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Pacemaker implantation at leading cardiac surgeons in Israel

 

Pacemaker implantation in Israel

 

 

The pacemaker implantation is one of the ways to treat arrhythmia in Israel. Arrhythmia is a failure of the heart rhythm.

 

We work with leading Israeli cardiac surgeons, electrophysiologists or arrhythmologists, heads of departments and research institutes in Israel, experienced specialists in the treatment of all types of arrhythmias, including the implantation pacemaker.

 

Our doctors perform the implantation of a pacemaker at leading Israeli Assuta Hospital.

 

A pacemaker is an electrical device which function is to keep up a heart rate. There is a pacemaker designed to treat disorders of sinus node, so its main function is to generate pulses.

 

Another type of pacemaker is designed to eliminate interference in the conductivity system  of electrical impulses, so its main function is to rhythmize the heart chambers. This mediator transmits impulses from the atria to the ventricles, helping a natural pacemaker.

 

Pacemaker-defibrillator or implanted cardiac defibrillator (ICD) is used in patients with an increased risk of heart failure:

  • with atrial fibrillation (VT / VF)
  • with severe cardiac insufficiency
  • with previous cardiac arrest

 

Biventricular pacemaker (BVP) is implanted to improve heart function in people with severe heart failure. A novelty in this direction is the innovative Smart Optimizer System pacemaker with CCM technology for cardiac insufficiency, which modulates cardiac contractility.

 

CRTD is a device, combining biventricular pacemaker and a defibrillator, and is used for increased risk of cardiac arrest.

 

Newer pacemakers can be programmed for physical exercises due to the built-in motion or breathing rate sensors. So, when the patient is under physical load, the device increases heart rate, imitating the natural response of the heart to physical activity.

 

How does the natural electrical system of the heart work?

A natural pacemaker or sinus node is located in the right atrium of the heart and initiates cardiac activity. At the first stage, electrical signals from a natural pacemaker are propagated through the atrium, causing it to contract and to fill the ventricles with blood. At the second stage, the atrial node transmits electrical signals from the atrium to the chambers of the ventricles, as a result of this action the chambers of the ventricles are compressed to remove blood from the heart back to the body.

 

When an Israeli cardiac surgeon can schedule the pacemaker implantation

For some heart conditions, problems can occur in a natural pacemaker generating electrical impulses for contractions or in a pulse transmission system. In both cases, the result is similar: the transmission of electrical impulses slows down, which causes a too slow pulse. This is also called bradycardia.

 

Some people have the opposite problem: the sudden appearance of a fast irregular heartbeat. In most cases, it is a benign rhythm disorder, such as atrial fibrillation which is usually not life threatening. A smaller part of cases (about 30%) – especially  with severe heart defects – are atrial cardiac arrhythmia (ventricular tachycardia / ventricular fibrillation or VT / VF). In this condition, the pulse becomes very fast (sometimes more than 200 beats per minute) and can lead to cardiac arrest.

 

In these cases  pacemaker is needed.

 

Pacemaker design

The pacemaker comprises two main parts:

  • Small electronic device with battery.
  • A flexible electrode or electrodes which conduct electrical impulses through the heart.

 

The type of implantable pacemaker is determined after consultation and the decision of an experienced cardiologist, as well as the results of a heart diagnosis:

  • Electrocardiogram – ECG
  • Holter monitoring during quiet activity and / or exercises
  • Echocardiogram – ECHO

A pacemaker is included in the work if it is necessary and provides the generation of electrical impulses to maintain proper cardiac activity.

 

How to prepare for the pacemaker implantation in Isreal?

  • Fast from midnight of the night before surgery
  • Medications should be taken as usual, unless otherwise prescribed
  • For diabetes, you should also consult a diabetologist or endocrinologist (we will coordinate appointments with these specialists if needed)
  • It is important to report about allergies and drug sensitivity
  • If necessary, sedatives will be given before and during implantation.

 

How is the operation of pacemaker implantation and hospital discharge performed in Israel?

Cardiac surgeon carries out the operation of pacemaker implantation in a catheterization room with sterile environment. The procedure is performed under local anesthesia or in rare cases under general anesthesia. The operation of pacemaker implantation takes 1-1.5 hours. Surgeon places tiny device with the battery in the upper part of the chest (under the collarbone on the right or left side) through a small incision, where the subcutaneous pocket is located. Electrodes are inserted into a blood vessel (vein) to the heart and positioned in the desired area. During the installation of the pacemaker, x-ray and electrical control devices help the surgeon to verify the correct location of the pacemaker and electrodes.

 

Next, the patient transfer will be carried out to the ward for further observation. If necessary,doctor can  prescribe painkillers. Be careful, when moving the arm to the side where the catheterization was performed.

 

The next day after the pacemaker was implanted, CT scan of the chest and hospital discharge will be performed. After about a week, the surgical wound is examined and the sutures are removed. Avoid getting water at the operation site. Also, it is prohibited to drive during the week.

 

Adaptation and rehabilitation after implantation – life with a pacemaker

 

The recovery process after  a pacemaker implantation is individual. Initially, after surgery, the weight of the device (about 50 g) may be felt, but soon this feeling will disappear. Pain in the suture will pass over time. A slight restriction is also possible when working with the hand, so it is necessary to do the hand physiotherapy in accordance with the doctor’s recommendations. Step by step, you can return to your normal daily activities, including:

  • bathing and showering
  • work and movement of goods
  • sexual activity
  • driving
  • walks
  • gardening, etc.

 

Our cardiac surgeon will advise you about activity in special cases, such as working with a high-voltage device or in the field of a strong electromagnetic field, or when driving public and heavy vehicles. Ionizing radiation does not affect the operation of the heart pacemaker, so the metal detector at the airport does not interfere with the normal pacemaker work. To avoid unpleasant beeps, you must notify the safety controller in advance. Drivers of public or heavy vehicles often have more stringent restrictions.

 

When to see a doctor after implantation of a pacemaker?

After installing a pacemaker, it is essential to undergo a medical examination every 6 months with our cardiac surgeon. Our doctor will check heart rhythm disturbances. If necessary, he will make changes remotely to the pacemaker configuration and optimally adapt it to your lifestyle. At every visit pacemaker and a battery status will be checked as well.

 

For your attention,  you should immediately consult a doctor, when you have such symptoms or their combination:

  • Dizziness, fainting, shortness of breath
  • Fever, weakness, constant fatigue
  • Fever with redness or swelling in the pacemaker area
  • Swelling of the legs and arms
  • Chest pain

 

It is recommended that you have a pacemaker identifier with you.

 

When do you need to replace a pacemaker?

The date of the pacemaker replacement will be announced in advance during the consultation of our cardiologist. The device’s batteries are in a charged state, when replaced.

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