What Is a Pacemaker?: A Cardiologist's Guide for Patients and Care Providers by Jeffrey L. Williams Dr

Author:Jeffrey L. Williams, Dr. [Jeffrey L. Williams, Dr.]
Language: eng
Format: epub
Tags: Health & Fitness, diseases, Heart
ISBN: 9781481916608
Google: cqG0nQEACAAJ
Publisher: Createspace
Published: 2013-05-09T23:51:22.508756+00:00

Figure 15A-F. Examples of Incisional Healing Normal pacemaker pocket (A) several weeks after implantation shows a uniform incision and mild fullness representing the pacemaker in the pocket. Pocket and incisional thinning with prominent skin tenting from a lead (circle) in an extremely elderly patient is shown in B. Redness and irritation from adhesive tape is shown in C. One can see redness and skin breakdown that is seen with imminent erosion (D) than can lead to complete erosion (breaks through the skin) of pacemaker (E). Finally, F depicts a pocket hematoma.

There is data to suggest that warfarin (Coumadin®) causes fewer pocket complications than heparin products. Specifically, temporarily interrupting anticoagulation (e.g., stopping Coumadin) is associated with increased thromboembolic events (e.g., strokes or transient ischemic attacks), whereas cessation of warfarin with bridging anticoagulation with heparin products is associated with a higher rate of pocket hematoma and a longer hospital stay.62 The discussion of perioperative anticoagulation is very important to discuss with the doctor who will be performing the pacemaker implantation.

Hospital lengths of stay: There is little data available on average length of hospital stays post pacemaker implantation. Our experience with pacemaker implantation in extremely elderly patients84 revealed an average hospital length of stay post-implant of 2.1 days; however, over 90% of pacemaker generator changes were discharged home the same day, and most patients that had an elective pacemaker implant (e.g., referred from the office) were discharged the day after implantation. An estimate of two to three days as an average length of stay post implant can be made from the available studies, though this includes patients that were already admitted to the hospital for other reasons.16,19,84 There is evidence that complications cause a substantial increase in the length of stay up to sixteen days.63 The mean complication costs are: $4345 ± $1540 for pacemaker lead revision, $24,459 ± $14,585 for pacemaker infection, and $6187 ± $2631 for hematoma evacuation.63

Complications that usually occur within thirty days of implant.

Pacemaker and lead function/failures: Electrocardiographic signs of pacemaker malfunction can be grouped into four categories: failure to pace the heart, failure to deliver a pacing signal, undersensing, and inappropriate pacemaker rate. There is an overall pacemaker and lead malfunction rate in 1–3% of patients.64

Failure to pace the heart (loss of capture). Failure to pace the heart means that a pacing signal is delivered but does not result in a heartbeat. You may not even notice this occurring, but patients can often feel palpitations or dizziness or even faint as a result. Loss of capture after pacemaker implantation has many causes:

- Dislodgement. Lead dislodgement means that the lead has fallen out of place and likely is in an area that does not pace correctly.

- Elevated thresholds: Device requires more energy than normal to pace and may lead to early battery depletion.

- Inappropriate lead placement: Lead may not be properly located and misplacement not discovered until follow-up.

- Lead fracture: Very rarely a lead may break (usually near insertion site to pacemaker header).

- Insulation failure: The silicone/plastic outer coating of the lead (insulator) has a defect and can cause lead to malfunction.

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