Heart Pacemaker

What is a Heart Pacemaker?

Natural Heart Pacemaker (SA Node) is a small mass of specialized cells in the top of the heart's right atrium (upper chamber). It initiates and generates the electrical impulses that cause your heart to beat. Artificial Heart Pacemaker or Cardiac Pacemaker is a small (size of a pager), light weight battery-operated device that helps the heart to beat in a regular rhythm when the Natural Heart Pacemaker is malfunctioning or not functioning. The Artificial Heart Pacemaker initiates, generates and propagates electrical impulses to the heart to help it beat properly and regularly.

Where can I get a Heart Pacemaker?

Country	Cost with MedSolution
India	$1,875 - single chamber  (inquire)
India	$2,250 - double chamber  (inquire)

Cost of procedure performed in the US: $15,000.

All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.

What are the different kinds of Heart Pacemakers?

Heart Pacemaker can be:

• Permanent (internal) Heart Pacemaker - This kind of Heart Pacemaker is implanted in a small pocket under your skin and is meant to be left in there for the rest of your life.
• Temporary (external) Heart Pacemaker - This is used for initial stabilization of the patient during a cardiac crisis.
• Demand Heart Pacemaker - This kind of Heart Pacemaker has an inbuilt sensing device which senses when the heart beat is too slow and turns the signal on. Once the heart beat is above a certain level, it automatically turns the signal off.
• Single Chamber Heart Pacemaker - This kind of device has one lead to carry signals to and from one chamber of your heart, either the right atrium or, more commonly, the right ventricle.
• Dual Chamber Heart Pacemaker - This kind of Heart Pacemaker has 2 leads and can monitor and deliver impulses to either or both of the heart chambers.
• Adaptive-Rate Heart Pacemaker or Rate-responsive Heart Pacemaker - This kind of Heart Pacemaker automatically increases the pacing rate to meet the body's changing need.

Why do you need a Heart Pacemaker?

A Heart Pacemaker is used to stabilize dangerously slow heart beats (bradycardia) (less than 60 beats per minute). Slow heart beats can result from metabolic abnormalities, blocked arteries to the heart's conduction system, Sick Sinus Syndrome or SA node dysfunction (commonly caused by congenital heart defects, illnesses, cardiotoxic drugs, the natural aging process, or scar tissue from a heart attack), heart block or cardiac surgery. If you suffer from any of the above heart problems, then you are an ideal candidate for Heart Pacemaker implantation.

How does the Heart Pacemaker work?

The Artificial Heart Pacemaker comprises of four major components:

• Batteries - The Heart Pacemaker operates with 2 lithium batteries.
• Sensing component - This component of Artificial Heart Pacemaker senses whether the heart is generating a normal heart beat or not. If the sensing component senses that the heart is not generating a natural heart beat, then the Heart Pacemaker takes over this function and will send an electrical impulse to initiate a heartbeat.
• Pacing component - This component of Artificial Heart Pacemaker sends the electrical impulse to generate a normal heart beat
• Programming component - This component of Artificial Heart Pacemaker is a computerized monitoring device which can adjust the settings of the Heart Pacemaker.

If the Heart Pacemaker circuit detects that the heart is beating too slow, then it will send a tiny electrical impulse called the pacing signal. This impulse travels through the wires of the pacing lead until it reaches the metal electrode which is in direct contact with the heart. This electrode delivers the electrical impulse to the heart tissue to begin a heartbeat. The pacing pulses are timed so that the heart beats in a manner very similar to a natural heart rhythm. However, in some Heart Pacemakers, especially Adaptive-Rate Heart Pacemaker or Rate-responsive Heart Pacemaker, sensor detects changes in the body such as movement of arms and legs or how often a person breathes. This is then translated in to the rate of heart beats that need to be generated depending upon the body's need for oxygen.

What does the procedure for Heart Pacemaker implantation involve?

The procedure to implant Permanent Heart Pacemaker is performed under local anesthesia and mild sedation to help you relax. Local anesthesia is injected to numb the skin over the area where the Heart Pacemaker will be implanted. A 2 inch incision will be made parallel to and just below the collar bone. Pacer wires or leads will then be inserted into a vein that lies just under the collarbone, the wires and leads are advanced through that vein under fluoroscopic guidance into the heart. The other end of the pacer wires are connected to a pacing device that is implanted under the skin (in a pocket) beneath the collar bone. your doctor will test and program the Heart Pacemaker and then suture the skin incision. The entire procedure for Heart Pacemaker implantation may take about 2 hours. You will be instructed not to eat or drink any thing 10 - 12 hours before the surgery.

What to expect after Heart Pacemaker Implantation?

There will be mild pain from the incision which will be relieved by pain medication. You will spend an hour or so in the recovery room under observation for any immediate complications, and will be allowed to go home later that day. Make sure to follow your doctors instructions closely about keeping the incision dry, not to sleep on that side to avoid putting pressure on the Heart Pacemaker, not to perform any strenuous activities like lifting or over-stretching of the near arm for the next ten days or so after Heart Pacemaker implantation. You will be able to resume most of your normal daily activities a few days after the Heart Pacemaker implantation procedure. The stitches will be removed after about two weeks and you doctor will provide you with instructions about programming, adjustment and to watch for low battery and malfunction signals to ensure optimum functioning of the Heart Pacemaker.

What is it like to live with a Heart Pacemaker?

It is important that you keep the following points in mind to obtain the optimum benefit from your Heart Pacemaker:

• Make sure to carry a Heart Pacemaker ID card with you at all times.
• Ensure that your physician adjusts and checks your Heart Pacemaker whenever a new medication is prescribed.
• Check periodically to ensure that your Heart Pacemaker is functioning correctly and that the batteries have not worn out.
• Electrical home appliances like TV, radio, microwave, heating pads, metal detectors, remote control etc. do not interfere with the functioning of the Heart Pacemaker.
• Cell phones especially digital cell phones do interfere with Heart Pacemaker functioning. Keeping the cellular phone at least 6 inches away from the Heart Pacemaker may decrease the chances of problems.
• You should not undergo imaging procedure like MRI (Magnetic Resonance Imaging), electric cauterization, dental procedures using electrical appliances if you have a Heart Pacemaker implanted.
• X-rays do not seem to have any adverse effects on your Heart Pacemaker
• As Heart Pacemaker are made of metal, they may set the alarm off when passing through metal detectors at the airport.

What is the outcome of Heart Pacemaker implantation?

Heart Pacemaker implantation is an effective approach to controlling the bradycardia (slow heart beat) that may result SA or AV node malfunction. The quality of life improves tremendously after the Heart Pacemaker implantation surgery. You can get back to your normal routine about 2 weeks.

B . R . A . N . D . of Heart Pacemaker implantation

Benefits of Heart Pacemaker implantation

• Heart Pacemaker implantation is a safe procedure in experienced hands. Heart Pacemaker will relieve bradycardia (slow heart beat) or irregular heart beat. Due to slow heart beat, the body's demand for oxygen is not met resulting in symptoms such as dizziness, extreme fatigue, shortness of breath, or fainting spells. Whatever the cause of slow heart beat may be, a Heart Pacemaker can keep the heart beating at a rate that allows you to continue living a normal life and meet your body's demand for oxygen whatever your activity level may be.

Risks of Heart Pacemaker implantation

Chances of complications during Heart Pacemaker implantation are extremely rare. Possible complications that might occur are:

• Excessive bleeding
• Bruising
• Infection at the incision site of Heart Pacemaker implantation
• Perforation of Heart due to rupture of heart muscle
• Damage to blood vessels
• Intubation due to introduction of air in the pleural space
• Stroke
• Heart Attack
• Malfunction of Heart Pacemaker

Alternatives to Heart Pacemaker implantation

• Medications - Anti-arrhythmic medications
• Cryoablation Therapy or Cryo-catheterization - This is a catheter-based cryotherapy procedure used to treat arrhythmias and other heart function abnormalities especially in children.

Now or Never

• Insufficient blood supply to organs of the body due to slow heart beat can result in organ failure. Heart Pacemaker implantation is not only performed in older people, this procedure is widely used in children with Congenital Heart Disease in the conducting system of the heart. Heart Pacemaker can maintain adequate heart rate and with the advent of Adaptive-Rate Heart Pacemaker or Rate-responsive Heart Pacemaker, whatever the level activity, Heart Pacemaker sensor can adapt and generate heart beats accordingly.

Decision to have Heart Pacemaker implantation

• Implantation of a Heart Pacemaker is a safe procedure with minimal chances of complications. A permanent Heart Pacemaker will correct the symptoms caused by abnormally slow or irregular beating of the heart and will allow you to enjoy a normal life.