Human heart is gifted with a specialized system which automatically creates rhythmic control via the sinus node. These specially designed pacemaker cells command control of rest of the heart through electrical impulses that travel from the right atria of heart to the lower ventricles. Speedy conduction of these impulses causes heart muscle cells of the atria to contract & force blood into ventricles, which again contract & squeeze blood into pulmonary arteries & aorta. Irregularities of heart rhythm known as arrhythmias can disturb & adversely affect cardiac control making it mandatory to use artificial means to maintain the rhythm of heart. According to reports today, some half a million women & men mostly over the age of fifty-five, carry implanted heart pacemakers that perform duties of the natural conduction system.
What is Pacemaker Implant Surgery?
Pacemaker is an electrically-charged medical device. Pacemaker implant surgery is a surgical method in which cardiac surgeons implant pacemaker under the skin of patients to help them manage abnormal heartbeats referred to as arrhythmias. Generally, modern pacemakers consist of two portions out of which one portion contains electronics & battery that control patient’s heartbeat. Another part is one or more leads that send electrical signals to heart of the patient. Leads are basically tiny wires that run from pulse generator to heart muscle of patients. Pacemakers usually treat the following two types of arrhythmias.
- Tachycardia – This is a condition where patient’s heartbeat is too fast.
- Bradycardia – This is a condition where patient’s heartbeat is too slow.
Arrhythmia can be caused if electrical signals that control the heartbeat are blocked or delayed. This can occur if nerve cells that generate electrical signals fail to work properly. Following factors can lead to arrhythmias.
- Smoking – Excessive smoking or heavy alcohol use can lead to irregular heartbeats.
- Medications or Caffeine – Use of several prescription or over-the-counter medications or excessive amount of caffeine can lead to condition of arrhythmias in some people.
- Emotional Stress – Strong anger or emotional stress can make the heart function harder, release stress hormones & raise blood pressure. Many times these reactions can cause arrhythmias.
- Heart Attack – Heart attacks or other conditions like stroke which damage electrical system of heart can also cause arrhythmias. Examples of such conditions include heart failure, rheumatic heart disease, an underactive or overactive thyroid gland & coronary heart disease.
- Congenital Heart Defects – They can also be responsible for arrhythmias.
Some other causes of arrhythmias are enumerated below.
- Scarring of heart tissue from a prior heart attack
- Nutritional supplements
- Changes to patient’s heart structure
- Blocked arteries in patient’s heart
- Sleep apnea
Arrhythmias can generate a wide range of symptoms, from barely noticeable to cardiovascular collapse & death.
- Skipped Beat – A single premature heart beat may be felt as a skipped beat or palpitation.
- Fluttering Sensation – Premature beats may cause greater awareness of fluttering sensation in neck or chest or heart palpitations.
When condition of arrhythmias lasts long, more serious symptoms may develop in patients which are given below.
- Feeling pauses between heartbeats
- Chest pain
- Fainting or nearly fainting
- Weakness & dizziness
- Shortness of breath
There are many conditions in which an artificial pacemaker may be recommended by surgeons. Pacemakers can be broadly classified as following.
- Temporary Pacemakers – These pacemakers are intended for short-term use during period of hospitalization. They may be used when arrhythmia is expected to be temporary & to gradually resolve.
- Permanent Pacemakers – These pacemakers are intended for long-term use.
The decision to use pacemaker, as well as which particular type, will depend upon the following factors.
- Underlying heart conditions
- Exact nature & underlying cause of arrhythmia
- Anticipated frequency of pacing
Multiple types of pacemakers & modes of pacing have been refined to restore a normal heartbeat in various ways. Pacemakers may be typically single, dual, or triple chambered.
- Single-Chamber Pacemakers – They have one lead to transport impulses to & from either right ventricle or right atrium.
- Dual-Chamber Pacemakers – Characteristically they have two leads, one to the right ventricle & one to the right atrium, which can regulate a heart rhythm that more naturally relates regular activities of the heart & imitates intrinsic depolarization.
- Triple-Chambered Pacemakers – These normally have one lead in the right atrium, one to stimulate left ventricle & one to stimulate the right ventricle. These devices are most commonly used in patients who have weakened heart muscle. They are also called as biventricular pacemakers.
There are various different implantation techniques for fitting a pacemaker. They are elaborated as below.
- Trans-Venous Implantation – Trans-venous implantation is a general technique of fitting a pacemaker. During trans-venous implantation, cardiac surgeons make a 4 – 5 cm incision just below the collarbone of patients, generally on the left side of the chest & insert thin wires of the pacemaker through the vein.
- Epicardial Implantation – Epicardial implantation is a less widely used technique of fitting a pacemaker. Pacing leads are connected to the outer surface of patient’s heart through a cut in abdomen, under the chest. Epicardial implantation is usually used in children & in patients who have a heart surgery at the same time undergo pacemaker implant surgery.
- Implantable Cardioverter Defibrillators – In majority of cases, implantable cardioverter defibrillators are properly planted transvenously, along a vein. They can also be implanted subcutaneously.
While diagnosing a serious heart arrhythmia condition, cardiac surgeons will review patient’s symptoms as well as their medical history & along with this they will also conduct a physical examination. Cardiac surgeons may test for several conditions that may trigger arrhythmia in patients, like cardiac disease or trouble with the patient’s thyroid gland. Surgeons may also execute heart-monitoring tests relevant to arrhythmias. These may include the following.
- Electrocardiogram Test – During an electrocardiogram, sensors that can identify electrical activity of the patient’s heart are connected to the chest & sometimes to limbs as well. This test calculates precise timing & duration of electrical phases in the patient’s heartbeat.
- Holter Monitor – This is a portable ECG equipment that can be worn to record patients heart’s activity as they perform their daily tasks.
- Event monitor – For conditions of sporadic arrhythmias, this device can be used; it can be attached to patient’s body & a button could be pressed whenever they notice symptoms. This lets cardiac surgeons check patient’s heart rhythm at the instant of symptoms.
- Echocardiogram Test – This is a noninvasive test in which a hand-held device is placed on the patient’s chest that uses sound waves to generate images of the heart’s internal motion, size & structure.
- Implantable Loop Recorder – This device identifies irregular heart rhythms & is implanted in the chest area of patients.
- Initial Tests – Prior to receiving pacemaker implant surgery, patients will have to undergo several tests. Tests like an echocardiogram, electrocardiogram, holter monitoring, stress tests & so on can ensure that a pacemaker is the right choice for the patient. When a pacemaker implant surgery is suitable for the patient, they can proceed further. Cardiac surgeons will give them complete instructions on how to prepare for surgery.
- Food Intake – Patients should not drink or eat anything after midnight prior to the day of pacemaker implant surgery.
- Discontinue Medication – Patients should stop taking certain medications as advised by the respective cardiac surgeon.
- Shower – Patients should shower & shampoo well, possibly with a soap prescribed by the surgeons. It minimizes risk of potentially serious heart infections during pacemaker implant surgery.
Following is a list of important questions which patients may ask their respective cardiac surgeons regarding pacemaker implant surgery.
- How many years of experience do you have in performing pacemaker implant surgery?
- What does a pacemaker implant surgery do?
- How will pacemaker implant surgery improve my overall health & quality of life?
- How does the pacemaker device identify how fast to pace my heart?
- I’ve been out-of-breath for a long period of time. How will pacemaker implant surgery help me cope-up with this situation?
- Will I be able to walk or play without getting out-of-breath or too tired?
- Will my pacemaker be able to offer a suitable heart rate for me to undergo physical exercise?
- Will I be able to feel the pacemaker implant inside my chest after pacemaker implant surgery?
- Am I at risk for a poor exercise response?
- What will happen when my pacemaker runs out of its battery power? How will I know?
- How long does a pacemaker implant last?
- What does my pacemaker feel like when it will be working?
- How long will it take for me to recover following pacemaker implant surgery?
Procedure for pacemaker implant surgery is usually quick. It does not need an open-heart surgery & most patients can go home within a day.
- Anesthesia – Prior to undergoing pacemaker implant surgery, medication is usually given to make patients comfortable & sleepy. This surgical procedure is generally executed under local anesthesia.
- Incision – A tiny incision, nearly two inches in length is made in the upper chest area.
- Leads – One or two leads will be inserted & guided through a vein into the patient’s heart. Cardiac surgeons will then connect these leads to patient’s pacemaker & programs it according to medical requirements of patients.
- Closing Incision – Pacemaker will be implanted beneath patient’s skin & the incision in the chest will be closed.
- Completion – At the end, surgeons will test the pacemaker to make sure it is working accurately in accordance with the patient’s need. Patients will generally stay in the hospital overnight after pacemaker implant surgery & then they can go home the next day with guidelines on caring for the incision.
After pacemaker implant surgery, there may be a slightly noticeable bulge under the skin of patients where the device is planted.
Patients should be able to resume their routine physical activities soon after undergoing pacemaker implant surgery. As a precaution, it is generally advised that strenuous physical activities are avoided for around five to eight weeks after undergoing pacemaker implant surgery. After surgery, patients should be able to perform most normal activities as well as sports. Patients will be able to feel the pacemaker device, but they will soon get used to it. A pacemaker may feel a bit heavy & uncomfortable at first when patients lie in specific positions. Patients will need to attend routine check-ups to ensure that their pacemaker is functioning properly. Household electrical devices are safe to use & won’t interfere with the patient’s pacemaker. Adhering to instructions of a cardiac surgeon is key to a successful recovery after pacemaker implant surgery.
Undergoing pacemaker implant surgery is generally a very safe procedure with low risk of complications. Certain possible risks & complications associated with pacemaker implant surgery are listed below.
- Malfunctioning of Pacemaker – Biggest concern after pacemaker implant surgery is the pacemaker losing its ability to regulate the heartbeat properly, either due to malfunctioning or if the wire has moved out of proper position. It may be re-programmed using wireless signals.
- Stroke – When heart of patients quiver, it is not able to pump blood efficiently & that may cause blood to pool. Blood clots can be formed due to this condition. When a clot breaks loose, it may propagate from patient’s heart to the brain. Regular flow of blood may be blocked causing a stroke.
- Damage to Body Parts – There may arise a possibility of damage to certain body parts during pacemaker implant surgery. Several medications like blood thinners, can reduce risk of damage to various organs of patients caused by blood clots. Cardiac surgeons will determine if blood-thinning medicines are suitable for the patient, depending upon the type of arrhythmia & overall health.
- Heart Failure – Heart failure can be observed if patient’s heart is pumping inappropriately for a prolonged period of time following pacemaker implant surgery.
Once pacemaker implant surgery is completed, the battery should last ten to fifteen years, which is considered to be an average battery span.When battery of a heart pacemaker wears-out then the pulse generator can be replaced. Leads of pacemaker can be left in same position though they may require to be completely replaced eventually & the time required for this procedure is often less & needs moderate recovery span than the first pacemaker implant surgical process did. Pacemaker implant surgery is a gold standard treatment for various conditions affecting the patient’s heart associated electrical system. By preventing irregular heartbeat rates, pacemakers can treat various symptoms such as fatigue, lightheadedness & fainting. By automatically adjusting the heart-rate, pacemakers can allow patients to resume more a healthy & active lifestyle. Most pacemakers save important information about patient’s natural heart rhythms. When they have follow-up sessions, cardiac surgeons can retrieve this vital information & use it to check health status of the patient.
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