What are the complications after permanent pacemaker surgery

What are the complications after permanent pacemaker surgery? Many patients who have installed permanent pacemakers are most concerned about this issue. This is not surprising. After all, only by understanding its complications and doing a good job of daily care can these complications be avoided. Only in this way can we truly ensure that our body remains healthy. For this reason, we first understand the postoperative complications of permanent pacemakers.

1. Wire displacement

The migration rate of the wires currently used is low, about 5% in the atrium and about 1% in the ventricle. 90% occur within one week after surgery and 10% after one week. Causes of displacement: ⑴ Improper lead implantation and loose fixation at the entry point; ⑵ Smooth endocardial structure; ⑶ Getting out of bed too early; ⑷ The pacemaker wanders in the sac and moves downward severely; ⑸ The displacement rate of bipolar leads is higher than that of unipolar leads, which may be related to the poor flexibility of bipolar leads.

Lead displacement is divided into subdislocation and complete dislocation. The former cannot be detected under X-ray, and only ECG reveals poor pacing and sensing. The latter can be seen under X-ray that the lead has left its original position, and ECG shows no pacing and no sensing.

The only solution for lead displacement is a second surgery to reposition it.

2. Skin bleeding

Most cases occur on the day after surgery, but some may occur one week after surgery. The clinical manifestations are severe local pain, swelling and protrusion, and a sense of fluctuation when palpated. Large amounts of bleeding in a short period of time are mostly from small arteries. Immediate debridement should be performed, and the bleeding small arteries should be ligated and sutured layer by layer. Never place a drainage strip. Chronic bleeding usually occurs within 5-6 days after surgery. A No. 12 puncture needle can be used to insert aspiration above the sac, and then the sandbag is compressed for 4-6 hours, and antibiotics are used to prevent infection. If necessary, suction can be performed continuously 2-3 times.

3. Postoperative threshold increase

Postoperative threshold elevation refers to the obstruction of current transmission to the myocardium caused by edema at the contact surface between the wire and the heart 1-3 weeks after surgery. The edema phase generally reaches its peak in 4-6 weeks, and then gradually returns to the chronic threshold level. The threshold during the edema period is more than 3 times higher than the chronic pacing threshold, and some may be as high as 10 times. Intermittent pacing or no pacing may occur clinically. If pacing is possible after increasing the voltage or pulse width, it indicates that the pacing threshold is increased. Otherwise, an X-ray examination should be performed to determine whether the lead is dislocated. The treatment for elevated threshold is to give dexamethasone 10 mg, potassium chloride 1 g, and normal saline 500 ml intravenous drip once a day for 3 consecutive days, which can generally lower the pacing threshold.

With the use of hormone wires in recent years, this phenomenon of increased pacing threshold has rarely been seen.

4. Phrenic nerve stimulation or abdominal muscle stimulating contraction

Phrenic nerve stimulation is common in atrial pacing. Its clinical manifestations include hiccups or abdominal muscle cramps depending on the pacing frequency because the lead is located close to the phrenic nerve. The prevention and treatment method is to perform a voltage increase stimulation test during surgery, increase the analyzer voltage to 10V, and adjust the wire position if the above situation occurs. If the above situation does not occur, diaphragm spasm generally will not occur after surgery. If it occurs after surgery, the only solution is to reduce the output energy.

In addition to paying attention to the above-mentioned permanent pacemaker postoperative complications, patients also need to pay attention to avoiding infection. Infection after surgery is the most common pacemaker complication in clinical practice. In order to avoid this situation, patients must disinfect and perform daily hygiene. Only in this way can they avoid the occurrence of infection and allow their bodies to gradually recover.