Pacemaker Implantation Surgery in Delhi, India

Pacemaker surgery is a medical procedure in which a small medical device called a pacemakeris implanted in the chest to help manage abnormal heart rhythms (arrhythmias).

A pacemaker device consists of a battery, a circuit, and two small electrical leads that are placed in the heart chambers. It works by generating an electrical impulses that stimulates the heartbeat and is timed to ensure a normal heart rhythm. Depending on the specific condition that is being managed with the pacemaker, it can speed up, slow down, or stabilise the heartbeat.

There are different types of pacemakers that are broadly categorised as single chamber pacemaker, dual chamber pacemaker, and biventricular pacemaker.

Pacemaker surgery is done to stabilise abnormal heart rhythms. There can be several conditions that alter the normal rhythm of the heart. Some of these include:

Bradycardia

Bradycardia is an abnormally slow heart rate, usually below 60 beats per minute, and is characterised by fatigue, dizziness, shortness of breath, and fainting.

Heart Block

Heart block occurs when the electrical signals from the atria (upper chambers) don’t properly travel to the ventricles (lower chambers). The three types of heart block are:

• First-degree: Delayed but not blocked signals; usually doesn’t need a pacemaker.
• Second-degree: Some signals don’t reach the ventricles, causing missed beats.
• Third-degree (complete heart block): No signals reach the ventricles, requiring a pacemaker.

Atrial Fibrillation (AFib) with Slow Heart Rate

AFib is an irregular and often rapid heart rate that can sometimes result in a slow pulse. The condition is characterised by palpitations, fatigue, and lightheadedness.

Sick Sinus Syndrome

This condition is a dysfunction of the sinus node, which is the heart’s natural pacemaker. It can lead to slow heart rhythms, pauses in the heartbeat, or alternating fast and slow heart rates (tachy-brady syndrome). The condition is characterised by fatigue, dizziness, shortness of breath, and fainting spells.

Cardiac Arrest Risk in Heart Failure (Biventricular Pacemaker)

Patients with heart failure may experience uncoordinated contractions between the heart’s ventricles, reducing blood flow efficiency. Symptoms include swelling, fatigue, breathlessness, and low exercise tolerance.

Long QT Syndrome

This is a rare disorder that causes fast, chaotic heartbeats due to issues with the heart’s electrical system, which can sometimes lead to sudden cardiac arrest. Symptoms include palpitations, fainting, and in severe cases, sudden death.

Neurocardiogenic Syncope (Vasovagal Syncope)

This condition causes sudden drops in heart rate and blood pressure, leading to fainting, often triggered by stress or certain body positions. Symptoms include lightheadedness and fainting.

Before pacemaker surgery, regular blood work is done to ensure a patient is fit for the surgery. This is followed by a brief on the surgery and what the patient can expect after the procedure.

On the day of the surgery, an IV will be used to deliver the sedatives directly into the bloodstream. That will ensure the patient is comfortable and relaxed throughout the procedure.

Local anaesthesia is used to numb the area on the chest where incisions are made. The surgery can be done while the patient is fully awake or lightly sedated, depending on what the doctor recommends for each case.

Pacemaker surgery starts with the surgeon making an incision in the patient’s chest. The leads of the pacemaker are inserted through the incision into a major vein. X-ray is used to help guide the leads through the veins.

Once the leads are at the heart, the surgeon will attach the electrodes to the heart muscle and other parts of the leads are attached with the pulse generator. The pulse generator is then placed under the skin near the collarbone.

Following this, the pacemaker is tested before closing the incision with sutures.

Post-surgery you’ll be required to stay at the hospital two day for close monitoring of any complications that may arise.

Pain relief drugs will be prescribed by the doctor. These will help ease the pain and discomfort that is often experienced after any surgery.

The patient may be advised to avoid strenuous exercise or heavy lifting for the first month following the installation of a pacemaker. They should also avoid applying pressure to the region where the pacemaker has been inserted.

The most obvious benefit of getting pacemaker surgery is that it will help stop the heart from failing or stopping abruptly. Apart from that, other benefits include:

• Improved Heart Function
• Reduced Symptoms
• Prevention of Life-Threatening Arrhythmias
• Enhanced Quality of Life
• Lowered Risk of Heart Failure Symptoms
• Increased Exercise Tolerance
• Reduced Hospitalizations
• Non-Invasive Maintenance
• Long-Lasting Solution
• Peace of Mind

Following is a list of risks associated with pacemaker surgery:

• Swelling and Infection: Swelling and infection are common complications associated with any surgery
• Blood clots: Blood clots or thrombosis in the vein where the pacemaker lead is inserted is a likely complication. It causes swelling and pain that can be treated with anticoagulant medication.
• Pacemaker malfunction: Though a highly unlikely scenario, sometimes the pacemaker can malfunction, which may lead to hiccups or fainting or dizziness. Seek medical care as soon as possible if you suspect any of these symptoms post surgery.
• Bleeding or Bruising: Small blood vessels can be damaged during the surgery, especially around the collarbone. Compression and observation often helps, although significant bleeding may require additional intervention.
• Pneumothorax (Collapsed Lung): In rare cases, one of the lungs may be accidentally punctured during lead placement, leading to chest pain and shortness of breath. Small pneumothoraxes often resolve on their own, but larger ones may require a chest tube to re-inflate the lung.
• Lead Dislodgement or Malfunction: Leads may shift from their position, resulting in irregular heartbeat. Lead repositioning or replacement may be required.
• Allergic Reaction to Anesthesia or Device Materials: Some patients may have reactions to anesthesia or the materials in the pacemaker, resulting in rash, swelling, and/or difficulty breathing. Allergic reactions are typically managed with medication. Alternative materials or anesthesia may be considered.
• Heart Perforation: A rare but serious complication where one of the leads punctures the heart muscle, requiring immediate intervention to repair the perforation.
• Device or Battery Malfunction: Rare technical issues can cause the pacemaker to stop working or misfire, leading to a recurrence of symptoms like fatigue and dizziness. Device check-ups may be essential to monitor function and arrange a replacement, if needed.
• Movement or Shifting of the Pacemaker Device: The pacemaker may move from its original position, especially during the first few weeks after surgery. Surgical adjustment may be necessary.
• Electrical Interference with Other Devices: Certain devices (e.g., MRI machines, high-voltage equipment) can interfere with pacemaker function. This may lead to device malfunction or irregular heartbeats.

1. What is the difference between single chamber, dual chamber, and biventricular pacemaker?

The main distinguishing factor between the three is the place where the electrical signals are sent. In the case of a single chamber pacemaker, the device sends electrical signals to the lower chamber of the heart. A dual chamber pacemaker sends signals to the upper and the lower right chambers of the heart; while a biventricular pacemaker, also known as cardiac resynchronisation pacemaker, stimulates both of the lower chambers of the heart.

2. Are there any lifestyle adjustments that need to be made post-surgery?

For a couple of weeks, do not:

• Lift heavy objects
• Engage in strenuous activities
• Get too close to devices that produce very strong electromagnetic fields

Attend periodic follow-ups with your doctor, and consult them about your exercise regime. A person with a pacemaker can travel without many issues, but it is important to inform airport security when taking a flight.

3. Can a pacemaker be put without a lead?

For patients whose chest wall or veins are infected, making it difficult to implant a traditional pacemaker, there is hope. Recently, a new leadless pacemaker has been introduced. This device is inserted through a vein in the groin, and then a small device is placed directly into the heart chamber, where it functions as a pacemaker.

4. How long does a pacemaker battery last, and how is it replaced?

A pacemaker battery can last from 5 to 12 years, depending on the frequency of pacemaker usage. When changing the battery, the same procedure is followed, except the leads are not changed this time and the recovery is also faster.

5. What is the life expectancy after a pacemaker surgery?

Pacemaker surgery significantly improves the quality of life for people with abnormal heart rhythms, but life expectancy depends on several factors like a person’s age, the severity of the condition, and their overall health. People with less-severe health concerns tend to live longer and live a normal or near-normal life.

6. What should I do in the event of accidentally coming into contact with devices that interfere with my pacemaker?

If you come into contact with a device that may interfere with your pacemaker—such as strong magnets or certain medical equipment—move away from the source immediately. Check for unusual symptoms, such as feeling dizzy or having an irregular heartbeat. If symptoms do occur, contact your doctor right away.

7. How soon can I travel or fly after having a pacemaker implanted?

Most patients are able to travel or fly several weeks after pacemaker surgery. It's a good idea to carry your pacemaker ID card with you at all times, particularly when passing through airport security, and be sure to inform security personnel about your device.

8. Will I feel the pacemaker working inside my body?

The device works quietly, controlling the heart rhythm with no sensations. While rare, people sometimes may feel minor vibrations or discomfort, especially when the vibrations of the pacemaker change as per the heart rate. It is best to discuss this with your doctor if you feel anything unusual.

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