Permanent Pacemaker

What is Pacemaker?
A pacemaker implantation is the insertion of an electronic medical device that sends out small electrical impulses to make the heart beat in a regular rhythm and at a normal speed. It is usually placed in the chest just below the collarbone.


Purpose of a Pacemaker
The primary purpose of a pacemaker is to maintain an adequate heart rate.
Diagnosis before Pacemaker Implantation:

  • Echocardiogram
  • Electrocardiogram
  • Holter Monitoring
  • Stress Test



Pacing methods:

  • Percussive pacing: - Percussive pacing is used usually on the left lower edge of the sternum over the right ventricle, striking to induce a ventricular heartbeat. This is an old procedure which is used as a lifesaving means till an electric pacemaker is inserted in the patient.
  • Transcutaneous pacing: - It is used for the initial stabilization of bradycardias of all types. The procedure is performed by placing two pads in the patient’s chest. The pacing rate is selected and gradually increased by the rescuer till an electric capture is received with a pulse. It acts as a bridge till transvenous pacing or other therapies can be applied.
  • Epicardial Pacing: - This is used in an open-heart surgery. Electrodes are placed in contact with the outer wall of the ventricle. This maintains a cardiac output till a temporary transvenous electrode is inserted.
  • Transvenous pacing: - Transvenous pacing, is used as an alternative to transcutaneous pacing. It is used as a bridge to permanent pacemaker placement as it can be kept till the pacemaker is inserted or till there is need of the permanent pacemaker, after which it is removed.
  • Sub clavicular pacing: - An incision is made in the vein where the electrode lead is inserted and passed along the vein, through the valve of the heart till it is positioned in the chamber. The basic types of pacemakers are:
    • Single-chamber pacemaker

    In this type, only one pacing lead is placed into the chamber of the heart.

    Dual-chamber pacemaker

    Wires are being placed in the two chambers out of which one lead paces the atrium and one paces the ventricle. This type resembles the natural pacing of the heart

  • Biventricular pacing: - A Biventricular Pacing is used to achieve Cardiac Resynchronization Therapy (CRT).It can pace both septal and ventral walls of the left ventricle So, the pacemaker can resynchronize the ventricular contractions.


Procedure of Implantation
During the procedure an ECG and blood pressure monitor will allow your heart rate and blood pressure to be recorded while you lie on the table in the cardiac catheter laboratory. The local anaesthetic will be injected under the skin in the area of the pacemaker insertion.
An 5-10cm incision will then be made below the collar bone and a small pocket under the skin or muscle will be made for the pacemaker battery, and one or more leads will be inserted into a nearby vein so they can be passed to the heart using x-ray control. The cardiologist will then close the incision with sutures and apply a dressing to the skin over the wound. Simple generator replacements may be done as a day case.


Recent advances –
Implantable cardioverter defibrillators (ICDs)
ICD is a device similar to a pacemaker which sends larger electrical shock to the heart that helps it to pump again. Some devices contain both a pacemaker and an ICD. They are often used as a preventative treatment. If the ICD senses the heart is beating at a potentially dangerous abnormal rate, this sends electric shock which helps the heart to beat in a normal rhythm. A newer type of ICD in which the pacing lead is implanted under the skin.

'Dynamic Pacemaker', could compensate for both actual respiratory loading and potentially anticipated respiratory loading. other artificial organ replacement efforts and this would be supported by traditional tissue welding. Stem cells may or may not be of interest to transitional tissue welding.
The Pacemakers that control both the atria and ventricles are called dual-chamber pacemakers

Nano stim Leadless Pacemaker – It is one of the most innovative technologies. It is a tiny device which is implanted in the heart via chambers. It attaches to the wall of the left ventricular apex. The small size of the device allows for percutaneous placement in the femoral vein using a steerable catheter.

What is the Cost of Pacemaker Implantation?

  • The cost for Double Chamber Pacemaker Implantation is 7,500 USD.


What is the treatment duration?

  • The average hospital stay after the surgery is 5 - 7 days. Complete recovery of the patient will take a few weeks to several months, depending on the health before surgery. Regular exercise and physiotherapy will help to recover more quickly.


What is the success rate?

  • For a 3-lead pacemaker system, the success rates are about 97 percent. The risks of major complications from a pacemaker implant are low.