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There are single wire pacemakers used for regulating heart beat. The wire will conduct pulse to the heart. How can one wire be enough? Where is the reference wire for the stimulation of heart?
Our Pacemakers For Bradycardia
Medtronic offers many pacemaker options — please talk with your heart doctor to determine the best pacemaker option for your health situation.
Micra AV and Micra VR
Micra™ is our smallest line of pacemakers — leaving no bump under the skin, no chest scar, and requiring no lead. Micra is completely self-contained within the heart and provides the therapy needed without a visible or physical reminder of a medical device.
Model numbers: MC1AVR1, MC1VR01
The Azure™ pacemaker is equipped with BlueSync™ technology and is compatible with MyCareLink Heart mobile app — the latest innovation from Medtronic in remote monitoring.
If Azure detects changes in your heart, it wirelessly and securely transfers your heart device information to your clinic. Azure pacemaker is safe in the MRI environment when specific conditions are met, and offers exclusive algorithms to accurately detect and reduce the likelihood of atrial fibrillation.
Model numbers: W1DR01, W1SR01, W3DR01, W3SR01
The Advisa™ MRI SureScan™ pacemaker is the second-generation FDA-approved pacing system designed for safe use in the MRI environment when specific conditions are met. Advisa is available in single and dual chamber options.
Model numbers: A2DR01, A3SR01
Adapta™ is a “physiologic” pacemaker. It waits for your natural heartbeat before delivering the pacing impulse to avoid unnecessary pacing. The Adapta pacemakers are also completely automatic, constantly adjusting their settings and adapting to meet your heart’s needs.
Model numbers: ADDR01, ADDR03, ADDR06, ADDRL1, ADDRS2
This list does not include all of our past pacemakers.
- Revo MRI™ SureScan™
- Kappa™ 400
Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.
Dual chamber versus single chamber ventricular pacemakers for sick sinus syndrome and atrioventricular block
Background: Dual chamber pacing or single chamber atrial pacing ('physiologic' pacing) is believed to have an advantage over single chamber ventricular pacing in that it resembles cardiac physiology more closely by maintaining atrioventricular (AV) synchrony and dominance of the sinus node, which in turn may reduce cardiovascular morbidity and mortality thus contributing to patient survival and quality of life. However, a significant proportion of pacemakers currently implanted are single chamber ventricular pacemakers.
Objectives: The objective of this review was to assess the short- and long-term clinical effectiveness of dual chamber pacemakers compared to single chamber ventricular pacemakers in adults with AV block, sick sinus syndrome or both. An additional objective was to assess separately any potential differences in effectiveness between dual chamber pacing and single chamber atrial pacing. The clinical effectiveness of single chamber atrial pacing versus single chamber ventricular pacing was not examined.
Search strategy: The Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2002), MEDLINE (1966 to 2002), EMBASE (1980 to 2002) and the Science Citation Index (1980 to 2002) were searched on 19th August 2002. Citation lists and web sites were checked and researchers in the field contacted.
Selection criteria: Parallel group or crossover randomised controlled trials of at least 48 hours duration comparing dual chamber pacing and single chamber ventricular pacing, and investigating cardiovascular morbidity, mortality, patient related quality of life, exercise capacity and complication rates.
Data collection and analysis: Data was extracted onto pre-piloted data extraction forms. Quality assessment was undertaken using a checklist, with a sub-sample of quality data independently extracted by a second reviewer. Where appropriate data was available, meta-analysis was performed. Where meta-analysis was not possible, the number of studies showing a positive, neutral or negative direction of effect and statistical significance were simply counted.
Main results: Five parallel and 26 crossover randomised controlled trials were identified. The quality of reporting was found to be poor. Pooled data from parallel studies shows a statistically non-significant preference for physiologic pacing (primarily dual chamber pacing) for the prevention of stroke, heart failure and mortality, and a statistically significant beneficial effect regarding the prevention of atrial fibrillation (odds ratio (OR) 0.79, 95% CI 0.68 to 0.93). Both parallel and crossover studies favour dual chamber pacing with regard to pacemaker syndrome (parallel: Peto OR 0.11, 95% CI 0.08 to 0.14 crossover: standardised mean difference (SMD) -0.74, 95% CI - 0.95 to -0.52). Pooled data from crossover studies shows a statistically significant trend towards dual chamber pacing being more favourable in terms of exercise capacity (SMD -0.24, 95% CI -0.03 to -0.45). No individual studies reported a significantly more favourable outcome with single chamber ventricular pacing.
Reviewers' conclusions: This review shows a trend towards greater effectiveness with dual chamber pacing compared to single chamber ventricular pacing, which supports the current British Pacing and Electrophysiology Group's Guidelines regarding atrioventricular block. Additional randomised controlled trial evidence from ongoing trials in this area will further inform the debate.
Conflict of interest statement
J Dretzke ‐ None WD Toff ‐ Joint principal investigator for the UKPACE trial received fees for speaking, support for research and expenses for attending meetings from pacemaker manufacturers and suppliers including ELA Medical, Guidant, St Jude Medical and Medtronic GYH Lip ‐ None J Raftery ‐ None A Fry‐Smith ‐ None R Taylor ‐ Consultancy work for Medtronic (Europe) in a therapeutic area not closely associated with pacemakers.
Risks / Benefits
Benefits of CRT
CRT improves symptoms of heart failure in about 50% of patients who have been treated maximally with medications but still have severe or moderately severe heart failure symptoms. CRT improves survival, quality of life, heart function, the ability to exercise, and helps decrease hospitalizations in select patients with severe or moderately severe heart failure.
CRT and ICD Therapy
Some patients with heart failure may benefit from a combination of CRT and an implantable cardiac defibrillator (ICD). These devices combine biventricular pacing with anti-tachycardia pacing and internal defibrillators to deliver treatment as needed.
Of the patients who receive a biventricular device at Cleveland Clinic, about 90 percent receive a device that also provides defibrillator therapy. However, only about 40 percent of the patients who receive defibrillators are also candidates for a device that includes biventricular stimulation (CRT/ICD combination device).
The CRT/ICD combination devices:
- Resynchronize the heartbeat
- Slow down an abnormal fast heart rhythm
- Prevent abnormally slow heart rhythms
- Record a history of the patient’s heart rate and rhythm
Some CRT and ICD combination therapies have an internal monitoring device inside so your doctor or nurse can track your heart rhythm and heart function, such as the pressure in areas of your heart.
You may be asked to use a telephone to transmit data electronically from your device to a computer server so your doctor or nurse can monitor your condition.
Is the Device Implant Procedure Safe?
A device implant is generally a very safe procedure. However, as with any invasive procedure, there are risks. Special precautions are taken to decrease your risks. Please discuss your specific concerns about the risks and benefits of the procedure with your doctor.
Will CRT Improve My Ejection Fraction?
Yes, CRT can help improve your ejection fraction. Ejection fraction (EF) is the measurement of how much blood is being pumped out of the left ventricle of the heart. A normal EF ranges from 50% to 70%. People with heart failure who have a poor ejection fraction (EF less than 35%) are at risk for fast, irregular and sometimes life-threatening heart rhythms. The CRT/ICD combination device can help protect you against these dangerous, fast heart rhythms.
Success of CRT
Cleveland Clinic experience has shown that CRT improves patients’ ejection fraction by 5% to 10%. In some cases, patients with a CRT device develop normal ventricular function. Based on our experience, it is not rare for a patient to increase his or her ejection fraction over 40%.
Pacemaker therapy in very elderly patients: survival and prognostic parameters of single center experience
Background: Permanent pacing is the therapy of choice for treating severe and/or symptomatic bradyarrhythmias. The number of very elderly patients receiving pacemakers is increasing and little is known about survival in this specific subgroup. This study is aimed at assessing the actual survival of patients requiring pacing therapy at age > 85 years and investigating variables associated with death.
Methods: Between 2010 and 2017, 572 patients aged ≥ 85 years underwent pacemaker implantation for conventional bradycardia indications in Department of Cardiology, S. Chiara Hospital, Italy.
Results: Thirty percent of patients were ≥ 90-year-old and comorbidities were frequent. Fifty-seven percent of patients required pacing for prognostic reasons (acquired atrioventricular block), and the remaining for relief of bradycardia symptoms. A dual-chamber pacemaker was implanted in 34% of patients. The 5-year survival was 45% (standard error: 3%), and the 8-year survival was 26% (standard error: 4%). The risk of death was similar in patients who received pacemaker for symptom relief and for prognostic reasons in the overall population (HR = 1.19, 95% CI: 0.93-1.52, P = 0.156), as well as in the ≥ 90-year-old group (HR = 1.39, 95% CI: 0.92-2.11, P = 0.102). At multivariate analysis, following variables were associated with death: higher age, lower ejection fraction, dementia/dysautonomia and diagnosis of cancer. The pacing indication and the implantation of a single chamber pacemaker were not associated with worse prognosis.
Conclusions: This study showed a good life expectancy in patients aged ≥ 85 years who received a pacemaker. Strong risk factors for all-cause death were non-cardiac. Pacemaker therapy seems a clinically effective therapeutic option to improve survival and to control bradyarrhythmia-related symptoms in very elderly patients.
Most pacemakers are small machines with two parts:
- A small, metal battery-operated computer that is typically implanted in the into soft tissue beneath the skin in the chest
- Wires (leads/electrodes) that are implanted in your heart and connected to the computer
The pacemaker continuously monitors your heartbeat and delivers electrical energy (as programmed by your physician) to pace your heart if it’s beating too slowly.
Your pacemaker also stores information about your heart. This allows your doctor to better evaluate the therapy and adjust your pacemaker settings, if necessary.
An implanted dual-chamber pacemaker
What Are The Different Kinds Of Pacemakers And Is There A Special Kind For Each Person?
-- Question: What are the different kinds of pacemakers and is there a special kind for each person?
Answer :A pacemaker is an implanted device that gives small electrical signals to treat slow heartbeats. A pacemaker is different than an implantable defibrillator, in that an implanted defibrillator, in addition to treating slow heartbeats, can give a shock to treat fast heartbeats. All defibrillators are also pacemakers.
Pacemakers and defibrillators may have one, two or three leads, or wires, into the heart. All have at least one wire, in which case that one wire is placed in the right ventricle, or bottom pump, to treat slow heartbeats, if it's a pacemaker, or fast heartbeats and slow heartbeats, if it's a defibrillator. In some people, there are abnormalities of the top and bottom chamber that are well-treated with pacemakers, in which case two wires are used.
If you have congestive heart failure or a weakened heart pump as well as electrical abnormalities of the heart rhythm, then your doctor may recommend a biventricular pacemaker or defibrillator. These are also called cardiac resynchronization devices, or CRT for cardiac resynchronization therapy. These devices have one wire to the top chamber, with an atrial lead, and then two wires to the ventricle. The two wires help coordinate the pumping activity of your heart's main pumps and then may increase the heart's strength and reduce symptoms of shortness of breath and fatigue related to a weakened heart pump.
It replaces the heart's defective natural pacemaker functions.
- The sinoatrial (SA) node or sinus node is the heart's natural pacemaker. It's a small mass of specialized cells in the top of the right atrium (upper chamber of the heart). It produces the electrical impulses that cause your heart to beat.
- A chamber of the heart contracts when an electrical impulse or signal moves across it. For the heart to beat properly, the signal must travel down a specific path to reach the ventricles (the heart's lower chambers).
- When the heart's natural pacemaker is defective, the heartbeat may be too fast, too slow or irregular.
- Rhythm problems also can occur because of a blockage of your heart's electrical pathways.
- The pacemaker's pulse generator sends electrical impulses to the heart to help it pump properly. An electrode is placed next to the heart wall and small electrical charges travel through the wire to the heart.
- Most pacemakers have a sensing mode that inhibits the pacemaker from sending impulses when the heartbeat is above a certain level. It allows the pacemaker to fire when the heartbeat is too slow. These are called demand pacemakers.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
Traditional pacemakers (also called transvenous pacemakers) have three main parts.
- A pulse generator creates the electrical pulses.
- Wires (also called leads) are implanted inside the veins and carry the pulses to your heart.
- Electrodes sense your natural heartbeat. When your heartbeat is slower than normal, the electrodes deliver electrical impulses to your heart to make it beat normally.
The device can send data to your doctor remotely. Your doctor will use these recordings to set up your pacemaker so it works better for you.
The image shows a cross-section of a chest and heart with a traditional pacemaker, which has wires (leads). Figure A shows a double-lead pacemaker (also called a double-chamber pacemaker) in the upper chest. Figure B shows an electrode using electrical signals to activate the heart muscle. Figure C shows a single lead pacemaker (also called a single-chamber pacemaker) in the upper chest. Wireless pacemakers (not pictured) are placed inside the right ventricle.
A traditional pacemaker generator is placed outside of your heart, either in your chest or abdomen. It is connected via wires to electrodes inside one to three heart chambers.
Single- and double-lead pacemakers send pulses to the right side of the heart. A biventricular pacemaker sends pulses to both ventricles and an atrium . The pulses help coordinate electrical signaling between the two ventricles to help your heart pump blood. This type of pacemaker is also called a cardiac resynchronization therapy (CRT) device.
Pacemaker technology wired vs wireless and single vs dual chamber (i don't want to be physically restricted)
I am due to have a dual-chamber pacemaker implanted on 20 July. I have slow sinus disease - bradiacardia. My resting heart rate during the day is in the 40's and lower over night.
My cardiologist said i would get more benefit from a dual-chamber pacer then a single chamber but didn't really explain this. I am interested to hear peoples experience and thoughts.
I am also considering a wireless pacemaker (micra wireless) but this is not yet available in a dual chamber.
I was all prepared to have the dual-chamber wired device implanted (and comfortable with that decision) but now only two weeks away from my operation I am questioning if the wireless device would be better.
I don't want to be physically restructed as I play a lot of sport and teach self-defence classes.
Any experience or thoughts would be appreciated.
By AgentX86 - 2018-07-09 23:26:46
I believe you're talking about "Sick Sinus Syndrome", where your SI node is failing. It's not a disease per se, rather a symptom in itself. It's cause is unspecified.
I'm not sure why your EP is suggesting a dual-chamber PM, unless there is something you're not telling us (don't know). If SSS is your only problem, it can be taken care of by pacing just the right atrium.
I tend to agree with Robin. It's a little early soon for a wireless PM. I'd wait for them to cook a few years. Maybe next time?
As far as your self defense classes, you might get away with shields sold to protect PMs. There are some in the "SHOP" tab on this page. I have no idea how well they work.
By LIssH - 2018-07-10 00:21:23
Thank you for your comments.
In addition to the low heart rate, my last holter monitor also reported a number of short pauses (3sec) over night.
I am weighing up the options as my DR said, at this stage it is a choice whether i have a pacemaker or not but that it would likely increase quality of life and a dual-chamber would be most benficial.
Thanks for the tip on the shop.
By Pookie - 2018-07-10 00:32:06
Hi. I have SSS and was implanted with a dual lead pacemaker and the reason given to me was: while they had me on the table, they might as well put the 2nd lead in (bottom) because in the future if I ever needed it - it is already there. I don't use it at all. I did, however, have to get them to turn OFF the self-testing it did because the feeling of it really bothered me, if your doctor doesn't want to do that then perhaps you could suggest they set the testing to the wee hours while you are sleeping. As far as self defense - hmmmm, that could prove to be an issue, however, there are vests (if I remember correctly) that sports people buy that will protect the chest/shoulder area. If you haven't spoken to the surgeon who is going to implant the pacemaker, I'd be sure to tell him/her of your self defense classes. as it does hurt A LOT when/if the device gets bumped or hit. Wishing you all the best and please keep us posted on how you do after you get your pacemaker. Take care.
By Tracey_E - 2018-07-10 09:40:49
Did your doctor suggest the leadless or did you find it doing your own research? They are fairly new and limited in use right now so you may not even be a candidate for it. Most with SSS use rate response, which is when the pacer detects activity and raises your rate accordingly when the heart doesn't go up on its own. I could be wrong, but I don't tihnk Micra has this capability.
Many of us use one lead either exclusively or most of the time, but it's standard to give us two because sometimes we end up using both of them, and the second lead provides information. The box itself isn't much different, it's just the second lead.
Make sure your surgeon knows you teach self defense. When I got my first one, I was young and very underweight so my doctor wanted to make sure it was comfortable and wouldn't affect activity since I'd have it for a long time. He brought in a plastic surgeon to assist. EP's know the heart, plastic surgeons know how to make things look and feel good.
Even if it's well buried, direct hits hurt! They don't do any damage to the pacer because it's titanium but we aren't so tough. These shirts are made by a member here, they may help, but I'd still want it buried under muscle. https://paceguard.com/
Why two leads? A very simplified answer.
By Gotrhythm - 2018-07-10 13:00:08
At the time I got a dual lead pacemaker, I only needed the atrial lead, because, just like you, the only problem was that the sinus node wasn't firing frequently enough. (Sick Sinus Syndrome) Once it did fire, the signal easily passed to the rest of the heart.
But as time went on, about 5 years in, problems developed so that the signal to the rest of the heart was sometimes blocked. Then I started to need the ventrical lead in addtion in order to keep my heartbeat regular.
That in a nutshell is why you might get a dual lead pacemaker when at the time, you only have to have a single lead. Your doctor can always turn off the ventrical lead if it's not needed, but if you don't have a ventrical lead and you need it, you will have to have another operation to put in a dual lead pacemaker.
Since you want to participate in the decisions (which I applaud!) I suggest you educate yourself about the electrical conduction system of the heart. There are lots of youtube videos on the subject that can get you up to speed on words like atrium and ventricle and help you understand how the electrical system works and how a pacemaker helps.
PS. The Micra is a wonderful development in pacemaker technology. By all means ask your doctor, but according to what I have read, the Micra's purpose is to pace the ventricles.Since your problem is with the sinus node, which is in the right atrium, it probably won't help you.
Very little Physical Restrictions
By RoboCop - 2018-07-20 12:05:22
I am 30y/o male with a dual-lead Medtronic MRI-safe pacemaker, implanted in 2013 for conduction disease. Resting hr from athletic lifestyle was always around 40, but would drop at times into the 20s which was the problem.
Before and after my implantation, I have been a practicioner of Brazilian jiujitsu, Muay Thai kickboxing, boxing, etc., as well as weight training. I used to compete but now I just train. I can say that the limitations for me are minimal. Some positions (if being clinched with forearm/elbow pressure over the device, or in a triangle choke-type position) can have some discomfort, but nothing that makes a difference for wired/wilireless. The issue is with the device itself. I've very rarely had to tap-out or take a break because of an odd position, and never had an issue with the actual wires restricting me. Personally I don't know if I trust wireless, but that's your call.
Also, I only pace in the top chamber, but the extra lead is a precaution and for any future issues I guess, so I don't think it's a bad thing to have. Direct message me if you have more questions. I was very nervous about my limitations before getting my device, but I still stay very active and participate in very rough sports. Good luck!
You know you're wired when.
Youre officially battery-operated.
I am just grateful to God that I lived long enough to have my ICD put in. So many people are not as lucky as us even though we sometimes don't feel lucky.
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