July 23, 2010

Surgery Concerns After Pacemaker or ICD Implant

Posted in Heart disease tips tagged , , , , , , , at 3:13 am by keepyourhearthealthy

photo by Filomena Scalise

Frequently, heart disease patients need to have other types of surgery after they have undergone implantation of a cardiac device such as a pacemaker or ICD (Defibrillator).

For example, one might need to have joint surgery or their gallbladder removed.  Any type of surgery with a cardiac device becomes a little more complicated than before the device was implanted.  Why? The problem is that electrical signals sent off by some surgical instruments can interfere with the functioning of the pacemaker or defibrillator.

To give a specific example, a surgical instrument called a “Bovie” or electrocautery is a great tool during surgery to burn away small blood vessels and limit bleeding.  When in use, the Bovie creates interference on the EKG that the pacemaker or defibrillator thinks is a fast and erratic heartbeat.  As a result, the cardiac device may not work properly during the times when the Bovie is being used.

There is an easy solution! Your cardiologist is usually involved in the process of clearing you for any type of surgery.  They can recommend that a magnet be placed over the cardiac device if needed.  A large magnet over a pacemaker causes it to signal the heartbeat without paying attention to the erratic Bovie signals.  When a large magnet is placed over a defibrillator, this prevents the defibrillator from giving inappropriate shocks related to the interference of the Bovie.  No matter which device you have, a magnet is usually the solution to preventing unwanted problems during the surgery.

July 10, 2010

Think Carefully Before Getting a Pacemaker or Defibrillator

Posted in Heart Disease in the News, Heart disease tips tagged , , , , , , , at 12:42 am by keepyourhearthealthy

by Arvind Balaraman

After reading an article called “What Broke My Father’s Heart” in the New York Times I was reminded of how life-changing cardiology can be.  Working in the field, I often take for granted the significant decisions that must be made by the patients and caregivers.  In my mind, getting a pacemaker or defibrillator seems as easy as pie!  I hardly consider it to be surgery at all anymore!  There’s only a few stitches required and the patients may go home the next day.  It’s certainly nothing like having your chest cracked open.

As the article points out though, the problem with these devices exists when there is longevity of a poor quality of life.  In my opinion, the pacemaker should not have been pushed on this particular writer’s father.  He had already suffered a stroke and required constant assistance from his elderly wife.  The only reason the pacemaker was placed was to get the patient through hernia surgery.  There are temporary pacemakers for that!  Eventually the family had made the decision to turn off the pacemaker but were denied due to ethical reasons on behalf of the doctor.  The whole ordeal was a complete mess for the patient and family!

I am not one to criticize or deny any patient a pacemaker/defibrillator when needed.  However, I sincerely encourage caregivers to consider every option before agreeing to a cardiac device.  I have personally helped a patient and his caregivers turn off an implanted defibrillator.  It was a much less dramatic experience than the one that the New York Times author had but it was still a big decision for everyone!  If quality of life is good at the time a pacemaker or defibrillator is needed then I say go for it.  If you really do not want to prolong suffering, then you always have the option of refusing a device.