Medical conditions when a Pacemaker is Needed? : Pacemaker Implantation in India

Heart rhythm disorder is a serious medical condition and could lead to problems ranging from simple palpitations to sudden death. But the modern Electrophysiology has provided great solution to the patients suffering from heart rhythm problems. The newer techniques and developments in Electrophysiology have enhanced the quality of life in these patients to a great extent. Heart hospitals in India have now the best electrophysiology teams to offer the best treatment for patients with heart rhythm disorders.

Implantable pacemaker

What is it?

In this surgical procedure, surgeons implant a device called a pacemaker, which regulates heart rate and rhythm.

Why is it performed?

It is performed to treat abnormal heart rates or rhythms (arrhythmia), particularly if they have not responded well to drug therapy (medication).

What is done?

The pacemaker consists of two parts. The leads are wires with electrodes at the tip that transmit electrical signals to the heart muscle from the pulse generator. These electrical signals cause the heart muscle to contract (pump). The pulse generator (often referred to as the pacemaker) is a small unit with a computer that generates the electrical signal. Most pacemaker implantations are performed under local anesthesia (similar to the anesthesia used by dentists).

What can you expect?

Usually, the procedure is scheduled ahead of time. A week or so before your operation, you will probably be asked to visit your hospital. Various tests, such as blood and urine tests, an electrocardiogram, and other tests may be performed. Your doctor will explain the risks and benefits of the procedure and you will be asked to sign a consent form. Before the procedure starts, inform your doctor if you:

• Have ever had a reaction to any contrast dye, iodine, or any serious allergic reaction (for example, from a bee sting or from eating shellfish).
• Have asthma.
• Are allergic to any medication.
• Have any bleeding problems or are taking blood-thinning medication.
• Have a history of kidney problems or diabetes.
• Have body piercings on your chest or abdomen.
• Have had any recent change in your health.
• Are, or may be, pregnant.

What happens during the procedure?

Endocardial lead positioning

This is the most common procedure for implanting a pacemaker. You will be awake throughout the procedure. You will be given a sedative to help you relax and local anesthetics in areas that are involved in the procedure (usually the upper chest area). A thin, flexible tube (catheter) will be inserted into a blood vessel and, using a fluoroscope (similar to an X-ray picture to visualize the catheter), threaded into the heart. Once in the heart, the leads will be attached to the inside lining. The leads will be tested to ensure they are working correctly. From time to time, you may be asked to take deep breaths or cough vigorously in order to test the placement of the leads.

Once the leads are in the best locations, they will be plugged into the pulse generator. The pulse generator will be slipped into a small pocket made just beneath the skin of your upper chest or your abdomen. You may feel slight pressure while the leads and pulse generator are being inserted into the pocket.

Epicardial lead positioning

Because a larger incision is made in the chest, this procedure is usually performed under a general anesthesia and you will be asleep. The exterior surface of the heart is exposed and the leads attached directly to the surface (epicardium) of the heart. The pulse generator is usually placed under the skin in the upper abdomen, but may also be placed in the upper chest area.

After the procedure

Once surgery is completed, you will be taken to a recovery room. There may be some soreness around the site where the pulse generator was implanted, but it can be managed with pain medication. Depending upon your condition and which procedure you had, you may stay in the hospital anywhere from several hours to a few days.

When you return home, keep an eye on your incisions. Some bruising is normal but contact your doctor if you experience increased pain, redness, swelling, bleeding or other draining from an incision, fever, or chills. Most people are aware of their pacemaker for a short time following its implantation, but this sensation usually decreases with time. 

Following implantation of a pacemaker, it is OK to take a shower, bathe or engage in usual sexual activity. During the initial eight weeks, avoid sudden, jerky movements with your arms, stretching or reaching over your head or touching the pacemaker. After this time, just avoid putting pressure on the chest area over the implant.

Monitoring your pulse

It is important to always carry your pacemaker ID card. You should also be aware of your pacemaker’s maximum and minimum programmed heart rates. Monitor your pulse regularly and report the readings to your healthcare provider at your pacemaker checkup. With the help of a special analyzer your doctor can detect if the batteries are about to run down.

Devices that may interfere with your pacemaker

General household and office appliances or equipment will not interfere with your pacemaker. This includes microwave ovens, televisions, radios, stereos, vacuum cleaners, electric blankets, hair dryers, shavers, gardening machinery, toasters, food processors, computers and copy machines.

Devices that may pose some risk to pacemaker function are anti-theft systems (also called EAS systems) at shopping malls, metal detectors for security and cell phones. Move through anti-theft systems or metal detectors at a regular pace without any delays. At airports, you can ask for a hand search to avoid the use of hand held metal detectors. It is advisable to hold your cell phone to the opposite ear, farther from the pacemaker implant. Do not keep a turned on cell phone in the shirt pocket.

MP3 player headphones, including the ear bud style, use a magnetic substance and therefore cause interference in pacemaker function. These headphones should be kept at least 1.2 inches away from the pacemaker and should not be placed in the breast pocket or worn by someone resting their head on your chest.

Certain medical procedures can interfere with your pacemaker`s function. These include magnetic resonance imaging (MRI) and extracorporeal shock-wave lithotripsy, a non-invasive treatment procedure for kidney stones. When MRI must be done, some pacemaker models can be reprogrammed. Dental drilling also has a tendency to increase the pacing rate. It is advisable to let a healthcare provider know about your pacemaker before testing with any medical devices. In addition, radiofrequency ablation procedure for arrhythmias, short-wave/microwave diathermy physical therapy, and therapeutic radiation for cancer and transcutaneous electrical nerve stimulation for pain may all interfere with pulse generation.

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Questions about Pacemakers - Best Cardiac Hospitals in India

Heart rhythm problems (arrhythmia) occur when the electrical impulses produced by your heart that coordinate heartbeat do not function properly, causing your heart to beat too quickly, too slowly, or irregularly.Age increases the probability of experiencing an arrhythmia. It can occur in people who do not have heart disease.Some heart arrhythmias are harmless, though some types, such as ventricular tachycardia (fast heart rates), are serious and even life threatening.
Pacemakers represent one of the earliest and most successful nonpharmacological therapy for arrhythmias. Millions of pacemakers have been implanted since the very first pacemaker was implanted. Drugs are no longer used except in the very acute setting before implantation of a temporary or permanent pacemaker.

A cardiac pacemaker is a device that is used to regulate the heart rate.

If you have been found to have a heartbeat that is too slow, a pacemaker can be implanted in the body to take over the function. This small electronic device automatically monitors and regulates the heartbeat, by transmitting electrical impulses to stimulate the heart when it is beating too slowly. A pacemaker consists of a pacing lead and a pulse generator. Single chamber pacemakers have only a single lead while dual chamber pacemakers have two leads with one lead in the atrium and the other in the ventricle. Dual chamber pacemakers are more physiological but more expensive.

The indications of pacing are now well established. The most important indication of pacing however remains complete heart block and the sick sinus syndrome which account for 95% of the indication for pacemakers implanted in Singapore. During the last pacemaker survey in 2005 in Singapore, the implant rate was 91 per million. With our ageing population, we can expect that the need for pacemaker implantation in Singapore will rapidly increase.

Types of pacemakers

Single chamber pacemakers are pacing systems that use one lead in either the right atrium or the right ventricle of your heart.

A single lead in the right atrium is commonly used in conditions where the normal pacemaker of the heart is not working adequately, such as in the case of sick sinus syndrome. Atrial pacing is used when the sinus node is sending out signals that are too slow or irregular. However, to use this method of pacing, the rest of the heart's normal conduction system must be functioning normally.

More commonly, the single lead is placed in the right ventricle to help correct a slow or irregular heart beat. This is most often the case when the electrical flow is slowed or blocked in the region of the atrio-ventricular (A-V) node and the normal impulses from the atria cannot reach the ventricle. This would result in too slow a heart beat. The pacemaker system would keep the heart beating at a steady rate

Dual chamber pacemakers are pacemaker systems that use a lead in the right atrium as well as the right ventricle (figure 6). This type of pacing most closely mimics the heart's normal conduction pattern by pacing sequentially from atria to ventricle thus maximizing the heart's pumping ability. By having a lead in both the atria and ventricle the pulse generator is able to continuously regulate the heart's electrical activity in both chambers. These are the most commonly used pacemakers at the present time.

Commonly asked questions about pacemakers

Will I need to make any lifestyle changes after my pacemaker is implanted?

There are no significant lifestyle changes that you will need to make as a result of having a pacemaker implanted. Most patients resume their normal activities soon after implantation. Specific issues or concerns should be addressed with your pacemaker physician or nurse.

How often will I need to have my pacemaker checked?

Your pacemaker system will need to be evaluated by your pacemaker physician, nurse, or your local cardiologist's office at least twice yearly. A special computer called a programmer is used to perform a comprehensive evaluation of your pacemaker system. The programmer has a wand (like a computer mouse) that is used to communicate with the pacemaker. The wand is placed on your chest directly over the pulse generator and a radio wave signal is used to send and receive information from the pulse generator. Changes in the pacemaker settings can be done via this method as well. A complete assessment of the pacemaker's sensing and pacing functions, battery life, and diagnostic information is obtained, which enables your pacemaker physician/nurse to fine tune your care.

How is the battery changed?

The battery that is used to power your pulse generator is tightly sealed within the metal shell of the device. Therefore, when the battery's energy is depleted a whole new pulse generator must be implanted. The skin over the pulse generator site is numbed up with local anesthetic. You may also receive a light sedative through a intravenous line to help you relax. A new incision is made in the skin and the pacemaker pocket is opened. The pulse generator is removed and lead(s) disconnected. At this time the lead(s) are hooked to a special analyzer that evaluates the lead(s) for any evidence of potential malfunction. A new pulse generator is then attached to the lead(s) and the system is reimplanted in the same pocket. The incision is sutured (sewn) together and a small dressing applied. Most patients can go home the same day as their procedure.

Can I use a microwave?

Microwave ovens will not interfere with the proper functioning of your pacemaker. You can use a microwave oven without concern.

Can I use a cell phone?

It is possible that a cellular phone might interfere with the normal functioning of your pacemaker. The interaction is temporary, however, and will only affect the pacemaker during the time that your cellular phone is close to your pacemaker. To avoid this potential interference, it is recommended that you hold the cellular phone on the opposite side of your body away from the pacemaker. You should also not store your cellular phone in your breast pocket.You should always try to maintain a distance of at least 6 inches between your cellular phone and your pacemaker system.

Do I have to take any precautions at the airport?

If you were to walk through the metal detector at the airport, it will not harm you nor your pacemaker. However, because the pacemaker is encased in a metal shell, it is possible that the pacemaker may set off the security alarm. To avoid this problem, it is generally recommended that you show your pacemaker identification card to the security agent and inform him/her that you have an implanted pacemaker system. They should let you pass around the metal detector. If the airport security wants to scan you with the "hand wand", they can everywhere except over the device. This information also pertains to any metal detector such as at a courthouse or federal building.

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                    https://www.facebook.com/medworld.india

Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors.

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