Bradycardia, Slow Arrhythmias, Atrial Fibrillation and more
Atrial fibrillation is the most common cardiac rhythm disorder. As such, atrial fibrillation can either directly lead to a slow pulse (bradycardia) or the medication required to treat atrial fibrillation can cause a small pulse. However, bradycardia can also occur without atrial fibrillation, e.g. an AV blockageIt's a heart block that occurs when the electrical signal between the heart chambers and ventricles is impaired. This situation occurs when the electrical conduction system within the heart is sick. This disease leads to symptoms such as dizziness, shortness of breath and syncope. The treatment is a dual-chamber pacemaker. Two-chamber means that the atrium and the ventricle are each provided with an electrode (cables) connected to the pacemaker. Finally, resynchronization may be necessary in certain situations, in which case a 3-chamber pacemaker, also called a bi-ventricular system, is used.
With atrial fibrillation and other cardiac arrhythmias, pacemakers are used to bridge the diseased conduction system of the heart. The pacemaker consists of a housing and one or two electrodes (cables) that generate the connection between the unit (battery) and the heart. The electrodes connect the chambers of the heart through the venous system to the pacemaker, which lies under the skin just by the clavicula. With the electrodes, the pacemaker adapts its performance to the heart and ensures a sufficient pulse rate, in case it stops.
Single-chamber pacemakers are used for slow atrial fibrillation, and dual-chamber pacemakers are mainly used for patients with a sick sinus node or AV block. There are also three-chamber pacemakers (bi-ventricular systems) used for patients with cardiac muscle weakness.
Electrode (Lead) extractions and pacemaker change
The Heart & Rhythm Centre specializes in the removal of old pacemaker electrodes when they are no longer necessary. These can potentially be very difficult interventions, that are carried out in the hybrid operating room, where a heart-lung machine is always on standby. These procedures are always performed in a HeartTeam setting with an experienced cardiac surgeon present.
The Classic - AICD
A defibrillator is an automatic device that is implanted to prevent sudden cardiac death or to treat ventricular tachycardia. Like a pacemaker, the battery is placed under the skin and a lead (a cable) is fixed in the heart with a small screw. When the defibrillator senses an arrhythmia, a controlled electric shock is triggered between the battery and the probe, which terminates the cardiac arrhythmia.
Subcutaneous defibrillator (S-ICD)
Meanwhile, there are also devices which do not require a lead in the heart. These subcutaneous defibrillators (S-ICD) have the great advantage that there is no foreign body (the lead) in the bloodstream. Prof. Dr. Salzberg was able learn this method directly from the pioneer of the method in Amsterdam and then brought the method to Switzerland. These devices can be removed again without any problems.