Pesmecoeur is a French name, which in English translates to pacemaker. A pacemaker is a specialized electronic device usually implanted in patients whose heart rates have a tendency to slow down. The device is typically inserted underneath the skin below one’s clavicles. The device usually communicates with the heart by a specialized wire(s) inserted through a nearby vein. It ensures that the heart rate does not become too slow by providing an electrical stimulus for the heart to beat (Hesselson 20).
A pacemaker does not prevent fast heart rate including the most common rhythm abnormality atria fibrillation. Therefore, when the heart beat is not too slow, the device is able to recognize this and not pace. This process is called ‘sensing’. There are two types of pacemakers: single chamber pacemakers and dual chamber pacemakers. A single chamber pacemaker only functions in one chamber of the heart (Hesselson 34). This is normally accomplished by use of a single wire placed in the atrium or ventricle depending on the type of heart rhythm abnormality the patient suffers.
On the other hand, a dual chamber pacemaker usually functions in two chambers of the heart, one chamber being an atrium while the other one is the ventricle. This normally allows for the normal sequence of beating, atria contraction followed by ventricle contraction. This sequence is maintained even in the face of a heart block. For this to be accomplished, a separate wire for each chamber is required. Implantation of the single chamber pacemaker or the dual chamber pacemaker depends on the kind of heart rhythm abnormality the patient suffers or the preference of the physician implanting the pacemaker (Jeffrey 15).
A complete permanent pacing system includes the pacemaker itself and the pacemaker leads. These are also referred to as pacemaker/ pulse generator and electrodes respectively. The pacemaker acts as both the power source and the ‘brains’ of the pacing system. The system contains a battery and an electronic circuitry that performs these functions. The lifetime of the battery usually varies depending on how much it is used to pace the heart (Hayes, Fallon and Noble 46).
The longevity can vary between five- ten years. When the battery begins to wear down, the pacemaker does not stop suddenly but rather shows signs over many months with the magnetic rate or other rate indicators. This usually calls for a replacement of the entire device. The battery is not the only one replaced as it is sealed inside the device. Once implanted, pacemakers can be reprogrammed and their behaviors completely reconfigured (Hayes et al. 52).
The use of pacemakers is more common in advancing age. Surveys have shown that up to 80% of pacemakers are implanted to the elderly, and the average age recipients in the randomized trials of pacing made was between 65 and 85 years. This is not surprising as sinus syndrome and atrio-ventricular block are the most common indicators for permanent pacemaker implantations representing more than 90% of the cases and are both strongly associated with age (Katlic 17).
Conventionally most patients who receive pacemakers suffer from either atrio-ventricular block or sinus node dysfunction with most of the recent increase in pacemaker implants rate being attributed to the latter diagnosis. Based on outcomes of patients treated with pacemakers, it is generally accepted that pacemakers improve survival of patients with atrio-ventricular block. In addition, in both atrioventricular block and Sinus node dysfunction, pacemakers reduce morbidity by preventing syncope, resultant injuries, and exercise intolerance and in some cases heart failure (Katlic 17).
In elderly patients, minimizing these symptoms and complications is of particular importance and they may frequently result in loss of independence and necessity for institutional care; however even with pacing, the risk of death or the need for institutional care remains high among elderly individuals. Although considered a minor surgery, the implantation of pacemakers entails risks, which may occur at a higher rate in the elderly compared to the young. Although the surgery may be performed without incident, it must also be appreciated that among frail elderly individuals, the stress, disruption, and immobility associated with even a brief hospitalization may be sufficient to trigger delirium or require short-term or even long-term institutional care (Jeffrey 19).
Understanding the rate of complications among the elderly patients is critical to the selection of the optimal surgical technique for cardiac rhythm device implantation. Special attention is therefore essential to such patients as they often have much co-morbidity, require multiple medications (including anticoagulants and steroid) and may have low body mass. With limited subcutaneous tissue under which to implant a pulse generator, their skin may be of poor quality with spontaneous bruising and reduced defense against infection. Vascular access may be challenging too due to venous thrombosis, tortuosity and obstruction particularly in the case of patients with existing pacemakers (Hayes et al. 63).
The pace maker is an implantable device and a life saving tool. It has proved itself as an extraordinary protean artifact as is successfully manages chronic disorders of heart that were almost impossible to treat in the past (Katlik 24).
Aaron B. Hesselson. Simplified Interpretation Of Pacemakers ECGS. New York: John Wiley and Sons. 2008. Print
David L. Hayes, Rebecca S. Fallon and Matthew D. Noble. Understanding Your pacemaker or Defibrillator: What Patients and Families Need To Know. Canada: Cadiotext Publishers. 2012. Print.
Kirk Jeffrey. Machines In Our hearts: The Cardiac Pacemaker, The Implantable Defibrillator and The American health Care. New York: Jitu Press. 2003. Print
Katlic, Mark R. Cardiothoracic Surgery in the Elderly. New York: Springer, 2011. Internet resource.