From the Guidelines
The implantation of a Venus pacemaker in the heart involves a series of complex steps, including proper indications, surgical implantation, venous access, intra-cardiac manipulation of leads, and electrophysiological interpretation, as outlined in the European Society of Cardiology guidelines 1. The procedure begins with:
- Proper indications for the implantation of the pacemaker, which is crucial for ensuring the patient receives the correct treatment.
- The surgical element of implantation, which requires a high level of technical expertise and specialized equipment.
- Venous access, which involves creating a small incision to access the subclavian or axillary vein, and then inserting a needle into the vein using fluoroscopic guidance.
- Intra-cardiac manipulation of leads, which involves threading a guidewire through the needle and then advancing the pacemaker leads through the sheath and positioning them in the appropriate heart chambers.
- Electrophysiological interpretation during implantation, which is critical for ensuring the pacemaker is functioning correctly and safely.
The implantation of a CRT device, such as a Venus pacemaker, is more demanding than implantation of a conventional pacemaker or implantable cardioverter defibrillator, and requires additional laboratory, operator, and technical support, as outlined in the guidelines 1. The following steps are also crucial for a successful implantation:
- Pre-implantation scheduling, which involves careful planning and preparation to ensure the procedure is done safely and efficiently.
- Requirements for the operating room, which includes having the necessary equipment and personnel to handle any potential complications.
- Personnel requirements during CRT implantation, which includes having a team of experienced and trained healthcare professionals to assist with the procedure.
- Competence for implanting CRT devices, which requires specialized training and expertise to ensure the procedure is done correctly and safely.
- Practical CRT implant recommendations, which involves following established guidelines and protocols to ensure the best possible outcomes for the patient, as outlined in the European Society of Cardiology guidelines 1.
From the Research
Steps to Placing a Venus Pacemaker in the Heart
The process of placing a pacemaker in the heart involves several steps, which are crucial for the successful implantation of the device. The following are the steps involved in the placement of a Venus pacemaker:
- Preparation: The patient is prepared for the procedure by administering local anesthesia and sterile draping of the area 2.
- Central Venous Catheter Placement: A central venous catheter is inserted into the right internal jugular vein or left subclavian vein 2.
- Pacing Wire Advancement: The pacing wire with a balloon is advanced through the catheter until it reaches the right ventricle 2.
- Electromechanical Capture: The pacing wire is positioned to obtain electromechanical capture, which is confirmed by the presence of ST segment elevation on the QRS segment 2.
- Lead Placement: The lead is placed in the right ventricle, and its position is confirmed using ultrasound or other imaging modalities 2.
- Pacemaker Implantation: The pacemaker is implanted in the chest, and the leads are connected to the device 3, 4.
- Testing and Programming: The pacemaker is tested and programmed to ensure proper functioning and to optimize its performance 3, 4.
Potential Complications and Considerations
The placement of a pacemaker can be associated with potential complications, such as:
- Central Venous Access Complications: Complications related to central venous access, such as bleeding or infection 2.
- Right Heart Catheterization Complications: Complications related to right heart catheterization, such as perforation or tamponade 2.
- Pacing Wire Malfunction: Malfunction of the pacing wire, which can require repositioning or replacement 2.