A Case Report on Permanent Dual Chamber Pacemaker

Background: The dual-chamber, rate-modulated mode (referred to as DDDR) is the most recent cardiac pacing mode to become available. It restores both rate responsiveness and atrioventricular synchronization in patients with sinus node dysfunction and atrioventricular block. This pacing method combines rate-modulated dual-chamber and single-chamber technology. As a result, it is required to program both a maximum and a minimum. tracking rate and a maximum sensor rate, as in dual-chamber and single-chamber rate-modulated devices, respectively. Case Presentation: A 55-year-old female was admitted to A.V. B.R. Hospital with a complaint of breathlessness on exertion chest pain last 10 days. The patient has had hypothyroidism seen 2 years. No history of Hypertension and Diabetes Mellitus, Patient was conscious and oriented, All the investigation was done. FORTIFY SSURA VVED DDDR pacing (MRI compatible) was connected to lead, P-wave 3:24.0, Rwave 9.211.5mV. Device positioned in right infra-clavicular pocket. Conclusions: A 55-year-old female patient was admitted to the hospital with the chief complaint of breathlessness on exertion chest pin last 10 days. After all investigation patient was diagnosed with Case Study Bhonde et al.; JPRI, 33(47A): 873-877, 2021; Article no.JPRI.75251 874 a case of permanent DDDR pacemaker. Now she is going to under a pacemaker procedure and treatment. Now patient prognosis is better than the previous and I advise the patient for the regular 15 days follow-up.


INTRODUCTION
When the heart's regular conduction pathway is compromised, an artificial cardiac pacemaker is employed to keep it going. The myocardium, one or more pacing leads, and a power source (battery-powered pulse generator) with programmable electronics make up the basic pacing circuit. a signal electrical the stimulation passes from the pulse generator to the myocardium's wall via the leads. The heart muscle is "trapped" and forced to contract. The FDA recently approved a leadless pacemaker that is entirely implanted in the right ventricle [1].
Pacemakers today are small, complex, and physiologically exact. The atrium and/or one or both ventricles are paced. Demand pacemakers make up the majority of pacemakers. This means they detect the electrical activity of the heart and only fire when the HR falls below a certain threshold. There are two main characteristics of demand pacemakers [2].
• When the heart rate is adequate, a sensing device disables the pacemaker. • When no QRS complexes occur within a certain amount of time, the pacemaker is triggered.

CASE PRESENTATION
A 55-year-old female was admitted to A.V.B.R. Hospital with a complaint of breathlessness on exertion chest pin last 10 days. The patient has been gone all the investigation patient was diagnosed as a case of permanent DDDR pacemaker. The patient has a history of Hypothyroidism. The patient does not have any past medical history about communicable diseases and non-communicable diseases like hypertension, diabetes mellitus, tuberculosis, hepatitis, acquired immunodeficiency syndrome The patient does not have any significant surgical history in the past; presently the patient did the symptomatic treatment. The patient belongs to a nuclear family with only four family members in the family no one having any communicable or non-communicable diseases except the patient. The patient and her family member do not have any abnormal genetic disorder or not genetic predisposing genetic history. The patient is a housewife, and he is leaving in a rural area of the Amravati district.

Clinical Finding
Patient undergone through blood investigation as follow:

Physical Examination was done before Surgery
The Patient's general appearance is good, he was well-nourished, the patient was active and not dull nature, the patient mentioned hygiene and personal grooming, Patient's mental status is normal, but slight behavior changes occur due to the hospitalization disease condition and diagnostic procedure. Patient height is 137cm, weight 52 kg, a Patient vital sign is normal. That is temperature 100 0 F, pulse: 78 beats/minute, respiration: 18 breath/minute, blood pressure 120/80mmhg, other physical examination is in respiratory system bilateral is clear, cardiovascular system S1 S2 node is positive, in abdominal examination abdomen is soft, nontender. In another no deformity.

Diagnostic Assessment Electrocardiogram (ECG):
Electrocardiogram measures abnormal heart's electrical impulses due to graphical leads was abnormal.
Echocardiogram: Echocardiogram abnormal images of beating heart on a monitor.

Discharge Planning
• Advice to make a therapeutic diet plan and follow them, avoid fatty foods, • Maintain personal hygiene and prevent further infection. • Advice to reduce heavy exercise, and heavy work. • Administration of medicine on time and regular follow-up. • Counseling the patient related to the disease.

Dietary Management
In health and disease, the basic nutrient needs of adults differ. These requirements will be discussed briefly from the carbon, carbohydrate, fat, protein, fluid, electrolyte, vitamin, and trace elements viewpoint, based on the American Society for Parenteral and Enteral Nutrition guidelines Board of Directors and the Clinical Guidelines Taskforce. The requirements for nutrients are macronutrients (energy, protein, lipids) and micronutrients (vitamins, minerals) [4].
• Increase your intake of whole-grain foods.
• Include a wide range of fruits and vegetables. • Reduce the amount of sugar and salt in your diet (sodium). • High-fat foods, such as red meat, cheese, and baked products, should be avoided. • Reduce the number of harmful fats, such as saturated and trans fats, in your diet. Butter and shortening, for example, are

DISCUSSION
The goal of a pacemaker is to keep the heart rate stable, either because the natural pacemaker isn't fast enough or because the heart's electrical conduction pathway is blocked. Modern pacemakers are programmable from the outside, allowing a cardiologist, specifically a cardiac electrophysiologist, to choose the best pacing modes for individual patients. Modern gadgets are demand pacemakers, in which the heart is stimulated according to the circulatory system's dynamic demand [5,6].
The majority of modern pacemakers have many functions. The most basic version keeps track of the heart's natural electrical beat. When the pacemaker wire or "lead" fails to detect heart electrical activity in the chamber -atrium or ventricle -within a typical beat-to-beat time frame -usually one second -it stimulates either the atrium or the ventricle with a brief low voltage pulse. It will delay stimulating if it detects electrical activity. This detecting and stimulating action are referred to as "demand pacing" since it occurs on a beat-by-beat basis. When the upper chambers of a dual-chamber device activate spontaneously or are stimulated, the gadget begins a countdown to guarantee that in an appropriate -and programmedmanner. There is an activation of the ventricle at the. -interval; otherwise, an impulse will be provided again [7,8].

CONCLUSION
A 55-year-old female patient was admitted to the hospital with the chief complaint of breathlessness on exertion chest pin last 10 days. After all investigation patient was diagnosed with a case of permanent DDDR pacemaker. Now she is going to under a pacemaker procedure and treatment. Now patient prognosis is better than the previous and advises the patient for the regular 15 days followup.

INFORMED CONSENT
Patient informed consent was taken and signed by the Patient before writing a case report.

ETHICAL APPROVAL
We conducted our research after obtaining proper IEC approval.