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How Does a Biventricular Pacemaker Work?

Reviewed on 10/27/2020

This type of pacemaker stimulates the lower left and right chamber of the heart.
This type of pacemaker stimulates the lower left and right chamber of the heart.

A biventricular pacemaker is a special type of pacemaker to treat heart failure with abnormal electrical systems. This type of pacemaker stimulates the lower left and right chamber of the heart.

A biventricular pacemaker is placed in the chest and is connected to three thin wires, called leads. The leads travel to different chambers of the heart. In the case of an irregular heartbeat, the pacemaker sends a painless signal through the leads to the heart muscles. These signals make the heart muscles of the lower chamber to contract, thus stimulating the upper and lower chambers to pump together. In some cases, a biventricular pacemaker along with an implantable cardioverter-defibrillator (ICD) may be used to regulate a dangerously irregular heartbeat. ICD is an electronic device that tracks the heart rate. Both these devices, when used together, prevent sudden death.

What is a biventricular pacemaker?

A biventricular pacemaker is a type of pacemaker to treat heart failure with abnormal electrical systems. This type of pacemaker stimulates the two chambers of the heart.

In a normal heart, the lower chambers of the heart pump together in sync with the heart’s upper chamber. During heart failure, the lower chamber and upper chamber do not pump together. When the contraction is out of sync, the left ventricle fails to pump sufficient blood to the body. Insufficient blood pumping ultimately leads to worsening of symptoms, such as:

  • Cough especially when sleeping or lying down
  • Shortness of breath
  • Swelling in the ankles or legs
  • Weight gain
  • Increased urination
  • Fatigue
  • Rapid or irregular heartbeat

Who should receive a biventricular pacemaker?

People with ejection fraction less than 35% are at a greater risk of fast, irregular, or sometimes, life-threatening heart rhythms. Ejection fraction is the measure of the blood volume pumped from the left ventricles. A biventricular pacemaker is appropriate for patients associated with the below factors:

  • History of cardiac arrest or are at risk of getting cardiac arrest
  • Moderate to severe heart failure symptoms
  • Take many medicines for a failed heart
  • Delayed electrical activation of the heart

What happens during the biventricular pacemaker implantation?

A pacemaker can be implanted by one of the two methods:

  • Endocardial, transvenous approach: This is the most common and simple method of pacemaker implantation. A lead is implanted into the vein present under the collar bone and guided to the heart. The tip of the lead attaches to the heart muscle. The other end is attached to the pulse generator, which is placed under the skin in the upper chest.
  • Epicardial approach: The physician opens the chest to attach the tip of the lead outside the heart. The other end is attached to the pulse generator, which is placed under the skin in the abdomen.

What happens after the biventricular pacemaker implantation?

After the implant, you will have to stay in the hospital overnight. The leads are tested to make sure it is correctly placed and functioning. Small amounts of energy are delivered through the leads into your heart muscle, causing it to contract. Once the testing is successful, the physician connects the lead to the device. The nurses continuously monitor your heart rate and rhythm to see for any variations. The Holter monitor attached to your chest records your heart rhythm for 12 hours to ensure that the pacemaker is functioning.

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References
https://www.webmd.com/heart-disease/heart-failure/biventricular-pacing#1

https://my.clevelandclinic.org/health/treatments/16784-biventricular-pacemaker/procedure-details

https://www.uofmhealth.org/health-library/abo3298#:~:text=A%20biventricular%20pacemaker%20is%20implanted,leads%20to%20fix%20the%20problem

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