What is Pacemaker Surgery?

Dr Foram Bhuta

Dr Foram Bhuta

BDS (Bachelor of Dental Surgery), 10 years of experience

February 19, 2021 Heart Diseases 575 Views

English हिन्दी Bengali

What is the meaning of Pacemaker Surgery?

Pacemaker surgery is a surgical procedure for the implantation of a pacemaker into the chest. People with irregular heartbeats, that is, heartbeats that are too fast or too slow, need to have pacemaker surgery. 

A pacemaker or cardiac pacing device is a small electrical device that helps control and correct your heartbeat in cases of arrhythmias (irregular heartbeat) as it mimics the action of the natural electrical system of the heart. Pacemakers can be implanted temporarily after a heart attack to correct a slow heartbeat or can be implanted permanently to correct a slow or irregular heartbeat, or to treat a heart failure as well. 

The pacemakers carry impulses to the four different chambers of the heart. The upper chambers of the heart are known as the atrium (right and left), and the lower chambers of the heart are known as the ventricles (right and left).

In today’s article, we will tell you about pacemaker surgery in detail.

  • What are the different types of Pacemakers?
  • What is the purpose of Pacemaker Surgery?
  • How does a Pacemaker work?
  • What are the diagnostic tests performed before the Pacemaker Surgery?
  • How to prepare for Pacemaker Surgery?
  • What is the procedure of Pacemaker Surgery?
  • How to take care after Pacemaker Surgery?
  • What are the complications of Pacemaker Surgery?
  • What is the cost of Pacemaker Surgery in India?

What are the different types of Pacemakers?

According to your symptoms and your heart condition, the different types of pacemakers that can be implanted include:

Single-chamber Pacemaker: 

  • Most people use this type of pacemaker device. 
  • It has one electrode that connects the pulse generator to only one chamber of the heart. 
  • It could be the right atrium or right ventricle of the heart, depending upon the patient’s symptoms. 

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.
  • A dual-chamber pacemaker helps both the chambers of the heart to contract and relax in a proper rhythm. 

Biventricular pacemaker: 

  • It is also known as a cardiac resynchronization therapy (CRT) device. 
  • It has three electrodes that are connected to the right atrium, right ventricle, and left ventricle of the heart. 
  • It is used for patients with arrhythmias that are caused by advanced heart failure.

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What is the purpose of Pacemaker Surgery?

The cardiologist or doctor will test you and check if you are a good candidate for a pacemaker. A pacemaker can be used in the following conditions:

  • Heartbeat is too slow
  • Heartbeat that pauses
  • Heartbeat is too fast
  • Heartbeat is irregular
  • In certain types of heart failures (the heart fails to pump enough blood to the body)

The above symptoms can be caused due to several factors, like:

  • Age-related changes to the heart
  • Congenital (present from birth) heart conditions
  • Damage to the heart because of:
  • Heart disease
  • History of heart surgery
  • History of a heart attack

( Know more about- What is Heart Attack? )

  • Certain medications that you may be taking, like beta-blockers or calcium channel blockers, slow down your heart rate
  • Health disorders like:
  • Pericarditis (inflammation of the tissue that surrounds the heart)
  • Myocarditis (inflammation of the heart muscle)
  • Systemic sclerosis (a rare condition causing scarring and inflammation of the skin and internal organs)
  • Cardiomyopathy (changes to the heart muscle, that affects its ability to pump blood)

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  • Hypothyroidism (when the thyroid gland produces too little thyroid hormone)
  • Sarcoidosis (a rare condition that leads to swellings known as granulomas in the organs of the body)

Some of the symptoms that may indicate heart failure or arrhythmia, which may require a pacemaker include:

  • Dizziness

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

( Know more about- What are Cerebrovascular Diseases? )

How does a Pacemaker work?

A Pacemaker has two parts:

Pulse generator: 

  • It is a metal box that consists of a battery and an electrical circuit. 
  • The role of a pulse generator is to regulate the electrical pulses that are sent to the heart.

Wires (leads/electrodes): 

  • These are insulated wires that are placed in the heart’s chamber to deliver electrical pulses to adjust the heart rate. 
  • They can vary from one to three and based on the number, they can either be placed in a single chamber or more than one chamber.

The device continuously observes the patient’s heartbeats. When a person’s heartbeats are slow; the pacemaker sends signals to the heart to correct the heartbeats. Thus, a pacemaker only works when it’s needed. The pacemaker also records information about the heart and thus makes it easy for doctors to evaluate and adjust the device accordingly.

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What are the diagnostic tests performed before the Pacemaker Surgery?

  • Physical examination: You will be examined physically by the doctor. Your symptoms will be noted, along with your medical history.
  • Electrocardiogram (ECG): This is a quick and painless test done to measure the electrical activity of the heart. It helps in checking if the heart is beating too slow, too fast, or not beating at all.
  • Echocardiogram: This test involves the use of sound waves to create images of the heart’s structure, size, and motion.
  • Stress Test: The patient performs certain exercises which increase their heartbeat, then tests like ECG, echocardiogram, or nuclear imaging are done to check the status of the heart.
  • Electrophysiology study:  In this test, a thin, flexible wire is passed through your vein of the hand or groin, to your heart. This test is done to evaluate the heart’s electrical system and check for abnormal heart rhythms.
  • Holter monitoring: A small, wearable device that keeps track of the rhythm of the heart is known as a Holter monitor. The doctor will recommend you to wear this device for one or two days. The device records all your heartbeats during this time and can help in diagnosing heartbeat problems that may occur at unpredictable times.

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How to prepare for Pacemaker Surgery?

Before the pacemaker surgery; doctors advise the following steps:

  • After midnight before the surgery, doctors advise patients to avoid eating or drinking anything.
  • Stay in touch with your doctor and update him/her about your current health conditions. Also, take medicines as prescribed by him.
  • Tell your doctor if you are currently taking any medications or supplements.
  • On the day of surgery, doctors will only allow you to have a few sips of water for taking your morning pill.
  • Medications such as Anticoagulants, Antiplatelet medications, and Nonsteroidal anti-inflammatory drugs (NSAIDs); must be stopped one week or more prior to the surgery, as they can cause increased bleeding. Thus consult your doctors for the same.
  • The doctor may recommend a special soap for having a bath the day before the surgery. This soap helps in killing all the germs and decreases the chances of developing an infection.

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What is the procedure of Pacemaker Surgery?

A pacemaker surgery can be performed in the following two ways:

  • Transvenous method:
    • Most wired pacemakers are implanted using this procedure.
    • The leads and electrodes are threaded through the veins and into the heart.
    • Veins in the chest, neck, or thigh are normally used.
    • The patient will first receive a sedative to relax the patient, and local anesthesia to numb the site of the incision. The patient will be awake during the procedure.
    • The surgeon will make a small cut or incision near the collarbone.
    • The leads are then guided through the incision and into a major vein.
    • An x-ray machine will help the surgeon guide the leads through the vein to the heart.
    • Once the leads reach the heart, the surgeon will attach the electrodes to the heart muscle.
    • The other end of the lead is attached to the pulse generator containing the electrical circuits and battery.
    • Once the leads and electrodes are in their proper place, the surgeon implants the generator under the skin near the collarbone.
    • Once the procedure ends, the surgeon tests the pacemaker to make sure that it is working well before closing the incision with sutures or stitches.
    • The procedure takes approximately one hour to complete. However, the time will vary depending on the number of leads being placed
  • Epicardial method:
    • This is the less common way of pacemaker implantation.
    • This procedure is done under general anesthesia, in which the patient is put to sleep during the procedure.
    • The electrodes are attached to the surface of the heart, rather than inside the heart.
    • Wireless pacemakers can be placed using a thin tube known as a catheter.
    • An x-ray machine is used for guiding the catheter and wireless pacemaker through a vein in the thigh to the heart.
    • This procedure usually takes less than one hour to complete.
    • Epicardial placement may be done in the following cases:
    • In case of pacemaker surgery done in an infant or child
    • As a precautionary measure during heart surgery
    • When the structure of the heart or veins makes it difficult to use the transvenous method

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How to take care after Pacemaker Surgery?

After pacemaker surgery, the doctor recommends the following precautions:

  • After surgery, the patient is usually kept overnight in the hospital. However, some patients can go home on the same day of the surgery. 
  • Before you are discharged, the doctor will make sure that the pacemaker is programmed properly for the needs of your heart, and may take a chest x-ray.
  • It is common to have some pain and discomfort after the procedure.
  • In order to prevent any complications, the doctor recommends some medicines to the patient, that must be taken at the right time.
  • The doctor will instruct you on how you can clean the wound and prevent infection.
  • Wear loose-fitting clothes during the recovery period to avoid irritation to the surgical area.
  • Avoid performing strenuous activities that will stress your heart.
  • You will most likely be able to resume your daily activities a few days after the surgery.
  • After pacemaker surgery, regularly visit your doctor for a check-up so that you can see if the device is working or not, and so that the doctor can readjust the programming of the pacemaker if needed.
  • Do not lift any heavy objects for 4 to 6 weeks after the procedure, as it may result in failure of surgery.
  • Keep your pacemaker at least six inches away from appliances such as cell phones, equipment having magnets, smartwatches, headphones, handheld metal detectors, anti-theft systems, and other electrical appliances.
  • In case of any other medical procedures in the future, inform your doctor if you have a pacemaker in your heart. Certain medical procedures like CT scans (imaging test to obtain a clear image of the internal organs of the body), radiation therapy (treatment for cancer), electrocautery (a procedure to control bleeding during surgery), shock wave lithotripsy (a procedure done to break up the large kidney stones or gallstones) can interfere with the pacemaker.

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What are the complications of Pacemaker Surgery?

The risks of pacemaker surgery include:

  • The place where the pacemaker is placed might get infected 
  • There might be an allergic reaction to a dye or anesthesia used during the procedure
  • Swelling, injury, bruising or bleeding, at the site of the pacemaker
  • Damage to the blood vessels or nerves near the pacemaker
  • Pneumothorax (collapsed lungs)
  • Thromboembolism (blood clot formation) near the pacemaker site
  • Hemothorax (blood in the space between the chest wall and lung)
  • Punctured heart or cardiac perforation due to the movement of the pacemaker device or leads (a rare condition)

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What is the cost of Pacemaker Surgery in India?

The total cost of pacemaker surgery in India can range from around INR 1,95,000 to INR 2,80,000. However, many prominent hospital doctors in India specialize in pacemaker surgery. But the cost varies across different hospitals.

If you are coming from abroad, apart from the cost of pacemaker surgery, there will be an additional cost of living in a hotel and the cost of local travel. After the procedure, the patient is kept for one day in the hospital and seven days in the hotel for recovery. So,  the total cost of pacemaker surgery in India comes to a total of INR 2,50,000 to INR 3,80,000. 

We hope that we could answer all your questions regarding pacemaker surgery through this article.

If you need more information about pacemaker surgery, you can contact a Cardiologist.

We only aim to provide you with information through this article. We do not recommend any medication or treatment to anyone. Only a qualified doctor can give you the best advice and correct treatment plan. 

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