Implantable Pacemakers

Implantable Pacemakers

It's weird to see that Alex, Cristina, Meredith, Jackson, April? … Are now the grown-up doctors policing the interns. Watching Stephanie and Leah fight for surgeries reminded me of the first few seasons when we would see Cristina or Alex try to sabotage each other in order to land scrubbing in on an exciting surgery with certain attendings. Competition is inherent in all surgeons, so a little dose of it between interns can be healthy, right? Well, not if you're Mrs. Crossely. Stephanie and Leah's competitive spirits almost gave her an air embolism. 

… Speaking of Mrs. Crossely…

What the heck happened to that poor woman to cause her to need to be upside-down?!?

Cristina implanted a pacemaker into Mrs. Crossely, and the surgery went fine. However after she returned home, Mrs. Crossely suffered a severe coughing fit, which dislodged one of the pacemaker's ventricular leads. When the leads are not properly connected, the pacemaker does not function. Therefore, Mrs. Crossely's heart started to slow down, giving her symptoms of weakness, fatigue, lightheadedness, dizziness, and subsequently, loss of consciousness.

So why did Mrs. Crossely seem perfectly okay when she was upside down? Well, when her body changed position in that direction, the ventricular leads reconnected, causing the pacemaker to work again and regulate her heart beat.

The solution when this happens? After confirming the dislodgement with a chest X-ray, the surgeon will take the patient back into surgery to securely reattach everything.

Besides lead dislodgement, what other complications may occur with pacemakers?

After implantation, patients may experience mild pain, swelling, or tenderness at the site of insertion. Doctors will recommend that the patient avoid vigorous activity or heavy lifting for a few days. Following this initial time period, other complications that may occur include:

• The pacemaker's battery may become weak or fail. Depending on how active the device needs to be set, the batteries need to be replaced on average every six to seven years.

• The patient's heart disease can progress, perhaps needing a pacemaker readjustment or alternative intervention.

• Devices may interrupt the pacemaker's electrical signaling after prolonged exposure or close contact (such as cell phones, MP3 players, certain household appliances, high-tension wires, metal detectors, industrial welders, or electrical generators).

• Certain medical procedures may disrupt the signaling (MRI, electrocauterization during surgery for bleeding, shock-wave lithotripsy for kidney stones).

Mrs. Crossely needed a pacemaker to treat her complete heart block. What are other reasons people need pacemakers?

A pacemaker helps control the heart beat, and many people struggle with irregular rhythms, or arrhythmias, for various reasons. The most common ones are heart block and bradycardia (a heart beat that is slower than normal). Heart block is a disorder that occurs if an electrical signal is slowed or disrupted as it moves through the heart. According to the National Heart Lung and Blood Institute, other indications for a pacemaker include:

• A past medical procedure to treat an arrhythmia such as atrial fibrillation.

Aging or heart disease that hinders the ability of the body to set the correct pace by causing slow heart beats, long pauses between beats, or a switch between slow and fast rhythms (also called sick sinus syndrome).

Certain medications that slow the heart beat, such as beta blockers.

Long QT Syndrome, which can cause dangerous arrhythmias.

Fainting or symptoms of a slow heart beat, such as when the main artery of the neck that carries blood to the brain is sensitive to pressure.

Heart muscle problems that slow down the traveling electrical signals.

Congenital heart defects or heart transplants.

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