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Pacemaker: Treatment, Procedure, Cost and Side Effects

Last Updated: Mar 17, 2022

What is the treatment?

A person who has abnormal heart rhythms may require a pacemaker to be placed in the heart or abdomen. It is a small device that is primarily used to treat arrhythmias, which happens when there is a problem with the rate or rhythm of the heartbeat. A person who suffers from this condition either has his/her beating too fast or too slow or in an irregular rhythm. Arrhythmia is caused due to faulty electrical signaling in the heart. The pacemaker uses low-energy electrical pulses to overcome the faulty signaling.

Pacemakers can help to speed up a slow heart rhythm, ensure that the ventricles contract properly if the atria are not working properly, help to control the heart if it has an abnormal rhythm, coordinates electrical signaling between the lower and the upper parts of the heart. Some pacemakers which are used to treat heart failure are called resynchronization therapy devices and they help to coordinate electrical signaling between the ventricles. They also help to treat a disorder called long QT syndrome that can lead to dangerous arrhythmias.

Tachycardia and bradycardia are conditions that occur when the heartbeat is too fast or too slow respectively. During such conditions, the heart is unable to pump blood properly to the body and this can cause symptoms like fatigue, shortness of breath and/or fainting. If the condition gets too severe, a person’s vital organs may get damaged or he/she may even lose consciousness. A pacemaker helps a person to get relief from some of these symptoms and can also help a person with an abnormal heart rhythm to lead a better life.

How is the treatment done?

The most common causes why a person needs to get a pacemaker installed are if he/she suffers from bradycardia or blockage of the heart. A pacemaker consists of a computerized generator, a battery and wires which have sensors at their tips. The generator is connected to the heart with the help of the wires and the battery powers the generator. The heart’s electrical activity is monitored by the electrodes, which then sends the data through the wires to the computer located in the generator. The computer will direct the generator to send electrical impulses to the heart if it finds that the heart rhythm is abnormal. The pulses reach the heart through the wires and ensure its normal functioning.

Pacemakers can also monitor blood temperature, breathing pattern and can even adjust the heart rate to the changes in a person’s activities. It records the heart rhythm and its electrical activity. These recordings help a doctor to adjust the pacemaker according to a person’s own needs.

There can be up to 3 wires in a pacemaker and they are usually placed in different chambers of the heart. In a single chamber pacemaker, the wires carry pulses to the right ventricle from the generator. In a dual-chamber pacemaker, pulses are carried to the right atrium and right ventricle from the generator. The pulses also help to coordinate the timing of these two chambers’ contractions. A biventricular pacemaker or cardiac resynchronization therapy device helps to carry pulses from the generator to one atrium and to both the ventricles.

Is a pacemaker a major surgery?

A pacemaker is a minor medical procedure that only takes 1-2 hours under the surgery. These small cardiac devices can be planted in different ways. Both epicardial implantation and transvenous implantation take about the same time to get surgically implanted into a patient’s heart.

Summary: Pacemaker needs at least 1-2 hours to be implanted into the heart of a patient. Both epicardial implantation and transvenous implantation take the same time.

What is the life expectancy of a person with a pacemaker?

The life expectancy of a child or an adult patient can be measured approximately 8-10 years post-implantation. However, the life expectancy of an individual can vary from 5 years to even 25 years depending upon the maintenance, lifestyle, and nature of the illness-causing cardiac discomfort.

Summary: The life expectancy of an individual with a pacemaker can vary from 5 years to 25 years. The average is between 8-10 years from the time of implantation.

Is having a pacemaker a disability?

Implantation of pacemakers, in general, is not considered a disability. But under such circumstances, there are some things that will be observed in order to conclude it as a disability.

If a person is not able to perform daily life activities or basic job guidelines due to the nature of the cardiac disorder. Some of the examples that can be categorized under disability are bradycardia and arrhythmia.

Summary: In general having a pacemaker in your heart can’t be termed as a disability. However, there are certain things that need to be looked for in order to consider chest device implantation as a disability.

Who is eligible for the treatment? (When is the treatment done?)

A person suffering from either of the two types of arrhythmias namely tachycardia or bradycardia is eligible to get a pacemaker installed. These two conditions occur when the heartbeat is either too fast or it is too slow. A person who has a severe heart failure will require a special type of pacemaker called biventricular pacemaker. A person is eligible for getting a pacemaker when his/her body does not enough blood and he/she suffers from fatigue, breathlessness or damage to vital organs. However, a person becomes eligible only after a doctor has checked him/her thoroughly and decided that he/she is a good candidate.

Who is not eligible for the treatment?

There are a number of tests that can detect arrhythmias like electrocardiogram, hoiter and event monitors, echocardiography, electrophysiology study and stress test. If the doctor does not find any anomaly with the functioning of a person’s heart after he/she has undergone these tests, he/she will not be eligible to get a pacemaker implanted.

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Are there any side effects?

Some of the side-effects associated with a surgery to install a pacemaker are bleeding, bruising, infection at the site of the procedure, damaged blood vessels or nerves and allergic reactions to anesthesia. In rare cases, a person may suffer from a collapsed lung or a punctured heart. However, these complications are rare. A person normally experiences temporary side-effects after getting a pacemaker installed.

What are the post-treatment guidelines?

A person undergoing this treatment is expected to stay at the hospital till the doctor is satisfied with the functioning of the pacemaker. A person may suffer from pain, swelling or tenderness of the area where the pacemaker has been placed. Normal pain relieving medicines can help to alleviate the discomfort. Many people are able to return to their normal daily activities within a few weeks. However, he/she will be advised against indulging in strenuous activities for a period of 1 month. A doctor may recommend a person to avoid prolonged contact with electrical devices or devices that have strong magnetic fields. This is because such devices can interfere with the working of the pace-maker.

Can you sleep on the side of your pacemaker?

No, sleeping on the side of pacemaker implantation is discomforting and harmful for the patient. It is recommended to sleep on the other side with your head and a little elevated from the level of the bed. This will help you to maintain blood circulation. Also if you have sleep apnea, do not sleep laying on your back unless you have the supporters.

Summary: Sleeping on the side of implantation is not recommended to the patient with pacemakers. It will cause discomfort and interruption in the working of the device.

How long does it take to recover?

Pacemakers help to deal with abnormal heart rhythms. Pacemakers can be both permanent and temporary. Temporary pacemakers are used to treat short-term heart problems while long-term pacemakers are used to control long-term heart rhythm problems. A person generally takes 1 month to recover from the surgery. However, there are certain guidelines that a person needs to follow to keep the device in a good condition. A pacemaker acts to supplement the functions of the heart. So a person who has got a pacemaker installed may need to use it throughout his/her life. There is no recovery period as such.

What is the price of the treatment in India?

Normally a pacemaker costs between Rs 45000 and Rs 1.5 lakh in India. However, higher varieties may come between Rs 2.75 lakh and Rs 3 lakh.

Are the results of the treatment permanent?

A person is normally required to visit his/her doctor every 3 months after installing the pacemaker. A pacemaker’s functioning is jeopardized if the wires gets dislodged or broken, it the battery gets weak or it fails, if the person’s heart disease progresses or if other devices disrupt the electrical signaling. The battery life of a pacemaker varies between 5 and 15 years and it depends on how active the device is. After the battery has run its course, a doctor will replace both the generator and the battery. Hence, installing a pacemaker may not be a permanent solution.

What are the alternatives to the treatment?

Magnesium helps to stabilize the heart and people in cardiac intensive care are sometimes given intravenous infusions of magnesium. Research has shown that fish oil helps to prevent dangerous heart arrhythmias. Vitamin C helps to prevent atrial fibrillation that can happen after a person undergoes coronary artery bypass grafting. N-acetyl cysteine also helps to reduce the occurrence of atrial fibrillation, which is a form of arrhythmia.

Summary: Pacemakers are small devices that are used to monitor, and manage the heartbeat. The device is mostly used in case a person has irregular or slow heart rate due to any underlying medical condition. The implantation requires surgery that does not take more than 1-2 hours. The life expectancy with the device may vary from 5 years to 25 years depending upon the maintenance, lifestyle, and nature of the illness.

References

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Written ByDr. Rahul Gupta MD - Internal Medicine,MBBS,DM - Cardiology,Fellow European Society of CardiologyCardiology
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