Pacemaker Implantation in India

Overview

The heart consists of a conduction system to transmit electrical impulses for proper rhythm of the heart muscles. These electrical impulses are generated by special Sino Atrial tissues (S A nodes) which are present in the right atrium and then these impulses spread through upper chambers. The impulses are spread through Atrio-Ventricular node between auricles and ventricles. Another bundle of tissues called Bundle of Hiss is also responsible for electrical conduction so that ventricles contract to pump blood to the body and lungs. Together these 3 comprise the natural pace makers of the heart.

Electrical impulses flow in the heart can be disrupted leading to a disease called arrhythmias.

Brady-arrhythmias is when the heart rhythm is abnormally slow. It can be caused due to heart block or sinus bradycardia. Sinus bradycardia is due to the slowdown of natural pacemakers. Heart block happens due to block or delay in the conduction of electrical impulses in the heart. Heart blocks can be of various degrees and types like 1st degree AV block, 2nd degree AV block as so on.

Tachy-arrhythmias is when the heart rhythm is abnormally fast. The types of tachy-arrhythmias treated with pacemakers are ventricular tachycardia and atrial fibrillation. Ventricular tachycardia originates in the ventricles and the rapid contractions can cause cardiac arrest. Atrial fibrillation originates in the atria and is ineffective in pumping the blood into the ventricles.

Symptoms of arrhythmias are:

Dizziness and syncope
Palpitations and shortness of breath
Mental confusion
Fatigue

The causes for cardiac arrhythmias are:

Natural ageing process of heart muscles
Coronary artery disease
Heart attack
Congenital heart defects
Certain medications

Artificial Pacemaker

The pacemaker is a surgically implanted device that prompts small electrical impulses to heart muscles so that normal heart rate is maintained or reinstated in cases where there is slow or erratic heart rate. Brady-arrhythmia is the commonest cause for pacemaker implantation, though the pacemaker decision is based on cause of arrhythmia, the level and the permanency of the condition, symptoms and risks to the patient.

The artificial pacemaker consists of following components:

A pulse generator which comprises of a thin metal box which produces the electrical impulses and a computer processor to set the rate, pattern, output and other parameters.
Leads carrying electrical impulses to the heart muscles from the generator.
Electrodes at the ends of leads to transmit electrical impulses to the heart muscles.

Treatment Options

There are different types of pacemakers to restore or maintain a regular heartbeat:

Demand pacemakers operate when the heart's own pacemaker is slow.
Rate-responsive pacemakers increase or decrease heart rate according to the body requirement like in rest or during activity.

Pacemakers are classified as:

Single-chamber pacemakers: These carry impulses of either right atrium or right ventricle.
A dual-chamber pacemaker: This has two leads, to the right atrium and right ventricle so that a more natural approach of the heart activity is obtained.
Triple-chambered pacemaker: This has leads to the right atrium, the right ventricle, and left ventricle. It is used in case when the heart muscles are weak.

Temporary pacemakers are used as a temporary solution for short term problem as during a surgery, he electrical impulses are generated outside.

Permanent pacemakers are for long-term use.

Candidates

There are particular guidelines pre-established for the placement of permanent pacemakers. Patients should approach the cardiologist for these guidelines and determine if they are suitable candidates. Usually chronic and recurring conditions such as symptomatic brady-arrhythmia require permanent pacemakers.

Procedure

Pacemaker implantation procedure is done by specially trained cardiologists or electro physiologists who are experienced to perform such procedures. It can be done under local or general anaesthesia. Fluoroscopy is used for imaging of the procedure. The type of device decides the length of the surgery.

Usually it is implanted into the soft tissue below the skin in the sub-clavicular area. This is called pre-pectoral implantation as it is located above the pectoral muscles. The leads are inserted through a major vein and advanced further till the right position on the heart muscles is reached. The pulse generator is attached to the other end of the lead.

Recovery

p>Recovery after pacemaker implantation is rapid, but arm movement and activity restrictions are advised for first few weeks. The hospital stay is short, a day or two after the surgery. Routine activities can be resumed in about two weeks.

Expected Results

Properly implanted pacemakers resolve arrhythmias and other symptoms of abnormal heart rate. Pacemaker usually lasts upto 10-15 years on an average. It can be replaced after that time.

Time & Cost

The surgery takes a few hours and typically, the patient is retained in the hospital for a day or two to monitor recovery. You would need another week to ten days in town before you can go back. A total of two weeks are sufficient for you to have permanent pacemaker implantation in India and go back.

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