A biventricular pacemaker is a battery-operated device used to treat delay in contractions of the lower chambers of the heart (ventricles). As per research, patients with a biventricular pacemaker have better survival rates after the diagnosis is made. The average life increases approximately between 8.5 and 20 years, depending on the overall health, age, and lifestyle. All subgroup women had significantly longer survival than men. If the patients follow a few simple precautions and the doctor's schedule for periodic follow-ups, the pacemaker should not noticeably affect their lifestyle in any negative way.
What is ejection fraction?
Ejection fraction is a measure of blood that is pumped out by the left ventricle of the heart and is expressed in percentage. A normal ejection fraction usually lies between 50% and 70%. Patients with heart failure have a low ejection fraction, which hampers the blood supply to various parts of the body and leads to symptoms of heart failure. The symptoms are shortness of breath, dry cough, swelling of the ankles and legs, weight gain, increased urination, fatigue, and rapid or irregular heartbeat.
What is a biventricular pacemaker?
A biventricular pacemaker is a small, battery-operated device that helps maintain a normal and coordinated heartbeat by sending electrical impulses to the heart. It is used to synchronize the contractions of the left ventricle with the right ventricle to improve the ejection fraction in patients with severe and moderately severe symptoms of heart failure. A biventricular pacemaker is typically used in people with symptomatic heart failure. This is diagnosed through an echocardiogram (ECG), which reveals that the walls of their ventricles (main pumping chambers) are not pumping in a coordinated manner.
Biventricular implantation is considered in patients with heart failure and
- Severe or moderately severe heart failure symptoms.
- Delayed electrical activation of the heart.
- Either a risk or history of cardiac arrest.
- On long-term medications for heart failure.
A biventricular pacemaker can be implanted either by an endocardial (transvenous) approach or epicardial approach.
- Endocardial, transvenous approach: This is the most common and simple method of pacemaker implantation. A lead is inserted 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.
When the heart rate drops below the rate set with the pacemaker, it senses the drop and transmits electrical impulses to the left and right ventricles to contract simultaneously. This improves the ejection fraction and cardiac function. The lead placed in the right atrium helps the heart to function in a more balanced way.
Biventricular pacemaker implantation is also called cardiac synchronization therapy and is only a part of any comprehensive heart failure management program. Medications, lifestyle changes, and regular follow-ups with a cardiac specialist are all crucial for managing the symptoms and improving the quality of life in patients with heart failure.
Patients with a biventricular implantable cardioverter defibrillator (ICD) must maintain a distance from magnetic resonance imaging (MRI) machines and hand-held security wands, which contain strong magnets. They should also avoid anything with a strong magnetic field, such as radio transmitting towers and high-powered electrical equipment. Patients may be provided with a medical card that will let them avoid metal detectors in public places such as airports and courthouses. Patients will periodically have to replace the generator’s battery. The procedure is similar to that of the original implantation but less involved and time-consuming.