Due to the continuous development of technology, nowadays there are various cardiac pacemaker systems available for a variety of indications. Pacemaker can be single-chamber, dual-chamber and three-chamber (biventricular):

Single-chamber pacemakers have one electrode in the right ventricle or rarely in the right atrium
Dual-chamber pacemakers usually have two electrodes, one in the right atrium and one in the right ventricle
Three-chamber pacemakers (known as cardiac resynchronization therapy – CRT) typically have one electrode in the right atrium, one in the right ventricle and one additional that stimulates the ventricle (placed in coronary sinus). This type of pacemaker is implanted in patients with impaired heart muscle (which can result in heart failure) to resynchronize the contraction of both ventricles and thereby improve cardiac contractions and consequently blood flow (see: cardiac resynchronization therapy)

Permanent pacemaker implantation. Permanent pacemaker is most commonly implanted in the area below the left collarbone (rarely below the right). Permanent pacemaker’s electrodes are most commonly implanted, through large veins, up to a specific part of the heart muscle and then connected to a pulse generator. The implantation of permanent PM is a surgical procedure performed by a doctor (invasive cardiologist, electrophysiologist or surgeon) under sterile conditions in a laboratory or operating room. The implantation of permanent PM is performed usually under local anaesthesia, or when needed, in deep sedation or rarely general anaesthesia. In the area below the left collarbone, an injection of local anaesthesia is given, followed by a smaller incision (3-5 cm) and formation of a surgical (subdermal) pocket, into which a pulse generator will be placed at the end of the procedure. Through the same incision, one of the larger veins is punctured and one or more electrodes are then introduced under X-ray control. After the electrodes are positioned in a specific heart chamber (atriums, ventricles, or both), their function is tested, and if the function is normal, is connected to the pulse generator and subdermally stored together in a previously formed surgical pocket. The wound is then closed with several sutures and covered sterile gauzes. Implantation lasts approximately 60 minutes.

After implantation of a permanent pacemaker, certain instructions must be followed (see: Instructions for patients when implanting a permanent pacemaker)

Regular check-ups and control. Check-ups after the implantation of permanent PM are usually performed every 6-12 months, depending on the type of PM implanted. At the examination, an ECG is recorded and the pacemaker’s function is tested. If needed, permanent pacemaker can be further adjusted and adapted to the patient’s needs and symptoms.

Permanent pacemaker’s replacement. When the pacemaker battery is depleted, the device’s battery must be replaced. At regular check-ups, the battery shows clear signals of depletion, and patients are then scheduled for shorter hospitalization.

The doctor makes a small incision in the skin over the old scar and removes the old battery, after which the new battery is connected to the existing electrodes and the whole system is than checked for normal functioning. The device is then stored in the same subdermal pocket and closed again with a few stitches. Device electrodes are only changed if something is wrong with them.

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]]> 1383 Atrial septal defect closure https://aritmije.kbcsm.hr/en/atrial-septal-defect-closure/?utm_source=rss&utm_medium=rss&utm_campaign=atrial-septal-defect-closure Fri, 03 Apr 2020 14:02:00 +0000 http://aritmije.kbcsm.hr/?p=1379

Atrial septal defect closure (ASD)

Atrial septal defect (ASD) is a hole in the muscular wall (interatrial septum) between the two upper chambers of the heart (atrium). Such deficiency leads to communication between both atria, which, if sufficiently large, can lead to a reversal of blood flow and consequently to many disorders such as heart failure, pulmonary hypertension, stroke, heart rhythm disturbances.

It is one of the most common congenital heart defects. There are many forms of defect, but the most common is the so-called type secundum, in which the described communication is located at the very middle of the septum.

Diagnosis is often made during adulthood because patients have no symptoms or have minimal symptoms.

For the last several decades, the treatment has been purely surgical, but today the method of percutaneous defect closure is being used with the help of so-called occluder, which is also available at our institution since 2018.

Procedure

Prior to the procedure, each patient is fully explained the benefits and potential risks of the procedure (informed consent of the patient). It should be noted that before and after the procedure, it is mandatory to take dual anti-aggregation therapy (acetylsalicylic acid plus clopidogrel) for a minimum of 3 months, due to the risk of thrombosis of the device. Prophylaxis of bacterial endocarditis is also required up to 6 months after surgery.

As part of the preparation for the procedure, a transesophageal ultrasound (TEE) is performed to determine in more detail the characteristics of the septal defect itself for better planning of the intervention (type of defect, size, anatomic borders). The same method excludes the existence of a thrombus in the left atrial appendage.

The procedure is performed by introducing a catheter via the groin vein, with previous local anesthesia of the injection site and intravenous titration of the analgosedation. The catheter is then placed first through the vein into the right atrium and then through the atrial septal defect into the left atrium. An ultrasound probe (TEE) is also placed in the esophagus during the procedure, through which the optimum position of the occluder can be clearly visualized, as well as early complications of procedure (alternatively, an intracardiac ultrasound can be placed via another groin vein).

When the sheath is positioned in an adequate anatomic location, the occluder is slowly released until it ‘sits’ on the septum defect. The septal occluder use din our center consists of two disks composed of nitinol and polyester, which are interconnected by a short central part that completely fills the defect. The very composition of the occluder enhances the process of closing the defect in such a way that in the weeks after the procedure it stimulates the device to grow into cardiac tissue, which definitely closes the defect.

The success rate of the procedure is extremely high (98% successfully closed ASD 12 months after the procedure) with a low risk of complications (<1%).

The day after the procedure, a control transthoracic ultrasound of the heart is performed, and it should be repeated within the control monitoring 3 months after the procedure.

The patient is most often discharged home day after the procedure if the postprocedural course is uneventful.

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]]> 1379 Cryoblation https://aritmije.kbcsm.hr/en/cryoblation/?utm_source=rss&utm_medium=rss&utm_campaign=cryoblation Mon, 09 Mar 2015 17:57:01 +0000 http://aritmije.kbcsm.hr/?p=1583 Balloon cryoablation is a method for paroxysmal atrial fibrillation ablation that has developed as an alternative to radiofrequency ablation.

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Cryoblation

Balloon cryoablation is a method for paroxysmal atrial fibrillation ablation that has developed as an alternative to radiofrequency ablation. The procedure is performed without a 3D mapping system, under X-ray control. A balloon with a diameter of 23 or 28 mm is placed at the ostium (mouth) of each pulmonary vein (heart usually has 4 of them) and then the inside of the balloon is cooled to -80 ᵒC. The potential benefits of cryoablation are shorter duration of the procedure in comparison to the radiofrequency ablation and the need for a single transseptal puncture. According to the results of studies done so far, success is similar to radiofrequency ablation.

Cryoballoon and Laso (Achieve) catheter

Cryoabaltion animation. (Source: Medtronic, Minneapolis, Minnesota, USA)

Treatment is available also at the Department for Cardiovascular disease of the Sisters of Mercy University Hospital Centre, whose team on March 9^th, 2015 performed the first two cryoablation (Dr. Pavlović, Dr. Manola, Dr. Radeljić)

Team. From left to right: Ivana Mrmić, Monika Filipović, Šime Manola, Nikola Pavlović, Gordana Hursa, Marko Perković, Ivica Benko

Gallery

First cryoablations at Sisters of Mercy University Hospital Centre, March 9th , 2015

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]]> 1583 Radiofrequency cardiac ablation https://aritmije.kbcsm.hr/en/radiofrequency-cardiac-ablation/?utm_source=rss&utm_medium=rss&utm_campaign=radiofrequency-cardiac-ablation Tue, 08 Jul 2014 17:28:01 +0000 http://aritmije.kbcsm.hr/?p=1604 Radiofrequency ablation is a procedure that enables the treatment of many types of rapid heart beat (tachycardia).

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Radiofrequency cardiac ablation

Radiofrequency ablation is a procedure that enables the treatment of many types of rapid heart beat (tachycardia). A special catheter (ablation catheter) is introduced into the heart and positioned over a small area of the heart muscle responsible for the occurrence of irregular heart beats (arrhythmia). The ablation catheters is able to deliver radiofrequency energy (frequency 300-500 kHz, energy 10-50 watts, duration varies for each separate application). Radiofrequency energy thereby causes permanent micro-damage to the tissue with heat. Thus, damaged tissue is no longer able to produce the impulses responsible for arrhythmia or significantly reduces their occurrence. This method enables the patient to be permanently cured in some types of arrhythmia.

What types of arrhythmia can be treated with catheter radiofrequency ablation?

Paroxysmal supraventricular tachycardia (PSVT), including:

Wolf-Parkinson-White Syndrome (WPW Syndrome) or atrioventricular re-entry tachycardia (AVRT)
Atrioventricular nodal re-entry tachycardia (AVNRT)
Atrial tachycardia (AT)
Atrial flutter (AFl)

Atrial Fibrillation (AF)

Ventricular tachycardia (VT) and ventricular premature beats (known as extrasystoles – VES)

Some days before the procedure, it is necessary to stop taking certain medications in agreement with the cardiologist-electrophysiologist (anti-clotting drugs, some antiarrhythmic drugs). Consult with your doctor about stopping taking some medication a few days before your scheduled procedure, unless you have been told otherwise.

RF ablation is a therapeutic procedure that usually continues after a diagnostic electrophysiology study (see Cardiac electrophysiology study). Prior RF ablation starts, the patient may receive a venous sedative and/or painkiller. The use of RF energy generally does not cause pain, but chest discomfort or burning sensation may occur, which disappears after RF energy delivery stops and/or after medication administration.

Cardiac electrophysiology study

The ablation catheter is introduced into the heart usually through the femoral vein or artery to the heart. Afterwards, the same electrode locates the origin of arrhythmia (so-called mapping) and delivers RF energy.

At the end of the procedure, the doctor tries to cause the arrhythmia again, and if the arrhythmia is not provoked, the procedure ends. However, if arrhythmia is again triggered, the use of RF energy is repeated.

The duration of the procedure varies from patient to patient, depending on the arrhythmia involved. Typically, the procedure lasts two or more hours.

Upon completion of the EP procedure the catheters are removed and bleeding is stopped by briefly pressing the blood vessels through which the electrodes were placed. After bleeding is stopped, the puncture areas are covered with sterile bandages and the patient is returned to the ward lying down. Depending on the type arrhythmia involved, whether the veins or arteries were punctured, it is necessary to rest in bed for 6-24 hours after the procedure in order to prevent the bleeding of puncture site. Sandbags are sometimes placed on the puncture sites, which further exert pressure and prevent bleeding. During this time, toilet, feeding and hygiene are provided in the bed.

Patients may experience fatigue after RF ablation due to the use of sedatives and painkillers.

RF ablation complications. Complications of RF ablation are very rare and vary with different procedures. The figures are total including also complex procedures.

puncture site complications, cardiovascular access: bleeding, haematoma, infection, embolism, pseudo-aneurysm, arteriovenous fistula, vascular perforation: 2-4%
mechanical injuries of the heart (with catheter): cardiac perforation, tamponade, pericardial effusion, valvular injury, coronary sinus injury, myocardial infarction: 1-2%
systemic thromboembolism, including stroke, and/or pulmonary embolism (<1%)
pulmonary hypertension after atrial fibrillation ablation due to pulmonary vein stenosis
phrenic nerve injury in sinus node modification or RF ablation of atrial fibrillation
oesophageoatrial (between oesophagus and left atrium) fistula after AF ablation: 0.01-2%
impulse conduction disorders in any part of the cardiac conduction system: AV blocks 1-3%
the appearance of new arrhythmias
death: about 0.1-0.3%

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]]> 1604 Cardiac electrophysiology study https://aritmije.kbcsm.hr/en/cardiac-electrophysiology-study/?utm_source=rss&utm_medium=rss&utm_campaign=cardiac-electrophysiology-study Tue, 08 Jul 2014 17:23:00 +0000 http://aritmije.kbcsm.hr/?p=1599 Cardiac electrophysiology study is an invasive examination conducted in patients in whom a superficial 12-lead ECG and other non-invasive (painless) examination do not provide sufficient information to diagnose and treat heart rhythm disorders.

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Cardiac electrophysiology study

Cardiac electrophysiology study is an invasive examination conducted in patients in whom a superficial 12-lead ECG and other non-invasive (painless) examination do not provide sufficient information to diagnose and treat heart rhythm disorders.

Electrophysiology study is performed at a specially equipped and specialized laboratory (electrophysiology laboratory – EP lab). The procedure can last 1-4 hours. After local anaesthesia is given in the groin area, 2 to 5 thin introducers (plastic tubes) are inserted and through the introducers electrophysiology catheters are placed in the femoral vein. Catheters can be introduced through the left and/or right femoral vein, and rarely through subclavian and/or jugular vein to the right heart (the choice is up to the cardiologist). The catheters are further introduced to the heart and placed in the heart under X-ray control. At the tip of each catheter an electrical signal coming from the heart is recorded.

Electrophysiology study is performed to clarify the nature of the arrhythmic disturbances and to determine where arrhythmia occurs. During the EP study the doctors want to cause the arrhythmia experienced by the patient in his life. The arrhythmia may be caused by the electrical impulses produced over the catheter tip and managed by doctors.

In most cases, the arrhythmias caused during the EP study are interrupted by the same impulses that caused them. However, there are times when one electroshock is needed to cease the arrhythmia. In accordance with the determined arrhythmia and its mechanism, the doctor will decide on antiarrhytmic therapy, ablation and/or prevention. In some cases, it is possible to completely cure clinical arrhythmia with radiofrequency ablation by ablating in the area where arrhythmia occurs. (see: Radiofrequency cardiac ablation).

Complications of electrophysiology study. With electrophysiological study, as with all invasive procedures, there is a possibility for complications. Local complications are most common, such as: a small haematoma at the groin (catheter introducing area) [occurs in 10%] or the possibility of prolonged bleeding at the groin (after catheter withdrawal), for a maximum of ten minutes [occurs in 1-3%]. Less frequent [occurring in total of <0.5%] are lesions from blood vessel pressure, their obstruction, infection, or nerve damage that are in close proximity of blood vessels. Lesions of blood vessels pressure near the heart or in the heart can occur in 1-2 cases in 500. The possibility of thromboembolic complications is even smaller [1-2 cases in 1000]. In most cases, the complications are passable or can be repaired during the electrophysiology study. In rare cases, immediate surgical intervention may be required in case of a major complication that may be hazardous to the patient. This happens in 1 in 1000 cases.

In conclusion, during electrophysiology study the risk is very low and the benefit that the patient gains is very high.

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]]> 1599 Implantable Loop Recorder (ILR) https://aritmije.kbcsm.hr/en/implantable-loop-recorder-ilr/?utm_source=rss&utm_medium=rss&utm_campaign=implantable-loop-recorder-ilr Sun, 06 Jul 2014 17:18:57 +0000 http://aritmije.kbcsm.hr/?p=1594 An implantable loop recorder (ILR) is a small, USB-sized electrical device that can be implanted with a simple surgery under the patient's skin.

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Implantable Loop Recorder (ILR)

Some episodes of dizziness, light-headedness and/or syncope can be associated with simple life changes, however they can sometimes also be life-threatening. With the help of an implantable loop recorder, doctors can determine the abnormal heart rhythm that is responsible for these symptoms.

An implantable loop recorder (ILR) is a small, USB-sized electrical device that can be implanted with a simple surgery under the patient’s skin. Its purpose is to detect a heart rhythm disorder automatically or at the patient’s request using a special activator when symptoms occur. ILR battery life is approximately 18-24 months.

Fainting (also known as syncope) is a sudden loss of consciousness. It occurs after a sudden drop in blood pressure and due to a reduced oxygen supply to the brain.

The ILR is implanted with a minor surgery by making a small incision (1-2 cm) on chest area which is under local anaesthesia. The device is placed under the skin and the wound is closed with one small suture.

After ILR implantation, patients have almost no restrictions while performing normal daily activities. Patients can normally work, take a bath, swim without the risk of damaging the device. Magnets which are used in everyday environment cannot harm the device; however, strong electromagnetic fields (substations, welding machines, magnetic resonance) must be avoided.

In case symptoms occur (sensation of irregular or accelerated heart beats, fainting, etc.), the patient should contact his/her doctor in order to check the IRL’s recordings. IRL, same as a pacemaker, is based on wireless technology and it is not necessary to open the wound in order to check-up the device. When a patient experiences a problem, he or she can also activate the recording using a special activator (similar to a remote control).

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]]> 1594 Cardiac resynchronization therapy (CRT) https://aritmije.kbcsm.hr/en/cardiac-resynchronization-therapy-crt/?utm_source=rss&utm_medium=rss&utm_campaign=cardiac-resynchronization-therapy-crt Sun, 06 Jul 2014 17:14:38 +0000 http://aritmije.kbcsm.hr/?p=1592 Cardiac resynchronization therapy (CRT) treats some types of heart failure. Heart failure is a condition when the heart is not able to pump (contract itself) enough blood to the body.

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Cardiac resynchronization therapy (CRT)

Cardiac resynchronization therapy (CRT) treats some types of heart failure. Heart failure is a condition when the heart is not able to pump (contract itself) enough blood to the body.

When the heart is pumping blood, the left and right ventricles should do so at the same time (synchronous). In some patients with heart failure, the left ventricle does not squeeze blood at the same time (due to left bundle branch block), thus causing heart failure which is further worsen.

The CRT is a special device known as the biventricular stimulator. This device is very similar to a two electrode pacemaker, with an additional third electrode stimulating the left ventricle. CRT, just like the conventional pacemaker, sends electrical impulses thus synchronizing the operation of the left and right ventricle. In this way, it is possible to reduce the symptoms of heart failure in patients.

CRT is a device very similar to the pacemaker and consists of:

pulse generator – a metal casing, in which a special battery and microcomputer are sealed.
3 electrodes, one of which is located in the right atrium, one in the right ventricle and one at the surface of the left ventricle (in coronary sinus).

Implantation of cardiac resynchronization therapy

The implantation procedure is the same as of a permanent pacemaker, only exception is that due to the complexity of the third electrode placing/implantation, the procedure can last longer (see permanent pacemaker implantation).

Depending on the type of heart disease, doctors may decide for a so-called combined device. This combined device has the ability for biventricular stimulation (cardiac resynchronization) and cardioverter defibrillator (ICD) ability (see Implantable Cardioverter Defibrillator).

Video: Implantation of cardiac resynchronization at Sisters of Mercy University Hospital Centre

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]]> 1592 Implantable Cardioverter Defibrillator (ICD) https://aritmije.kbcsm.hr/en/implantable-cardioverter-defibrillator-icd/?utm_source=rss&utm_medium=rss&utm_campaign=implantable-cardioverter-defibrillator-icd Sun, 06 Jul 2014 17:11:14 +0000 http://aritmije.kbcsm.hr/?p=1589 An implantable cardioverter defibrillator (ICD) is an electronic device similar to a pacemaker that is implanted under the skin of a patient.

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Implantable Cardioverter Defibrillator (ICD)

An implantable cardioverter defibrillator (ICD) is an electronic device similar to a pacemaker that is implanted under the skin of a patient.

Cardiac arrest or sudden cardiac death occurs when an abnormal heart rhythm such as ventricular tachycardia (VT) or ventricular fibrillation (VF) disturbs normal heart function and blood circulation to the brain and other important organs. These dangerous arrhythmias without warning can be fatal in a matter of minutes, making them difficult or impossible to treat by conventional methods.

An ICD, sometimes popularly called a defibrillator, is a device, powered by a special battery, which significantly increases survival rate in the event of dangerous (malignant) arrhythmias. ICD cannot prevent arrhythmia occurrence, but it can successfully detect and treat it, restoring normal heart rhythm and save lives.

ICD treats arrhythmias in three ways:

cardioversion
defibrillation
stimulation (anti-tachycardia stimulation)

Cardioversion and defibrillation are both terms that indicate the delivery of an electric shock that interrupts a dangerous arrhythmia and restores a normal heart rhythm. If the patient is conscious the delivery of the shock is painful and is described as a “blow to the chest”. In most cases, however, while in a dangerous arrhythmia, shock is delivered only when the patient loses consciousness and does not feel the shock delivery. Anti-tachycardia stimulation involves the delivery of short cycles of stimulation (5-10). Anti-tachycardia stimulation is not painful, and it is almost imperceptible. Fewer patients may experience an unpleasant feeling of heart palpitations.

Because ICD is a sophisticated computer, it has a memory that records the patient’s heart activity as well as any disturbance of the heart rhythm and their treatment by the ICD. Such monitoring is of great diagnostic value and makes it easier for physicians to treat patients and further adjust the therapy and the device for each patient.

In addition to treating dangerous tachycardia, today’s modern ICD has all the possibilities of a standard pacemaker to treat bradycardia.

An ICD, just like a pacemaker, consists of a pulse generator and one or more electrodes. The pulse generator consists of a special battery that produces electrical shock and drives the entire system, and a computer circuit with an application that monitors the entire system. ICD electrodes monitor electrical impulses from the heart and send information about the patient’s heart activity to the ICD’s computer.

Cardioverter defibrillator implantation. Most often, the surgery is performed under local anaesthesia or deep sedation, and if necessary, it is possible that the patient is completely dormant for the purpose of device testing. The implantation technique is the same as for the implantation of a pacemaker (see: Permanent pacemaker implantation). The implantation lasts about 60 minutes.

Cardioverter defibrillator implantation complications – complications can occur during surgery or after surgery.

Complications during surgery:

lung collapse (pneumothorax) in 1% of cases – the therapy is to place a drain into thorax
cardiac perforation (cardiac tamponade) done with an electrode, which causes blood to accumulate in the closed space around the heart; in 1% of cases; therapy is placing a drain in the area where blood is collected (pericardium)
bleeding at the operative incision where the ICD’s battery (pulse generator) is located; additional risk is seen in patients prescribed with drugs that affect clotting (varfarin, acetylsalicylic acid, etc.)
the risk of device infection is less than 1%
electrode displacement in the heart occurs in about 1% of cases and usually requires a new procedure where the electrode/s are repositioned
death; death while implanting an ICD is less than 1:500.

Complications after:

implantation area infection – usually the entire system must be removed and re-implanted after the infection has resolved
electrode dysfunction – electrodes are the most sensitive part of the ICD, and thus strong mechanical forces from the outside can move or break the electrode, requiring new procedure and the electrode replacement
inadequate detection and delivery of electric shock
premature ICD battery discharge

Instructions for patients after implanting a cardioverter defibrillator.

After the implantation of the ICD, it is necessary to attend regular check-ups and controls, which are performed every 3-6 months. At the check-up completely painless control of the device is done with a special programmer. The ICD is a device that operates on the principle of wireless technology and that makes it very easy to test and adjust without necessity to open a wound.

If a shock was delivered. If the patient has felt shock delivery from an ICD, he/she should immediately report to the hospital where the device was implanted. There, the doctor will determine why the electric shock occurred and whether additional adjustments to the device or the introduction of additional medications are needed.

Fear of cardioverter defibrillator. Some patients describe the delivery of a shock as very uncomfortable and painful. However, most patients tolerate this discomfort because it saves life. Some patients may feel anxious and depressed about their dependency on the device or they fear of device failure. Talking to a doctor or psychologist can be helpful.

Restriction in driving a vehicle. Following the implantation of the ICD, it is necessary to follow the doctor’s instructions regarding driving. Because VTs and VFs most commonly cause loss of consciousness in patients, it is possible to lose control of the vehicle while driving. Generally the recommendations are:

you can drive a vehicle 3 months after the ICD was implanted
it is not recommended to drive for 6 months after ICD shock delivery

In any case, you should consult your cardiologist regarding operating a vehicle.

Avoiding electromagnetic interference. As ICD’s function depends on adequate recording of heart electrical activity, it is important to avoid strong electromagnetic fields that could interfere with the cardioverter defibrillator.

use your mobile phone on the opposite side of the ICD
household appliances (TV, radio, toaster, microwave) can be used normally as long as they function correctly
electromagnetic security systems at the shop entrances, courtrooms, airports and other high-security areas – it is recommended not to stay in the passage or vicinity of similar devices – you should pass through them at normal speed and avoid standing near them
medical examinations such as X-rays, computerized tomography (CT) and/or ultrasound do not interfere with the ICD’s function
magnetic resonance imaging (MR) may interfere with the ICD’s function and you should consult your cardiologist or a nurse
lithotripsy which is used in the kidney stones treatment and transcutaneous electroneurostimulation (TENS) as a pain management method may interfere with the ICD’s work and you should consult your cardiologist or a nurse
patients are required to inform all medical staff (doctors, dentists, nurses, engineers) that they are cardioverter-defibrillator carriers in order to carefully plan out medical procedures

Pregnancy. Women with implanted cardioverter defibrillator can normally carry out a pregnancy without increased risk to the fetus. If there are cardiac or other diseases in the medical history, it is necessary to consult your cardiologist about possible risks, possible medication changes, and care plans during pregnancy.

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]]> 1589 Temporary pacemaker https://aritmije.kbcsm.hr/en/temporary-pacemaker/?utm_source=rss&utm_medium=rss&utm_campaign=temporary-pacemaker Sun, 06 Jul 2014 17:08:38 +0000 http://aritmije.kbcsm.hr/?p=1587 The temporary pacemaker (TPM) involves heart stimulation due to often slow heart rate (bradycardia) or less frequently rapid heart rate (tachycardia), for a short time until the cause of heart rhythm disturbance is eliminated or until a permanent pacemaker is implanted.

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Temporary pacemaker

The temporary pacemaker (TPM) involves heart stimulation due to often slow heart rate (bradycardia) or less frequently rapid heart rate (tachycardia), for a short time until the cause of heart rhythm disturbance is eliminated or until a permanent pacemaker is implanted. A temporary pacemaker, if indicated, is sometimes implanted in patients scheduled for surgery most commonly under general anaesthesia, to protect them from heart rhythm disturbance during the surgery.

TPM implantation is performed under local anaesthesia by puncturing one of the larger veins (groin, subclavian, or jugular), and through that vein a temporary electrode is introduced into the right ventricle. The electrode is then connected to an external battery of pacemaker.

Treatment after implantation of TPM. After implantation of TPM, the patient is advised to rest with the arm or leg through which the TPM has been implanted. The puncture area through which the electrode was implanted must be kept dry and sterile (the puncture area will be regularly controlled and the wound nursed). Symptoms such as pain and burning at the puncture area, redness, as well as throbbing, irregular heartbeat, dizziness and lightheadedness must be reported to the medical personnel caring for the patient.

TPM removal. After removing the cause of the patient’s heart rhythm disturbance or implantation of a permanent pacemaker, the temporary electrode is removed and the puncture area is compressed for 5-10 minutes to stop the bleeding and the wound is sterilized and covered. Shorter bed rest is required to prevent bleeding from the puncture site.

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]]> 1587 Electrical cardioversion https://aritmije.kbcsm.hr/en/electrical-cardioversion/?utm_source=rss&utm_medium=rss&utm_campaign=electrical-cardioversion Sat, 07 Jun 2014 17:05:07 +0000 http://aritmije.kbcsm.hr/?p=1585 Electrical cardioversion, often called (electro)cardioversion, is a procedure that treats abnormal and usually fast heart rhythm (cardiac arrhythmia).

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Electrical cardioversion

Electrical cardioversion, often called (electro)cardioversion, is a procedure that treats abnormal and usually fast heart rhythm (cardiac arrhythmia). The most commonly treated arrhythmia with cardioversion is atrial fibrillation. Other cardiac arrhythmia which are treated in the same way are some circular supraventricular arrhythmias, such as atrial flutter, and ventricular tachycardia. During electrocardioversion under controlled environment, an electrical “shock” is delivered through the chest to restore normal heart rhythm.

How does electrical cardioversion work? Cardioversion includes the delivery of electrical shock across the patient’s chest to the heart muscle in order to interrupt the circulation of the tachycardia and allow the normal physiological (sinus) rhythm of the heart to be awaken.

How is electrical cardioversion performed? Electrical cardioversion is performed in a specially equipped room (intensive care unit, ward, EP laboratory) where patient’s heart rate, blood pressure, respiration and blood oxygen level (saturation) is monitored. In order to make delivery of electric shock less painful for the patient, the procedure is performed under short-term general anaesthesia. In that way the patient does not feel the electric shock, nor does he/she remember the procedure. After the patient has been sedated/anaesthesized, two electrodes are positioned on the chest which has been shaved beforehand. One electrode is positioned on the right side of the sternum and the other electrode is positioned on the left side of the chest, approximately above the heart. A controlled electroshock between the two electrodes is then delivered to interrupt the abnormal heart rhythm. The energy level is determined by the doctor depending on the arrhythmia, and if the first attempt is unsuccessful, the shock can be repeated with higher energy levels. After the patient is sedated/anaesthesized, the electrical cardioversion itself takes a few seconds, and the time required for the patient to wake up is approximately 5 to 10 minutes.

Electrical cardioversion in patients with an implanted cardiac pacemaker or implantable cardioverter defibrillator (ICD). With patients who have an implanted cardiac pacemaker or an ICD some caution is needed. Cardioversion can disrupt the pacemaker’s or ICD’s function, may damage the pacemaker’s casing, electrodes, or heart tissue. In order to reduce the risk, the external defibrillator electrodes should be placed at least 12 cm from the implanted device or, most commonly, the electrodes should be placed in the middle of the thorax and on the back between the shoulder blades (the anteroposterior position). Before and after electrical cardioversion, the implantation device requires testing in order to ensure that it is working properly.

Treatment after electrical cardioversion. After cardioversion, the patient is monitored for several hours, and if no additional medical treatment (hospitalization) is planned, he or she can be discharged. Recommendation is that the patient is discharged in company of a relative or a friend. A patient who was under sedation during cardioversion should not drive vehicles for 24 hours due to the possible side-effects of anaesthesia. Some patients may have skin irritation in the area where cardioversion electrodes were attached and recommendation is that the skin is treated with soothing creams to reduce irritation.

Electrical cardioversion in pregnancy. Cardioversion can be performed during pregnancy without affecting the fetal heart rate. However, recommendation is to monitor the fetal heart rate during the procedure.

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