Cardiology: Atrial flutter (fibrillation) — Pacemaker implantation. Treatment
Atrial fibrillation and flutter are the most common types of arrhythmias. According to the global statistics, they are diagnosed in about 10% cardiac patients. The treatment strategy is determined by the form of the disease and general state of the patient. In some cases, implantation of a pacemaker allows achieving positive results.
Device installation is indicated to patients with chronic atrial fibrillation (AF), showing a slowed rate of ventricular contractions (bradysystole). The device is implanted in the heart chamber and, sending additional pulses to the myocardium, helps to increase the heart rate to normal.
Due to surgery, the development of severe bradycardia and associated asystole (pauses in the heart work) is prevented. Atrial fibrillation itself is not cured thereby, but the patient begins to feel subjectively better. Besides, the physician now is able to use more effective dosages of antiarrhythmic drugs.
The pacemakers of two kinds can be implanted:
- working in the "on demand" mode. These devices continuously monitor the ventricular performance and send electrical pulses only when the frequency of their rate falls below the norm.
- permanent. They generate electrical pulses continuously at the programmed frequency. Installation of these devices requires the prior destruction of the atrioventricular node using radiofrequency ablation.
A suitable pacing option is selected by the attending physician.
The surgery is performed under local anesthesia. In the upper part of the chest, the physician makes an incision up to 7 cm long, and then brings the pacemaker electrodes through the subclavian vein to the heart chambers. S/he forms a "pocket" under the skin, into which s/he inserts the device. All manipulations are carried out under continuous supervision of the ECG. The interference duration ranges from 1.5 to 3 hours.
There remains a small scar and appears an elevation (due to the device) at the implantation site. The life of different pacemakers can be 5 to 10 years. To monitor the device operation, the patient should regularly visit the cardiac surgeon.Hide
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