors their health, life expectancy is not limited by anything, including the number of possible IVR replacements.

Initially, the pacemaker is installed in the left shoulder, then the battery can be replaced, and the device itself, along with the electrodes, will remain in place. A new device instead of the old one can be installed here with new electrodes (if, for example, they were pulled out of the vessels - or if they were removed surgically).

Finally, implantation is possible in another place - in the right shoulder or abdominal cavity. At least the number of repeated operations is not limited to 2-3 - there was a guy in the room with me who had almost a dozen operations. This, of course, is not very pleasant, but, in general, it is not fatal. In total, the answers to the question of how long people live with a pacemaker are as follows:

• the overall life expectancy with regular justified replacements is tens of years, in some cases much longer than in people without ECS (preventive motives) and in many (if not all others) no less;
• The service life of the device, if it has taken root normally (the network names different percentages of “without consequences” and rejection - usually 92 - 98%), is 7 - 8 years under normal conditions, and 3 - 4 years if the device works “non-stop” (if it functions as insurance, then for all 14 - 16 years, and sometimes more than 20).

How long do people with pacemakers live active lives? There are known cases of continuing to play sports with an ECS: at the amateur level, alpine skiing, a professional hockey career (although, in general, game sports where a push or blow is possible are prohibited), mountaineering (and in these cases the device saved the lives of people in conditions of hypothermia ).

Childbirth is not prohibited (although not every maternity hospital is eager to “get involved” with a woman in labor with an ECS - but this is a question for the conscience of individual doctors), professional activities not related to the maintenance of electrical installations and power lines, etc. All this does not reduce the allotted operating time of the device and does not affect human life expectancy.

Types of pacemakers

Pacemakers are classified according to several criteria, taking into account the technical parameters of the device. Depending on the principle and duration of use, the devices are:

• temporary (when the casing of the CS is not implanted, but is used only until the problem is eliminated);
• permanent (implanted under the skin for a long time);
• others (for example, a cardioverter-defibrillator, which combines the functions of an artificial heart pacemaker and a defibrillator).

Permanent pacemakers are the most common. This is due to their ability to return even those patients who are in serious condition to a normal lifestyle.

According to the number of heart chambers put into operation, pacemakers are single-chamber, two-chamber, three-chamber and four-chamber (used extremely rarely). In each case, a corresponding number of electrodes are applied to areas of the heart muscle to regulate the rhythm of its contractions. Models with three electrodes usually have additional functions.

First week after surgery

1. It is important to keep the postoperative wound dry and clean (doctors and nurses will tell you how to do this).

2. If the early postoperative period proceeds well, then 5 days after the installation of the CS you can take a shower. And after a week, most patients return to work on their usual schedule.

1. You cannot lift objects heavier than 5 kg (postoperative sutures may come apart).
2. Heavy household work (removing snow, trimming bushes and lawn in the yard) must be temporarily abandoned. When doing easier tasks (washing dishes, dusting), listen carefully to how you feel: if you feel uneasy, it is better to postpone work. There is no need to do something through force.

Answering the main question

And still. How long do patients live with a pacemaker? Life expectancy is not at all limited by this factor. Let us only note that in clinics in Kyrgyzstan there are patients for whom ECS has been prolonging their lives every second for three decades (my grandfather is one of these patients). They have a busy and active life. Modern pacemakers are well protected even from MRI radiation, they are reliable, trouble-free and do not allow pathological changes to develop without the knowledge of the doctor and the patient.

Recovery after surgery

Rehabilitation after installation of a permanent pacemaker usually takes from 7 to 30 days, but certain restrictions apply during the first 3 months after surgery. Three important stages of postoperative life:

1. The first 7 days after implantation of the CS. Usually during this period the patient is left in the hospital. The doctor and medical staff carefully monitor the healing process of the wound and ensure that it is clean and dry, and regularly measure heart rate indicators. If there are no complaints on the 5th day, the patient is allowed to take a light shower, and after 7 days he is discharged.
2. The first 3 months after surgery. The patient is registered at the dispensary and undergoes the first examination after 3 months. However, it is necessary to consult a doctor ahead of schedule if the patient feels a deterioration in health (for example, he is dizzy) or if the device beeps. To prevent the seams from coming apart, you should not lift a load weighing more than 5 kg, or do heavy physical work. Light tasks are performed with the hand located further from the CS.
3. The period before the battery expires. A follow-up examination is scheduled 6 months after surgery. Then the examination is carried out every six months, and such consultations are mandatory.

The doctor sometimes removes some of the restrictions associated with exercise if the patient feels well, but it is still not worth exposing the body to excessive stress (for example, playing heavy sports).

Rehabilitation period

After implantation, the doctor should take the time to provide consultations regarding the recommended lifestyle. During the first week, you will gradually get used to the idea that there is a special device in the body that helps the heart make the correct rhythmic contractions. This postoperative period must be spent in a hospital.

Many people ask about permissible load limits. There is no exact answer, but doctors do not recommend lifting weights over 5 kg. You should listen sensitively to your feelings. If you suddenly feel tired during your usual physical work, it is recommended to stop and take a break. You must understand that the heart muscle has not become stronger, so do not abuse fatty and salty foods, alcohol, and follow a healthy diet.

Rehabilitation

Over the next month and a half, the patient must visit an arrhythmologist at least once a week. This is necessary to ensure that the stimulator is working properly and that there is no withdrawal syndrome or other undesirable reactions. In the future, the number of visits to the doctor will decrease significantly. It will be enough to visit it once or twice a year.

At the same time, lead a full-fledged lifestyle without worrying about the performance of your heart. For several months, you should not sharply raise the arm on which the device is installed. Do strenuous physical activity, lift weights. Physical education for the next 3 months is also excluded.

When to replace

It is difficult to say with certainty how long a pacemaker will last. On average, its service life is from 5 to 7 years. There are cases when replacement is carried out earlier or later. The operating time of the device is affected by:

1. Type of installed device. Devices that operate continuously are replaced earlier than their “smart” counterparts, which turn on only when necessary. Some modern models last about 14 years.
2. Battery Type. The more powerful the battery, the less often it is replaced.
3. Unforeseen disruptions in the operation of the CS. Failure to comply with restrictions after surgery sometimes results in the device having to be reconfigured or replaced.
4. The diagnosis given to the patient. The more chambers of the heart the CS stimulates, the more intense its work and the shorter its service life.
5. Emerging complications. Inflammation sometimes appears at the installation site of the device. If the case is severe, the pacemaker is urgently removed or replaced, even though it would have lasted a long time. Most often, the cause of inflammation lies in the displacement of the device under the skin or infection.
6. Critical conditions. The device is removed if there is a need to perform surgery (for example, as a result of an injury), and the CS does not allow assistance to the patient.

When the battery is low, the device gives a signal. It is detected during a routine patient visit, after which the battery is replaced with a new one. Therefore, regular visits to the doctor are mandatory. The operation of installing a new battery is less complicated than the original one.

One month after surgery

1. Sport. Walking is useful, and the more, the better. Swimming pool, golf, tennis and other, more difficult sports will have to be forgotten for a while. Depending on how you feel, the doctor may, after the next examination, remove some of the restrictions on sports.
2. Visit the doctor regularly: the first examination is 3 months after discharge, the second examination is six months later, and then 1-2 times a year. But if you suddenly feel any discomfort or reasonable concern regarding the operation of the CS, consult a doctor immediately.