Pacemaker - what is it? How is the pacemaker installed? Cost of operation

Pacemaker - what is it from a medical point of view? First of all, it is a miniature electronic device, normalizing the work of the heart muscle. Cardiac pacemaker provides the optimal number of contractions necessary for normal life. The device is able to overcome the electrophysiological dissociation of the atria and ventricles, the so-called atrioventricular blockade, and thus stabilize the work of the heart.

History of creation

Pacemaker - what is this for a physiologist? How can this device be used to affect the pathological processes in the cardiovascular system of the human body? The application of weak impulses of electric current to eliminate arrhythmia scientists were conceived as early as the end of the 19th century. However, the lack of technology to generate electrical messages in a minimized sense did not allow even to begin research in this direction.

Only in the first half of the 20th century, physiologists could begin to study the effect of electrical impulses on the activity of the heart. The discoverer in this area was the Italian researcher Luigi Galvani. Later, Russian physiologists NE Vvedensky and Yu. M. Chagovets engaged in the study of the possibility of using weak electrocution discharges to treat certain heart diseases.

In 1927, American cardiologist Albert Hayman designed the world's first electro-mechanical device that maintains the rhythmic stability of the human heart. The device weighed more than three hundred grams, the device was suspended on special belts and was hidden under clothes. However, the electrostimulator functioned well, its serial release was soon established.

First results

Pacemaker - what is it for Albert Hayman, the creator of the apparatus and his colleagues dealing with problems of cardiac arrhythmia? First of all, this is the first stage in the long process of studying electrotechnical techniques that could be put at the service of medicine.

Practical application of Hyman stimulant in an extreme situation took place in 1951, when the patient managed to save the patient after the operation with the developed transverse blockade of the heart and bouts of extrasystole. Nevertheless, the patient had to stay in the hospital for a long time, since he could not move freely with a bulky apparatus on the body and, in addition, needed constant observation by the medical staff.

Stimulator-Implant

World cardiology centers have joined forces to create a compact electrostimulator that weighed no more than 80 grams. In 1958 a group of Swedish scientists led by Dr. Rune Elmquist created a miniature "Siemens-Elem". The stimulator was enclosed in a thin-walled body made of titanium alloy and could be implanted under the skin. However, the energy intensity of the Swedish invention was small - the battery provided impulses for only 18 months, after which the patient was forced to perform an operation to replace the power source.

Creation of domestic ECS

Finally, a pacemaker - what is this from the point of view of the patients themselves? Of course, this is a life-saving device that prolongs the life of cardiac patients suffering from various rhythm disturbances. The heart muscle, functioning in the right tone, is the guarantee of the stable functioning of the whole circulatory system of the body.

In 1960, the Soviet academician A. N. Bakulev addressed the leading technical centers of the USSR with a proposal to create apparatus for cardiac stabilization. The first to respond was the staff of the Design Bureau of Precision Engineering in Engineering, which had the status of a defense enterprise. In a short time, experimental ECS samples were created, technological tests were carried out, and already in December 1961 the first pacemaker of Russian production EKS-2 "Moskit" was successfully implanted in a patient suffering from complete atrioventricular blockade of the heart. The pacemaker Mosquito was produced for 15 years, thousands of sick people were saved thanks to a reliable miniature device.

A high percentage of deaths due to cardiovascular diseases in the USSR, marked in the late 50's, began to decline. The cardiac pacemaker, whose reviews on the part of the patients were generally positive, quickly gained popularity.

The novelty was constantly improved, the characteristics of the domestic EKS improved. At the end of 1962, new samples were introduced, recommended by the Ministry of Health for serial production. Thus, a cardiac pacemaker created in Russia, whose quality feedback was positive, began to be produced immediately at several medical facilities.

External Pacemaking

Before implanting the stimulant-implant patient can receive preliminary help using an external contact device consisting of two plates that are located on both sides of the chest: one in front in the heart area, the other on the back, under the left scapula. The impulse passing through the sternum causes the smooth muscles to contract on both sides, as well as the heart muscle. This method causes a feeling of discomfort in the patient, but as a temporary method of stabilizing the rhythm of the heart beat is quite appropriate. The disadvantage of the method of external stimulation is also that the patient should not be left unattended, especially if he is unconscious. Installation of a pacemaker working On a permanent basis, requires special training, which takes several weeks.

Temporary endocardial stimulation

The principle of this effect on the heart muscle is to insert the probe-electrode into the heart cavity. For such operations, a sterile kit is created from the conductor and the probe itself, which is delivered through the venous canal to the heart. The end of the electrode is installed in the right atrium, and its opposite, proximal termination is connected outside to the source that generates electrical impulses.

Setting a pacemaker on a temporary basis is usually used when there is no time for more radical techniques. After normalization of the patient's cardiac activity, one can begin to implant a permanent device.

How to implant a permanent EX

A pacemaker, the implantation of which is a small surgical intervention, is designed for long-term use. Implantation is carried out, as a rule, with local anesthesia. The whole process is divided into several stages. First, a cut of the skin and fiber and the separation of the vein. Then, to the heart, the required number of electrodes are placed, which are placed in the heart chambers. After the introduction of conductors, all data are checked: the sensitivity, the threshold of stimulation, the optimal arrangement of the wires that conduct the impulses. Then, the electrodes are fixed, a bed is formed for the pacemaker, and the device is implanted.

In some cases, the implant does not immediately get accustomed, there may even be a slight rejection, but the inflammatory process quickly abates under the influence of conventional medicines, and the patient continues to live normal normal life.

Main functions of EX

The device is an electronic device, mounted in a compact metal case. The microprocessor is powered by a battery designed for several years. The principle of action of domestic ECS is to react to the absence of another reduction in the heart muscle of the patient. The pacemaker is designed so that the pulse sent by its electronic brain is practically not late - the difference in time is a hundredths of a second.

In normal operation of the heart, the device behaves indifferently - does not send impulses. There is a group of pacemakers that have the ability to frequency adaptation. Such devices incorporate a sensor that is sensitive to changes in patient activity. In fact, this is an acceleration sensor, an accelerometer that responds to changes in the parameters of the electrocardiogram and respiratory rate. During exercise, the pacemaker sends rapid pulses.

The latest models of ECS are able to accumulate data on the work of the heart, which can then be output to a monitor or digital media for analysis. This function allows the doctor to prescribe the optimal medication, as well as to select the parameters of the pacemaker. Revision of such devices should be conducted at least once every six months. A pacemaker, the price of installation is quite affordable for a person with an average income, can be replaced if necessary.

Transesophageal pacing

To diagnose the phenomenon of arrhythmia, the patient uses a test system with a probe. A special conductor with an electrically conductive tip is inserted into the esophagus. The probe stops at the point of contact of the heart, or rather the left atrium, with the esophagus. Then the generator is turned on, which provides pulses of different frequencies. The meaning of such studies is to detect the presence of ischemic heart disease. Rapid heartbeat under the influence of electrical impulses can show a rejection of the load by the heart muscle.

Esophageal stimulation is universal enough, with its help it is possible to diagnose a number of cardiological diseases. In some cases, NPP allows for treatment: to remove paroxysmal tachycardia, to suppress atrial flutter, to perform temporary stimulation with bradyarrhythmia accompanied by a rare pulse, to eliminate the syndrome of weakness of the sinus node. Some manipulations are possible only with a deeper placement of the probe in the esophagus.

Pacemaker: cost of surgery

Installation of an EKS in Russia can cost from 65 to 650 thousand rubles. This amount consists of the cost of the device itself, the costs of implantation and the post-operation period. The pacemaker itself, the price of which is determined by the manufacturer, can be relatively inexpensive (from 20 thousand rubles.). The choice of the model is given to the patient. It is better to buy a pacemaker, reviews of which are mostly good. These are the devices of the companies Medtronic, StJudeMedical, Guidant and Biotronic.