Heart pacing surgery is a medical procedure performed to implant Cardiovascular Implantable Electronic Devices (CIEDs) to help people with arrhythmias, a group of cardiac conditions characterized by abnormal heartbeats (too fast, too slow, or irregular). Examples of CEIDs in use today in Singapore include pacemakers, implantable cardiovascular defibrillators (ICDs), and implantable loop recorders (ILRs). One medical center in Singapore that specializes in heart pacing surgery and related treatment is the Dr. Davinder Singh Cadence Heart Centre. Read on for additional information about heart pacing surgery.
How does a CIED work?
CIEDs are simply devices that are implanted in the patient’s chest (via surgery) and continuously track his or her heartbeat. When an irregularity is found, the CIED will discharge electrical shocks or pulses to rectify any abnormalities or irregularities in the heartbeat.
What are pacemakers?
A pacemaker (also known as a cardiac pacing device) is designed to regulate or control a person’s heartbeat by providing the heart with regular, low-energy electric shocks to keep it beating normally. Pacemakers are commonly used to deal with the following conditions:
- Bradycardia-causes the heart to beat too slowly
- Atrial fibrillation-the heart beats erratically, frequently too fast and occasionally even too slowly
- Heart block-a partial or whole blockage of the electrical signal controlling the heartbeat
- Heart failure-the heart is unable to adequately pump blood to the body’s tissues
- Syncope or fainting
What are the types of pacemakers?
The type of pacemaker to be implanted will depend mainly on the person’s condition. Here are the types of pacemakers used today:
- Single-chamber-where the one chamber of the heart is connected to a single wire
- Dual-chamber-utilizes two wires that are connected to your two chambers of the heart; the type most commonly used
- Biventricular (cardiac resynchronization therapy)-employs three wires: two of which are attached to the ventricles (the heart’s lower chambers) and the third to the right atrium (the heart’s right upper chamber).
- Leadless-does not require any wires (or leads) but is directly implanted in the heart via catheter-based procedure.
What happens during the process of implantation of pacemakers?
A person who will undergo the (surgical) procedure of implanting a pacemaker will spend one to two days in the hospital and be required to fast the night before the treatment. The surgeon will do routine electrocardiograms and blood tests as a part of the preparatory process. Some necessary medicine such as antibiotics will be administered as well. During the surgery, the surgeon will make an incision near the patient’s collarbone and insulated wires (typically two of them) will be put into the patient’s vein. X-ray imaging is then used to route these wires to the patient’s heart. Consequently, the other end of the wires is connected to the pacemaker implanted in the small pocket beneath the skin.
In the case of implanting leadless pacemakers, a catheter will be used. A catheter will be placed into a vein close to the groin and used to guide the leadless pacemaker to your heart using X-rays. The catheter is removed after the device has been tested, and the incision used to introduce the catheter will be stitched up. The right ventricle or bottom right chamber of the heart is where the leadless pacemaker is inserted.
What are implantable cardiovascular defibrillators (ICDs)?
An implantable cardiovascular defibrillator (ICD) is a tiny, battery-powered device designed to prevent or halt potentially hazardous heartbeat by use of a low- or high-energy electric shock. ICDs are mostly required in cases of:
- Ventricular tachycardia-characterized by irregular and dangerous heartbeat
- Ventricular fibrillation-the heart’s ventricles quiver (fibrillate) instead of contracting regularly and which prevents the heart from pumping blood to the body’s other organs
- Cardiac death survivors or those who have escaped death caused by abrupt loss of the heart function
What are the types of ICDs?
There are 2 main types of ICDs. The first type is called the traditional ICD where the device is implanted in the chest and the wires are connected to the heart through invasive surgery. Meanwhile, the second type is called the subcutaneous ICD (S-ICD) which is implanted beneath the skin on the side of the chest below the armpit and wired to an electrode that runs along the center of the breastbone. S-ICDs are larger than traditional ICDs but are not connected to the heart.
What happens during the process of implantation of ICDs?
For implantation of ICDs, hospital admission will be required and the patient can be allowed to be discharged a day after the procedure, given there are no complications. An incision will be created below the collarbone during the surgery, and a lead (a flexible, insulated wire) will be put into the patient’s vein and directed to his or her heart using X-ray imaging. The ICD will then be attached to the lead’s opposite end. The final step is to implant the gadget slightly below the collarbone.
The surgeon will test the ICD and program it for the patient’s distinct cardiac rhythm requirements after it has been implanted. An ICD can be programmed as to pace in low energy where the ICD responds to mild changes in the patient’s heartbeat and will just feel like a painless fluttering in the chest. Alternatively, a higher energy shock can be programmed for more complicated heart rhythm conditions.
What are implantable loop recorders (ILRs)?
An implantable loop recorder (ILR) is a small diagnostic instrument implanted in the chest, just beneath the skin that enables cardiologists to monitor a patient’s heart as he or she goes about his or her regular daily activities for 2 to 3 years. The use of ILRs is recommended for those who are experiencing unusual heartbeats and unidentified causes of stroke and fainting, dizziness, light-headedness, and seizures.
What happens during the process of implantation of ILRs?
The implantation of ILRs is mostly done as an outpatient procedure and just takes around 10 minutes to complete. The patient will be able to go home on the day, after the surgery. A tiny incision will be created at the chest during the surgery, to the left of the breastbone. Then the insertion of the ILR device is done just beneath the chest’s skin. After the procedure, your doctor will give you a transmitting device placed by your bedside that will automatically transfer information captured by your ILR device to them, along with a portable activator to measure your heart rate when you experience symptoms. Your doctor will monitor the data supplied by your ILR gadget and tell you once your condition has been successfully confirmed.
Given the above-mentioned succinct discussion, there are many interventions available depending on your condition, so you should speak with specialists (like Dr. Davinder Singh Cadence Heart Centre) who can accurately diagnose your illness and choose which of the many treatment options will be the most appropriate for your particular requirements.
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Cadence Heart Centre
Mt. Elizabeth Hospital, 3 Mount Elizabeth #14-13
Mt Elizabeth Medical Centre, Singapore 228510
Mobile: (65) 8318 9884
Phone: (65) 6369 8789
