A pacemaker is a small electrical device that is implanted into the chest to regulate the heartbeat, it sends electrical impulses to the heart muscle to maintain a suitable heart rate and rhythm. In dual chamber pacemaker, two-leads are implanted in the heart. One lead paces the atrium and one paces the ventricle, closely matching the natural pacing of the heart.
Types of pacemaker
- Single chamber pacemaker: This type of pacemaker usually carries electrical impulses from the pulse generator to the right ventricle of a heart.
- Dual chamber pacemaker: A dual chamber pacemaker carries electrical impulses from the pulse generator to both the right ventricle and the right atrium of your heart.
- Biventricular pacemaker: A biventricular pacemaker stimulates both of the lower chambers of the heart (the right and left ventricles) to make the heart beat more efficiently.
Indications for Pacemaker Implantation
A cardiologist may consider pacemaker placement when medications and other less-invasive procedures are not effective at correcting heart problems, eg. conditions including:
- Bradycardia: A condition in which the heart beats too slowly, causing symptoms such as fatigue, dizziness or fainting spells.
- Atrial fibrillation: A common heart rhythm disorder in which the upper chambers of the heart beat rapidly and chaotically.Medicines used to control atrial fibrillation may result in slow rhythms which are treated by pacemakers.
- Congestive Heart failure: A condition in which the heartbeat is not sufficient to supply a normal volume of blood and oxygen, a pacemaker can be carefully programmed to increase the force of muscle contractions in the heart.
- Frequent fainting spells (Syncope): A pacemaker may prevent the heart rate from slowing to the point of fainting.
- A dual-chamber pacemaker is necessary when the heart is too weak to maintain the timing of the right atrium and ventricle
Tests and diagnosis
- Medical history and Examination: The consultant takes complete medical history to check for symptoms. Performs clinical examination
- Holter monitoring: Records your heart rhythms for an entire 24-hour period.
- Echocardiogram: Shows functioning of the heart, and recorded pictures allow your doctor to measure the size and thickness of your heart muscle.
- Stress test
- The cardiologist will dicussin detail the procedure
- Past and present medical problems andprevious operations
- Preoperative assessment to check fitness for surgery.
- Discuss with a consultant if H/o allergic reaction to anaesthetics.
- Advised to stop certainmedications few days before surgery.
- Stop smoking, eating a healthy diet and exercising regularly
- The procedure usually takes about 1-2 hrs
- A small incision is made in the upper-left side of the chest and the dual-chamber pacemaker is secured just underneath the skin.
- With the aid of X-ray imaging, the surgeon guides two wires into the subclavian vein and directs them to their respective chambers in the heart.
- The wires are connected to the pacemaker and tested
- The surgical incision is then closed.
- Patient is hospitalised for 1-2 days to monitor the vitals and make sure the pacemaker is functioning properly.
- You may feel some pain or discomfort during the first 48 hours after having a pacemaker fitted, and you'll be given pain-relieving medication.
- There may also be some bruising where the pacemaker was inserted. This usually passes within a few days.
- Antibiotics and painkillers are prescribed to combat infection and pain
- Frequent follow-up visits in the first six months are important to determine if pacemaker settings need to be adjusted
- Lifestyle changes, maintaining healthy weight and exercise and regular follow ups are important for improved prognosis.
Complications of pacemaker implantation
Though, rare complications may include
- Lead dislodgement - usually occurs within two days following implantation of a permanent pacer and may be seen on chest radiography
- Failure to output- This may be due to battery failure, lead fracture, a break in lead insulation, oversensing , poor lead connection
- Air embolism
Factors affecting the cost of treatment of Pacemaker Implantation
Cost to the patient depends on a variety of factors like:
- The hospital patient chooses
- Fees for the team of doctors
- Cost of medicines, tests and diagnostic procedure
- Cost of procedure
- Cost of pacemaker device
- Cost of follow-up care required