Im­plantable pace­mak­ers

> Some of the lat­est de­vices have the ca­pa­bil­ity of home mon­i­tor­ing

The Sun (Malaysia) - - SUNBIZ -

DID you know your heart is con­trolled by elec­tric­ity? Amaz­ingly, the con­trac­tion of heart mus­cle in all hu­mans and an­i­mals are ini­ti­ated by elec­tri­cal im­pulses. The cells in the heart that cre­ate th­ese im­pulses are known as pace­maker cells.

Th­ese im­pulses are then con­ducted to the rest of the heart by the elec­tri­cal con­duc­tion sys­tem of the heart, much like elec­tric­ity is con­ducted in your house­hold wiring sys­tem. In some cases, when th­ese pace­maker cells are dam­aged or if the con­duc­tion sys­tem of the heart is dam­aged, a de­vice called an ar­ti­fi­cial pace­maker can be used to pro­duce and con­duct th­ese im­pulses syn­thet­i­cally.

The first car­diac pace­maker was thought up back in 1889 and the first ar­ti­fi­cial pace­maker was im­planted in a hu­man in 1958, us­ing a car bat­tery as its power source!

The first ar­ti­fi­cial wear­able pace­maker was also im­planted the same year, in a pa­tient, Arne Lars­son, who even­tu­ally re­ceived 26 dif­fer­ent de­vices in his life­time, and even out­lived the sur­geon who did the pro­ce­dure! He lived healthily and passed away from skin can­cer at 86.

From the time pace­mak­ers were in­vented, they have evolved in size from the large AC cur­rent op­er­ated de­vices be­low to cur­rent gen­er­a­tion de­vices that can fit in the palm of your hand. The lat­est gen­er­a­tion of de­vices is even as small as a 20 sen coin!

New car­diac de­vices are not only able to pace the heart, it can also de­fib­ril­late (shock) the heart when it goes into an un­sta­ble rhythm and resyn­chro­nises the heart in pa­tients with heart fail­ure.

In ap­prox­i­mately 25-50% of pa­tients with heart fail­ure, the left and right sides of the heart do not con­tract si­mul­ta­ne­ously. In

th­ese pa­tients, by pac­ing both sides of the heart, the pace­maker can resyn­chro­nise the heart and there­fore im­prove the qual­ity of life and re­duce mor­tal­ity in a se­lected group of pa­tients with heart fail­ure.

The lat­est de­vices even have the ca­pa­bil­ity of home mon­i­tor­ing – where the de­vice can wire­lessly send in­for­ma­tion to their doc­tor or tech­ni­cian and is mon­i­tored for events or in­ter­ven­tions in real-time, and thus promptly at­tended to.

Many pa­tients would ben­e­fit from a car­diac de­vice. Pa­tients who have too slow a heart­beat, those who have ir­reg­u­lar or rapid heart­beats or those with heart fail­ure may be a can­di­date for a car­diac de­vice.

Signs and symp­toms such as dizzi­ness, faint­ing, pal­pi­ta­tions (an abnormal aware­ness of your heart beat), chest dis­com­fort or short­ness of breath could be signs that you need a car­diac de­vice and should prompt a visit to your physi­cian.

This ar­ti­cle is con­trib­uted by Dr Ng Jit Beng, a lec­turer in Medicine at Pe­nang Med­i­cal Col­lege (PMC) and Clin­i­cal Car­di­ol­o­gist at Pe­nang Hos­pi­tal.

Dr Ng Jit Beng.

Pace­maker smaller than a 20 sen coin.

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