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Pacemaker Surgery

The implantation of a pacemaker into the chest of a person by a surgeon is known as a pacemaker surgery. Pacemaker surgery is indicated in people having an irregular heartbeat, that is, a heartbeat that is too fast or too slow.

A cardiac pacing device or pacemaker is a small electrical device that mimics the action of the natural electrical system of the heart and helps in correcting irregular heartbeat or arrhythmias. Pacemakers can be implanted temporarily or permanently, and they carry impulses to the four different chambers of the heart, namely right atrium, left atrium, right ventricle, and left ventricle.

Causes:

There are several causes that may lead to various heart conditions. These heart disorders may require treatment by a pacemaker surgery. The various cause includes:

  • Increase in age
  • History of heart surgery
  • Heart disease
  • History of heart attack
  • Congenital heart disorders (present at birth)
  • Some like calcium channel blockers or beta-blockers may slow down the heart rate
  • Health disorders such as:
  • Hypothyroidism: When the thyroid gland produces less thyroid hormone, the condition is known as hypothyroidism.
  • Pericarditis: The inflammation of the tissue surrounding the heart is called pericarditis
  • Myocarditis: An inflammation of the heart muscle is known as myocarditis.
  • Cardiomyopathy: Certain changes to the heart muscle may affect the ability of the heart to pump blood, and is known as cardiomyopathy.
  • Systemic sclerosis: It is a condition leading to the scarring and inflammation of the skin and internal organs.
  • Sarcoidosis: Sarcoidosis is a condition that causes swellings called granulomas in the various body organs. 

Types: The different types of pacemakers that can be implanted depending on the condition of the heart and the symptoms of the patient include:

  1. Single-chamber pacemaker: It has one electrode that connects the pulse generator to only one chamber of the heart, usually the right atrium or right ventricle.
  2. Dual-chamber pacemaker: This type of pacemaker has two leads that are connected to the right atrium, as well as the right ventricle of the heart.
  3. Biventricular pacemaker: It has three electrodes that are connected to the right atrium, right ventricle, and left ventricle of the heart, and is used for patients with arrhythmias that are caused by advanced heart failure.

Parts: A pacemaker is made up of two parts:

  1. Pulse generator: This is a small metal container consisting of a battery and electrical circuits which control the rate of electrical pulses that are sent to the heart.
  2. Electrodes or leads: One to three insulated, flexible wires are placed in one or more chambers of the heart to adjust the heart rate by delivering electrical pulses. Some pacemakers are implanted into the heart muscle directly and are known as leadless pacemakers (pacemakers without leads).
Minimum Price : 195000 Maximum Price : 285000

Symptoms

Purpose: Pacemaker surgery is required in the following conditions:

  • Heartbeat that pauses
  • Heartbeat is too fast (tachycardia)
  • Heartbeat is too slow (bradycardia)
  • Heartbeat is irregular (arrhythmia)
  • Heart failure (a condition in which the heart fails to pump sufficient blood to the body)

 

Symptoms: Certain symptoms may indicate heart disorders that may require a pacemaker. The symptoms include:

  • Dizziness
  • Fainting
  • Light-headedness
  • Tiredness
  • Heart palpitations (when the heart adds an extra beat or skips a beat)
  • Chest pain or tightness
  • Shortness of breath

Diagnosis

  1. Electrocardiogram (EKG or ECG): This test measures the electrical activity of the heart and helps in showing if the heart is beating too fast, or too slow, or not beating at all.

  2. Echocardiogram: Sounds waves are used in this test to obtain images of the heart.

  3. Holter monitoring: A Holter monitor is a small device that needs to be worn for one or two days to keep track of the rhythm of the heart.

  4. Stress test: An electrocardiogram is taken before and immediately after doing some form of exercise, such as walking on a treadmill or riding a stationary cycle. This helps in checking for any heart problems.

 

Treatment

The pacemaker surgery can be performed in the following different ways:

1. Transvenous method:

  • This is the most commonly used method for pacemaker surgery.
  • The procedure is usually done under local anesthesia (the surgical area is numbed).
  • One or more wires are inserted by the surgeon into a major vein near or under the collarbone.
  • These wires are then guided to the heart using x-ray images.
  • The end of each wire is secured at an appropriate position in the heart, and the other end of each wire is attached to the pulse generator, which is normally implanted by the surgeon under the skin beneath the collarbone.
  • In the case of a leadless pacemaker, the parts of the pacemaker are contained in a single capsule. A catheter (thin tube) is inserted in a vein in the groin region, and the pacemaker is guided through the catheter to position it properly in the heart.
  • The procedure takes approximately one hour to complete.

2. Epicardial method:

  • This procedure is done under general anesthesia (the patient is put to sleep during the procedure).
  • In this procedure, the electrodes are attached to the surface of the heart, rather than inside the heart.
  • The catheter and wireless pacemaker are guided using an x-ray through a vein in the thigh to the heart.
  • This procedure is normally completed in less than one hour.

Risks

The complications of pacemaker surgery are:

  • Infection

  • Bruising, bleeding, or swelling

  • Thromboembolism (blood clot formation)

  • Pneumothorax (collapse of lungs)

  • Blood vessels damage or nerve damage 

  • Hemothorax (collection of blood in the space between the chest wall and lungs)

  • Shifting of the leads or pacemaker device causing the perforation of the heart

After Procedure

  1. You will most likely stay in the hospital for one day after the procedure.

  2. The pacemaker is programmed to fit the patient’s heart rhythm needs.

  3. Avoid heavy lifting and vigorous exercises for one month after the surgery.

  4. The doctor may prescribe pain killers to ease your pain and discomfort after the procedure.

  5. Avoid putting pressure on the site of pacemaker implantation.

  6. Keep your mobile phone at least six inches away from the pacemaker.

  7. In case of future medical treatments, inform your doctor that you have a pacemaker. This is because certain medical procedures can interfere with the pacemaker.

  8. Stay at least two feet away from power-generating equipment like motor-generator systems, high-voltage transformers, or welding equipment.

  9. Carry an ID stating that you have a pacemaker when passing through a metal detector in places like the airport and malls.

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