Cardiac
pacing, also known as artificial cardiac pacing or pacemaker implantation, is a
procedure that uses electronic medical devices to regulate the beating of the
heart. Cardiac pacing involves the careful placement of leads, which are thin,
flexible wires that deliver electrical impulses from a pacemaker to the heart
muscles. These leads are essential for cardiac pacing to work effectively as
they allow the pacemaker to detect the heart’s electrical signals and deliver
stimulation pulses when needed.
Different Types of Leads
There are different types of cardiac pacing leads used for cardiac pacing based
on the location where they are placed in the heart.
Ventricular Leads
Cardiac
Pacing Leads are used to pace the lower chambers of the heart, which
are the ventricles. They have a small tip electrode that is placed inside the
ventricle, usually the right ventricle, through a vein. The electrode delivers
the electrical impulse to make the ventricle contract. Ventricular pacing is
commonly used for slower heart rhythms originating in or below the ventricles.
Atrial Leads
Atrial leads are similar to ventricular leads but have a tip electrode placed
inside the upper chambers of the heart, which are the atria. The most common
location is the right atrium. They are used for pacing the atria, usually in
conjunction with ventricular pacing. Atrial pacing is needed for certain
arrhythmias that affect the atria.
His Bundle Pacing Leads
His bundle pacing leads are a specialized type that are placed near the bundle
of His, which conducts electrical signals from the atria to the ventricles.
They help restore more normal activation of the ventricles during pacing. His
bundle pacing is still an emerging technology but shows promise for more
physiologic cardiac contractions.
Lead Configuration and Placement
Leads are available as either unipolar or bipolar configurations based on their
electrode design. Unipolar leads have one electrode at the tip that acts as the
cathode, while the pacemaker case acts as the anode. Bipolar leads contain both
tip and ring electrodes, allowing current to flow between them.
Leads are typically placed via veins into either the right atrium or right
ventricle. They are then tunneled subcutaneously to the pacemaker pocket.
Proper placement is important for effective pacing as well as to avoid
complications. Imaging such as fluoroscopy is used to guide lead placement.
Leads are secured to heart tissue to prevent dislodgment.
Cardiac Pacing Functions of Leads
Once implanted, cardiac pacing leads serve several critical functions to allow
the pacemaker to regulate the heart.
Sensing – Leads detect native electrical signals from the heart muscle.
Electrodes pick up depolarization waves and transmit them to the pacemaker for
analysis.
Pacing – When needed, the pacemaker delivers electrical impulses through the
leads to stimulate contractions of the heart muscle. The electrodes emit
low-energy pulses to initiate each heartbeat.
Impedance Monitoring – Pacemakers continuously measure the electrical
resistance or impedance along the path of the leads. Significant changes could
indicate a lead fracture or dislodgment requiring attention.
Communicating – Modern pacemakers can communicate wirelessly with external
programmers via the leads. Programmers can retrieve data, change settings,
perform checks without surgery.
Providing Power – Leads carry the operating power from the pacemaker battery
directly to the heart tissue. This powers the sensing and pacing functions on a
continuous basis.
Lead Fixation and Extraction
Long-term lead performance depends on maintaining secure fixation to the heart
wall. Fixation mechanisms like tines or helical coils prevent migration of the
electrode. However, leads can become dislodged or fail over many years. Rarely,
infected or problematic leads require extraction which must be performed
carefully to avoid complications.
In summary, cardiac pacing leads are essential components of modern pacemaker
systems. Their precise placement and variety of functions allow artificial
pacing devices to sense and stimulate the heart as needed, restoring normal
heart rhythms. Advances in lead technologies continue to make pacing therapy
more effective.
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