What Is a Transvenous Pacemaker?

A pacemaker actually refers to the entire pacing system. The pacing system consists of a pacemaker, a pacing electrode lead, and a program controller. The pacemaker and pacing electrode lead are implanted in the human body. The pacemaker consists of a circuit and a battery installed in a metal box.

pacemaker

The pacemaker sends tiny electrical pulses to the heart when needed. The pacing electrode leads consist of insulated wires that are responsible for transmitting tiny electrical pulses to the heart and stimulating the heart to beat.

Chinese name: pacemaker
Definition: Refers to the entire pacing system
Make up: Pacemaker, pacing electrode lead and program controller

Implanted: Pacemaker and pacemaker
Pacemaker composition: Circuits and batteries installed in metal boxes
Launch direction: heart

initial,

Asynchronous pacemaker (fixed-frequency pacemaker). This type of pacemaker is used only for ventricular pacing, and lasts for the third time.

Artificial cardiac pacemakers can be divided into three categories according to the way the pacemaker is carried:

External portable pacemaker (also known as percutaneous pacemaker).

Embedded pacemaker in the body.

Semi-buried pacemaker (also known as induction pacemaker).

Pacemaker implantation is usually done in the catheterization room. The operation takes about 1-2 hours, and the patient needs to be hospitalized for about 1 week after surgery. The procedure for implanting a pacemaker is roughly as follows:

Local anesthesia (no need for general anesthesia for pacemaker implantation)

Subclavian puncture (placement of guide wire)

Put the pacing electrode through the vein and test

Make a pouch and place a pacemaker

suture

The patient remained awake throughout the procedure. After the pacemaker is implanted, the patient needs local sandbag compression to stop bleeding (6 hours) and lie supine for 24 hours. You can sit up and move up to 24 hours after surgery, but care should be taken to avoid movements of the upper limbs and shoulder joints. Short-term postoperative use of antibiotics (1-3 days), dressing changes the next day, and the stitches can be removed after 7-8 days.

Pacemaker concept

"Pacemaker" is also called "deep brain electrode stimulation" in medicine. This method is a major breakthrough in the surgical treatment of Parkinson's disease in recent years.

Brain pacemaker It has previously been recognized by the medical community as an effective treatment for Parkinson's disease.

"Pacemaker" is to send a weak current to stimulate the relevant nerves that control movement in the brain, suppress the abnormal brain nerve signals that cause the symptoms of Parkinson's disease, so as to eliminate the symptoms of Parkinson's disease, and to restore the patient's free life and self-care . The "brain pacemaker" consists of a set of exquisite and compact microelectronic devices, including an electrode, an extension lead, and a microcomputer pulse generator (Figure 1). These parts are all implanted in the body. The implanted components do not cause rejection and do not affect the patient's daily life.

Pacemaker suitable for installers

Primary Parkinson's disease

Taking levodopa (medopa) has a good effect

Drug efficacy has gradually decreased or side effects

The patient can no longer maintain normal life, work and social activities

No obvious mental retardation, willing and able to cooperate during implantation and subsequent review

Pacemaker treatment effect

Since the 1990s, with the help of "brain pacemakers", tens of thousands of patients with Parkinson's disease worldwide have begun a new life, and its efficacy has been stable for a long time:

Control the main symptoms of Parkinson's disease: tremor, stiffness, slow or inability to move, impaired balance, etc.

Can reduce the dose of medicine

Eliminate or reduce side effects caused by drugs

Increase on time, improve off quality of life, and improve daily activities

Non-invasive adjustments in vitro can be made according to the patient's condition to control the symptoms for a long time

Bilateral simultaneous implantation can be used to control bilateral symptoms, especially midline symptoms such as standing, kicking, turning, turning over, etc.

Pacemaker surgery process

With accurate stereotactic positioning, the "bracer pacemaker" can be smoothly implanted in the body. This kind of surgery has high safety, less trauma, and does not damage brain tissue. The installation process can be basically divided into the following steps:

Step 1: Install the stereo headpiece: This is the basis of the entire operation. Help doctors locate and perform surgery. This procedure uses local anesthesia, with the exception of a slight pressure sensation, and generally no discomfort.

Step 2: Accurate positioning: Through magnetic resonance (MRI), help doctors obtain the position parameters of nuclei that need to be implanted with electrodes.

Step 3: Implant the electrode: According to the position parameters, open a 1-cent coin-sized hole on the patient's head, and accurately place the 1-mm-thick electrode into the corresponding nucleus of the brain. The damage in this process is minimal, and because the brain itself does not feel pain, it does not feel pain. The patient was awake with local anesthesia.

Step 4: Effect test: After the electrode is implanted, the doctor performs a preliminary test to adjust the parameters, and observes and checks the improvement of the patient's symptoms. Further adjust the electrode position based on the patient's feeling and improvement of symptoms. If the symptoms are significantly improved during the test and the patient is satisfied, the doctor can proceed with the entire system implantation process below.

Step 5: Implant the entire system: If the symptoms are controlled during the test, the doctor can further implant the entire "pacer" system. The specific operation is to implant a microcomputer pulse generator under the skin of the chest, and then connect the electrodes and the microcomputer pulse generator through a wire through the skin.

Comparison of "Pacemaker" and Destructive Surgery

One of the great advantages of installing a "brain pacemaker" is that the damage to the brain tissue is small during the operation. The operation is reversible. The best effect can be achieved by adjusting the position of the electrodes, and there are fewer complications. And the electrodes can be implanted on both sides to improve systemic symptoms. From a technical point of view, the method of positioning a "brain pacemaker" is exactly the same as the positioning method for a destructive surgery. Based on the successful completion of more than 1,000 Parkinson's disease operations, we are Accuracy is fully certain. However, there are not many patients with "brain pacemakers" currently installed in China because the implanted electrodes are expensive and the stimulation parameters need to be adjusted repeatedly within about six months after the operation. Therefore, we will comprehensively consider all factors, and at the same time fully consult the patient to formulate the most suitable surgical plan.

Pacemaker patient cooperation

During surgery, most of the time the patient is awake, because the doctor needs the cooperation of the patient to determine the position of the electrode and the effect of the treatment.

For "bracer pacemaker" users, follow-up after surgery is very important. About a month after surgery, after the patient's various aspects returned to normal, the doctor will use computer telemetry technology to adjust the parameters of the "microcomputer pulse generator" embedded in the chest under the skin in vitro. This process is called "program control". This is a non-traumatic and painless process. There is also a patient program controller, in which the patient can adjust the parameters within the safety range defined by the doctor to coordinate their limb movements (Figure 3).

(3) The program control needs to be performed about 3 times within six months after the operation according to the patient's symptoms. Through program control, help patients to achieve the best symptom control. In the future, patients can go to the hospital for corresponding testing and program control according to their own conditions, an average of 1-2 times a year.

Within six months after surgery, patients will experience fluctuations in symptoms. This is a normal phenomenon. The main reason is that the patient's postoperative drug dose changes and the patient has a process of adaptation to the "bracer". As long as you talk to your doctor and adjust the medication and stimulation parameters, the symptoms will gradually stabilize.

Pacemaker side effects

"Pacemaker" is a new type of treatment. Its high safety is a big advantage. There are few permanent side effects. Very few patients feel weakened muscles, reduced speech tone, transient dizziness and transient. Numbness, if these side effects occur, can be reduced or eliminated by in vitro programming.