A transuctane pacemaker is used externally, outside the body. It is connected to so-called pacing electrodes, which stimulate the heart for a limited time. This pacemaker is used only in emergencies or prophylactically after surgical procedures.
What is a transuctoral pacemaker?
Transcutaneous pacing of the heart involves sticking electrodes to the patient’s skin that deliver stimulating electrical shocks to the heart. Transcutaneous pacing of the heart involves sticking electrodes to the patient’s skin that deliver stimulating electrical shocks to the heart. There is a certain distance between the electrodes and the heart, so a higher current intensity is required. This has an effect on the entire musculature of the body. For this reason, transcutaneous stimulation is used only in emergencies. In addition, the patient should be sedated in an analogous way to achieve shielding. With this method it is possible to electrically stimulate the patient’s heart externally for a short time. Transcutaneous stimulation is used in cases of bradycardia and serious AV block. If asystole occurs, this procedure is not recommended because the prognosis is poor. The advantage of external pacing is that it is a noninvasive procedure that can be performed quickly. For this, it is necessary to stick large electrodes, which provide the necessary energy. Depending on the manufacturers, there are different solutions of stimulation and different ways for attaching the electrodes. The handling of the pacemakers can also vary.
Shapes, types and styles
The transcutaneous pacemaker is composed of the pulse generator and the electrode, which connect to the ventricle of the heart. Electrical impulses are sent to the heart by means of the electrode. The heart signals are then returned to the pulse generator. This is how the pacemaker control works. There are pacemaker probes for temporary stimulation. After heart surgery, temporary cardiac arrhythmias often occur. In such a case, epicardial pacemaker electrodes are inserted, which can be removed after about seven days. These electrodes consist of insulated and conductive wires, which are fixed to the ventricular and atrial myocardium. The actual device is external to the body. With the transvenous pacing probe, a sheath is created centrally venous, which opens into the right ventricle. The electrode stimulation is performed by an external device. This allows reliable stimulation over a longer period of time. However, complications can occur, such as dislocation of the electrodes or infections caused by the catheters. Furthermore, there are the stick-on pacemaker pads, in which stimulation is performed transcutaneously by means of two large electrode pads. Negative electrodes are fixed precordially or parasternally, while the positive electrodes find their place between the left scapula (shoulder blade) and the spine. In this procedure, the ventricles are stimulated. Again, high currents are needed, which in turn affect the muscles of the skeleton and cause pain. The so-called transesophageal pacing probes are pushed through the esophagus to approximately the left atrium. The atrium can be stimulated well. However, stimulation of the ventricle requires a functioning AV lead. Direct stimulation is only possible with very high and painful currents. The advantage here is that it can be placed quickly and does not require invasive surgery.
Structure and mode of operation
The transcutaneous pacemaker has two basic functions. This is first the sensing of the patient’s own heart actions, which is called sensing. In what is called pacing, the pacemaker delivers the impulses. The electrical heart signals are in the millivolt range, and the pacemaker senses them. The sensing sensitivity can be adjusted. It is displayed in millivolts. This value shows the minimum level of spontaneous heart impulses so that they can be detected. This limitation is necessary to prevent the pacemaker from misinterpreting signals or reacting over-sensitively. If the range is set too high, the pacemaker will not be able to sense the cardiac actions. In this case, we speak of undersensing.The transcutaneous pacemaker has control lamps that indicate the detected signals in the atrium or ventricle. The stimulation pulse or pacing is composed of voltage strength and duration, which can also be adjusted. The pulse strength is indicated in volts or milliamperes and the duration in milliseconds. For the current strength, a high value can be entered for the time being. Once the stimulus strength for excitation of the heart has been determined, the actual setting of the device takes place. The stimulus threshold of the heart, which was determined individually for the patient, is then set. The pacemaker is also equipped here with small control lamps that monitor the stimulation of the heart. However, it must be noted in this case that the flashing activity only serves to confirm the pulse emission. ECG monitors are used for safety and verification.
Medical and health benefits
The transcutaneous pacemaker is used in emergency medicine for emergencies and for symptom relief, which can occur with slow heartbeats, or bradycardias. Fainting and dizziness may indicate serious complications. Normal heart rates are restored via the transcutaneous pacemaker. It also ensures the patient’s blood supply. If, in an emergency, there is an imminent threat to life, the device can be used safely and quickly on the spot. Only a few emergencies necessitate the use of transcutaneous pacemakers. However, the use of the device becomes imperative in cases of symptomatic bradycardia that cannot be influenced by medication in AV block III. Asystolic cardiac activity as well as ventricular tachycardia that cannot be treated also necessitate its use.
