When a pacemaker is essential

The pacemaker, a device that stimulates the heart and maintains the heartbeat, It becomes essential when the heart is no longer able to maintain a sufficiently slow and regular rhythm to ensure good blood circulation. In practice, it is used especially when there is a pathological bradycardia (heart too slow) or blocks in the heart's electrical system.

But the pacemaker is not inserted just because the heartbeat is a little slow, it becomes necessary when the slow rhythm causes symptoms or there is an electrical disturbance at risk of worsening or stopping.

How a lifesaving device works

The heart It is not just a mechanical pump, but it depends on a electric system that regulates each heartbeat. If that system is blocked, blood doesn't circulate sufficiently. In some forms of heart block (especially complete AV block), electrical impulses no longer reach the ventricles. Without a pacemaker, the heart can progressively slow down, stop for prolonged pauses, or experience a cardiac arrest.

The pacemaker avoids all this by maintaining a minimum effective rhythm.

Also, if the heart beats too slowly, the brain receives less oxygen and may appear fainting (syncope) sudden

These episodes are not just annoying: they can be fatal if they occur while driving, at heights, or in other risky situations.

In some diseases (such as sick sinus syndrome), the heart alternates between beating too slowly and suddenly pausing. The pacemaker prevents these sudden "drops" in rhythm. And it prevents complications in a chain reaction, as too slow a rhythm can lead to heart failure (a heart that pumps poorly), worsening blood pressure, and organ damage due to poor perfusion.

Types of pacemakers

Pacemakers can be classified in different ways: number of stimulated rooms, to function, And for implant technologyHere are the main types.

• Single-chamber pacemaker

Stimulate a single room, usually the right ventricle, has a single lead and is used when only a minimal heartbeat is needed. Simpler, but less "physiological," it can be useful, for example, in elderly people with atrial fibrillation.

• Dual-chamber pacemaker

Stimulate right atrium and ventricle, has two electrocatheters (one installed in the atrium and the other in the ventricle) and better reproduces the heart's natural rhythm. It is the most commonly used type today because it maintains a more coordinated contraction, and is particularly suitable when connecting the two chambers of the heart, in individuals subject to blockages that prevent the impulse originating in the atrium from reaching the ventricle.

• Rate-responsive pacemaker

Increases or decreases the heart rate based on body activity, using different sensors (movement, breathing, etc.). It better simulates the heart's natural behavior during exercise.

• Pacemaker “on demand”

It activates only when the heart rate slows below a certain threshold, and if the heart beats normally, it remains in standby mode. It is considered the most modern standard.

• Leadless pacemaker

It's called this because it's a small device implanted directly into the ventricle, without a catheter. It reduces complications related to leads, although it's not suitable for everyone (but this is a doctor's assessment), and has several advantages. The leadless device has no surgical pocket and no external "pathways" for bacteria, thus reducing the risk of difficult-to-treat infections. Its implantation does not cause scars that are visible, and it lasts longer than conventional pacemakers (15 years instead of 10). Finally, it does not cause discomfort during sports activities. On the other hand, the wireless pacemaker has some contraindications. First of all, at the moment, it stimulates right ventricle only (therefore, it has a single chamber), it cannot perform more complex functions (such as atrioventricular synchronization or CRT), and removal or replacement can be more complex. Not to mention the cost: it can be up to five times more expensive than a conventional pacemaker. The wireless device alone costs between 3,000 and 6,000 euros, while the traditional one costs between 1,000 and 3,000 euros.

Read also

• How to protect your heart
• How to protect your heart from the heat
• Why heart attacks are always more serious in the morning