Pacemaker Surgery
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Relevant Background: "A cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural pacemaker of the heart), is a medical device that generates electrical impulses delivered by electrodes to cause the heart muscle chambers (the upper, or atria and/or the lower, or ventricles) to contract and therefore pump blood; by doing so this device replaces and/or regulates the function of the electrical conduction system of the heart....The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart's natural pacemaker is not fast enough, or because there is a block in the heart's electrical conduction system. Modern pacemakers are externally programmable and allow a cardiologist, particularly a cardiac electrophysiologist to select the optimal pacing modes for individual patients. A specific type of pacemaker called a defibrillator combines pacemaker and defibrillator functions in a single implantable device, which should be called a defibrillator, for clarity. Others, called biventricular pacemakers have multiple electrodes stimulating differing positions within the lower heart chambers to improve synchronization of the ventricles, the lower chambers of the heart....Modern pacemakers usually have multiple functions. The most basic form monitors the heart's native electrical rhythm. When the pacemaker wire or "lead" does not detect heart electrical activity in the chamber - atrium or ventricle - within a normal beat-to-beat time period - most commonly one second - it will stimulate either the atrium or the ventricle with a short low voltage pulse. If it does sense electrical activity, it will hold off stimulating. This sensing and stimulating activity continues on a beat by beat basis and is called "demand pacing". In the case of a dual chamber device, when the upper chambers have a spontaneous or stimulated activation, the device starts a countdown to ensure that in an acceptable - and programmable - interval, there is an activation of the ventricle, otherwise again an impulse will be delivered...Sometimes devices resembling pacemakers, called implantable cardioverter-defibrillators (ICDs) are implanted. These devices are often used in the treatment of patients at risk from sudden cardiac death. An ICD has the ability to treat many types of heart rhythm disturbances by means of pacing, cardioversion, or defibrillation. Some ICD devices can distinguish between ventricular fibrillation and ventricular tachycardia (VT), and may try to pace the heart faster than its intrinsic rate in the case of VT, to try to break the tachycardia before it progresses to ventricular fibrillation. This is known as fast-pacing, overdrive pacing, or anti-tachycardia pacing (ATP). ATP is only effective if the underlying rhythm is ventricular tachycardia, and is never effective if the rhythm is ventricular fibrillation..." ("Artificial cardiac pacemaker", https://en.wikipedia.org/wiki/Artificial_cardiac_pacemaker)
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