Recently, our hospital successfully implanted a wireless double-cavity pacemaker. Today, let’s share with you the relevant knowledge of pacemaker .
In the past, when the heartbeat is slow or the heart stops, we may choose drug treatment, but drug treatment itself has various side effects; it is difficult to choose medications that are fast and slow when the heartbeats are fast. Therefore, the best treatment for bradycardia is a pacemaker.
With the development of technology, pacemakers, as a heartbeat assist device, can solve the above problems. Heart diseases such as third-degree atrioventricular block, -disease sinus syndrome , and hyperbradycardia, can all lead to the heart beating regularly by implanting pacemakers.
The function and complexity of pacemakers are also constantly improving, making them more intelligent, smaller in size, longer in life, cheaper in price, and wider in use. The earliest pacemakers could only solve the problem of slow heartbeat. The current pacemakers can also be used for the synchronous treatment of cardiomyopathy , and defibrillation prevents sudden death.
Traditional cardiac pacing system mainly includes two parts pulse generator and electrode wire . The pulse generator is the pacemaker; in addition to the pacing function, the pacing system also has the perception function of transmitting the heart's own electrocardiogram activity back to the pulse generator. The following figure shows the traditional pacemaker.
In recent years, miniaturized pacemakers have appeared, so that the pacemaker can be directly implanted into the heart through intervention to avoid the use of electrode wires. This is a wireless pacemaker. The battery-like object in the middle of the figure below is a wireless pacemaker. It is only one-third of the weight of a one-yuan coin. It is precisely because the weight and volume are very small that they can be implanted into the heart without affecting the function of the heart and the quality of the patient's activity.
Let’s take a look at the difference between the two types of pacemakers from the image (the left picture shows a wire, and the right picture shows a wireless pacemaker):
Comparison of the chest X-ray after implantation of the two pacemakers (the left picture shows a wire, and the right picture shows a wireless pacemaker):
The implantation method of two pacemakers:
Traditional pacemakers have relatively complex surgery. After puncture of subclavian vein as the pathway, the pacemaker electrode is sent to the right ventricle and right atrium to fix it. Then, it makes all the mouths on the upper part of the pectoralis major muscle on the ipsilateral side. The pacemaker is connected to the electrode wire and buried under the incision. The surgery is completed. Traditional pacemakers will inevitably leave a 3-4 cm scar on the chest, which may cause postoperative infection. The operation of a wireless pacemaker is simple, and it enters through blood vessels throughout the process, and minimally invasive scars can basically be ignored.
There are some problems with traditional pacemakers: wear and breakage of pacemaker wires; rupture and infection of pacemaker capsules; some patients cannot implant traditional pacemakers due to illness and defects in the venous system, and they lose their chance of treatment. There are also some complications: venous embolism, severe tricuspid valve regurgitation , etc.
The implantation of a wireless pacemaker is through femoral vein puncture, which implants the pacemaker into the heart cavity through a catheter, which not only reduces pain, trauma and complications, but also reduces the risk of infection, covering almost all the disadvantages of traditional pacemakers. Moreover, the wireless dual-cavity pacemaker Micra AV has made breakthroughs through innovative sensors and revolutionary algorithms to achieve a beating mode closer to the natural heart of the human heart, better simulate the physiological conduction function of the heart, and achieve physiological, accurate and pacing in line with human needs. After implantation, patients can hardly feel the presence of pacemakers, which can greatly improve the patient's quality of life.
Currently, the world's smallest wireless pacemaker Micra AV is currently used in clinical practice. It is shaped like a capsule and weighs only 2 grams. Its core technology is the acceleration sensor , the size of a nail. It can not only accurately sense the patient's own activities, but also sense the frequency of the heart beating, which is more intelligent. It is suitable for almost all patients with bradycardia and has a great preventive and therapeutic effect on chronic arrhythmias.
The benefits of are obvious: minimally trauma, no incision scars, no wires, no capsule bags, simplified surgery, short surgery time (30-50 minutes), greatly reducing the incidence of complications such as infection in patients. They can move normally after about 24 hours after the operation, and can be discharged from the hospital about two days after the operation. They also avoid complications such as tricuspid valve regurgitation caused by traditional pacemaker electrode wires. Moreover, patients with can undergo 1.5T or 3T whole body magnetic resonance scan after surgery, which is indeed a great blessing for elderly patients.
wireless pacemaker is suitable for almost all patients with traditional pacemaker indications, especially for patients with axillary vein, subclavian vein, and superior vena cava occlusion, and is suitable for patients with high risk of cystic bag infection, such as elderly, many comorbidities, skin diseases, and low resistance.
Of course, some friends may ask, are there no shortcomings in wireless pacemaker? I personally think the biggest disadvantage is that the price is too expensive, but as the domestic dosage increases, the price will inevitably drop. In addition, although it is a minimally invasive, it is a surgery after all, and the surgery still has certain risks: such as complications of femoral vein-related pathways, or the need to replace the instrument, as well as cardiac perforation, pericardial effusion, etc. Of course the probability of these risks is negligible.
Finally, what you may be most concerned about is the life and price of pacemakers! This type of pacemaker has a service life of about 128 years and a price of about 160,000 yuan. Currently, medical insurance in some regions can also be reimbursed part of it, and generally 40,000 to 50,000 yuan can be reimbursed. The specific medical insurance policies are different in each local area.
