Permanent Pacemaker Implant (PPI) in India

A pacemaker is an electronic device implanted in the chest or abdomen which uses electrical pulses to regulate the heartbeat at a normal pace. Permanent pacemakers are made to adapt to the state of the heart in such a way. In the pacemaker, the lowest heart rate is set and if the heart rate drops below the set rate, electric pulses are fired to stimulate quick heartbeats so that it can beat at a regular rate.
There are two forms of pacemakers. Temporary pacemakers are used to treat short-term heart problems such as heart surgery, heart attack, or medicine overdose, that slow down the heartbeat. Permanent pacemakers are used to monitor long-term heart rhythm disorders.

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A pacemaker includes:

• A computerized pulse generator for regulating the heartbeat with electrical signals
• One to three leads between the pulse generator and your heart, wires that deliver signals
• Electrodes to assist in signal delivery
• A battery, a battery

How does a Pacemaker Implant work?

Pacemaker implantation is a common surgery and it significantly improves the quality of life led by the patient.  The blood-pumping organ, heart, is essentially made of a few groups of muscles. These muscles are controlled by electrical signals to ensure that the heart beats naturally and effectively to circulate blood to all parts of the body. When this electrical signal gets disrupted due to some reason, then an individual may experience tachycardia (where heart beats abnormally slow), heart block, arrhythmia (irregular heartbeat), or a cardiac arrest (abrupt and sudden stopping of the heartbeat).
The contractions happen as a result of triggered electrical pulses generated by the sinoatrial node or the SA node. It acts like a pacemaker of the heart. This electrical pulse is then sent to the atrioventricular node or the AV node for relaying the pulse to the ventricles. Pacemaker implantation is suggested when this electrical signaling network is disrupted.The faulty functioning of the natural pacemaker of the heart may lead to the following:

Sick sinus syndrome: It is characterized by a slow heartbeat (bradycardia) or fast heartbeat (tachycardia) or a combination of both. It can happen due to age, a previous history of heart attack, and thyroid problem, too much potassium accumulation in blood, heart surgery, or sleep apnea.
Heart Block: In this case, the impulse is either delayed or absent.
Cardiac arrest: The heart can stop beating. It may result because of the presence of coronary artery disease and muscle problems in the heart, which can happen after the age of 35.
Symptoms: Some of the symptoms observed in patients requiring pacemaker implantation are:

• Bradycardia
• Tachycardia
• Uncontrollable fatigue
• Dizziness experienced throughout the day
• Shortness of breath
• Acute chest pain
• Palpitation and fluttering of the heart (arrhythmia)

What is a pacemaker implant?

A pacemaker implant is a small device that weighs around 20 g to 50 g and is the size of a matchbox. It has a pulse generator with a battery, a tiny computer circuit and a few wires called pacing leads. This system is attached to the heart and it emits signals through the wires. The pacing rate or the rate of electrical impulses can be adjusted as per the requirement of the body and be accordingly programmed. It can sense if a heartbeat is missed or if the heart is beating too slow. Accordingly, it starts sending a steady signal to normalize the beating of the heart. If the beats are normal, then it simply does not send any signal.

What is a pacemaker device?

• A pacemaker is a device that regulates arrhythmic heartbeat.
• The pacemaker is a small metal device that weighs between 20 and 50g and is implanted under the skin on the chest below the collarbone, near the heart and connected to the heart with leads.
• There are 3 different types of pacemakers, single-chamber pacemakers, dual-chamber pacemakers, and biventricular pacemakers

What is pacemaker Implantation?

• A pacemaker is implanted in the chest to regulate the heart rate and rhythm. A Pacemaker Implantation procedure is considered routine.
• Every day, hundreds of pacemaker implant surgeries are performed globally.
• The procedure often takes place in an operating room, cardiac cath or EP lab, and usually takes an hour or two.

What are the different methods of Pacemaker Implantation?

There are two methods

Endocardial Lead Positioning :
The best pacemaker implant hospital in India uses the most common technique that involves advancing the pacemaker lead, an insulated wire coil, into the heart through a vein. Once the lead is inside the heart, the physician places its tip to the inside lining of the heart. At this point, the doctor tests the lead to see if this location is suitable for pacing.
The team tests the lead by attaching it to a small, hand-held computer called an analyzer. As the lead is checked, a technician or nurse calls out numbers. Another technician may monitor an electrocardiogram (ECG) machine and call out information to the doctor. Lead testing is not painful, but it is the loudest phase of the operation. These numbers refer to your pacing threshold (the lowest amount of energy needed to stimulate your heart to beat) and help the doctor determine the best position for the lead in your heart.
After the test, your doctor may decide to move the lead and run the test again. You may hear the team call out numbers several times as the doctor attempts to find the best position for the pacing lead. Repositioning and re-testing a pacing lead several times is not unusual in pacemaker surgery.
Once the leads are in place, you may be asked to take deep breaths and cough vigorously while the physician observes an x-ray of your heart. This is done to ensure proper and secure placement of the leads. Once the leads are in place, your physician plugs them into the pacemaker and slips the pacemaker into a small pocket made just beneath the skin of your upper chest. The pocket is closed with stitches to complete the procedure.
You may feel slight pressure while the leads and pulse generator are being inserted into the pocket; alert your physician to any signs of discomfort.

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Epicardial Lead Positioning :

In another implantation procedure, an incision is made in the chest to expose the exterior surface of the heart. The lead is attached directly to your heart’s surface (epicardium). This method is usually performed under general anesthesia. The pulse generator is usually placed under the skin in the upper abdomen, but it may also be placed in the upper chest area. This method is usually used when there is some reason to avoid the endocardial positioning method.

Why is a pacemaker implantation surgery recommended to a patient?

A pacemaker implantation surgery is recommended for:

• Atrial fibrillation
• Sick sinus syndrome
• Bradycardia
• Heart block

The expression for a Permanent Pacemaker

Patients have been urged to have a pacemaker implanted if they suffer from a condition such as:

• With bradycardia (heartbeat slower than normal)
• With tachycardia (heartbeat faster than normal)
• Heart block due to aging, damage to the heart
• Syndrome of Sick Sinus
• Fibrillation in the atrium
• Heart drugs such as beta-blockers need to be taken
• Fast pulse, fainting or other signs
• Problems of heart muscles
• Syndromes of Long QT
• A disease of the congenital heart
• Transplants of Hearts

Types of Permanent Pacemakers

The kind of pacemaker you need depends on your condition and your particular heart issue. Three forms exist, namely,
Single Chamber: It has one lead that connects the pulse generator to one heart chamber. Single chamber In one chamber, this is to encourage pacing.
Dual Chamber: on the right side of the heart, the right atrium and the right ventricle, it has two leads leading to both chambers. This helps to control the contraction rate on both sides of the room.
Biventricular Chamber: It has three leads linked to the right atrium and two ventricles, the biventricular chamber. It is used to treat patients with advanced heart failure-induced arrhythmias.

Diagnosis and Tests for Permanent Pacemakers

• Physical review
• Checks for blood
• Electro-cardiogram
• Echocardiogram
• Event and Holter controls
• Study of Electrophysiology
• Test of stress

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During the Surgery

• Local anesthesia will be given to you so the implantation region will be numb, you will be drowsy, but you will not feel pain.
• The procedure is between 2 and 5 hours long.
• To record the heart rate and blood pressure, an ECG and blood pressure monitor will be used to record
• To carry the wires into your vein, your doctor will insert a large needle into your vein and put them in your heart.
• A small incision will be made for the pacemaker about 5-10 cm below the collar bone, another incision will be made for the pacemaker battery under the skin
• To be transferred to the heart, a lead will be inserted into a nearby vein
• The lead is reviewed and tied to the pacemaker.
• The incision and the dressing made for the wound would be closed.

After the Surgery

• You’ll be in the hospital for at least a night.
• An external computer is used by the doctor to set the pacemaker settings
• The pacemaker is tested so that it normally works
• Your heart rate will be tracked continuously.
• To check the lungs and the locations of the pacemaker and lead, a chest X-Ray will be done to
• In the region where the pacemaker is located, you can experience soreness, swelling or discomfort. Medications for pain may bring relief.
• How to take care of the pacemaker will show you how to
• In order to allow the pacemaker electrodes time to connect themselves within the heart, it is recommended to restrict arm motion, especially on the side of the pacemaker.
• A temporary pacemaker identification card will be issued to you so that you can display it at the airport.
• To ensure the pacemaker works properly, a regular check-up is required.

Q: Who wants a pacemaker that is permanent?
A: Most patients in need of a pacemaker suffer from conditions such as arrhythmias that make the heart rhythm irregular.
Q: How does it operate?
A: A pacemaker is a battery-operated system that if found to be too slow or too fast, responds to the body’s movement or breathing rate by using electrical pulses to normalize heart rhythms.
Q: How long will the procedure last?
A: It lasts for about 2 to 5 hours.
Q: Is the treatment a painful one?
A: Local anesthesia will be given to you, so you’ll be numb to the pain and feel drowsy. You may feel soreness, swelling, or pain after the surgery. In order to relieve the after-effects, medicines are available.
Q: Can my quality of life be increased by using a pacemaker?
A: Pacemaker will help you feel better, and the previous symptoms will vanish, such as fainting, dizziness, etc. This is going to help you have a normal life and live longer.
Q: How long does it last with a pacemaker?
A: The majority of pacemakers last 8 to 10 years or so. After this, a replacement will be needed for the battery and/or wires. A minor procedure will be conducted for this purpose.
Q: Are there any measures I can take to be a patient with a pacemaker?
A: You should be aware that near or prolonged contact with electrical devices or those with strong magnetic fields can interfere with your pacemakers, such as cell phones, MP 3 players, household appliances such as microwaves, metal detectors, electrical generators, high-voltage wires, and industrial welders.

What does a pacemaker do?

An implanted pacemaker mimics the action of your natural pacemaker. It consists of two parts.
The pulse generator. This small metal container houses a battery and the electrical circuitry that regulates the rate of electrical pulses sent to your heart.
Leads (electrodes). One to three flexible, insulated wires are each placed in a chamber, or chambers, of your heart and deliver the electrical pulses to adjust your heart rate.

Which tests will be taken to determine if you need a pacemaker implantation?

Electrocardiogram.
Holter monitoring.
Echocardiogram.
Stress test.

What to expect during a pacemaker implantation surgery?

During surgery, one or more flexible, insulated wires (leads, or electrodes) are inserted into a major vein under or near your collarbone and guided to your heart with the help of X-ray images.
One end of each wire is secured to the appropriate position in your heart, while the other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone

What to expect after a pacemaker Implantation Surgery ?

• After the surgery, you will be taken to a recovery room. You may feel slight soreness around the incision site where the pulse generator was implanted, which can be managed with medication. Depending on your particular case, you may stay in the hospital anywhere from several hours to several days
• Though people are generally aware of their pacemakers for sometime after the implant, the sensation decreases eventually. Sometimes there will be a bruise at the area where the device was implanted. This is typical with any surgical procedure and will go away with time. If the incision becomes red, hot, more painful, swollen, or begins draining fluid, notify the doctor immediately.
• The abnormal heart rhythm before the implant should diminish or disappear. Inform your physician about any new sensations after the pacemaker implantation to help him readjust the programmed settings of the device to suit your comfort level.
• After the surgery, you may feel the urge to touch or poke the implant site which you should resist as the new pacemaker and lead can get tangled. During your follow-up visits, the doctor uses a computer called a programmer, to communicate with the pacemaker. Attached to the programmer is a small device called a wand. The doctor uses the programmer to adjust and fine-tune the pacemaker’s settings. The doctor places the wand over the implant site, and the programmer communicates with your pacemaker.

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Fortis Escorts Hospital New Delhi

Number of beds:  310
ICU Beds:                 158
Airport Distance: 19 KMs

Brief About:

• It was established in 1988 and is JCI accredited.
• Fortis Escorts Heart Institute is a premier multi-disciplinary hospital providing tertiary care and is recognized worldwide for its clinical excellence in cardiac care.
• The 310-beded hospital is a globally renowned centre boasting admirable outcomes for interventions like Cardiac Bypass Surgery, Minimally Invasive Surgery, Interventional Cardiology, Non-invasive Cardiology, Paediatric Cardiology and Paediatric Cardiac Surgery.

Medanta The Medicity Hospital

Number of beds:  1250
ICU Beds:                300
Airport Distance: 18 KMs

Brief About:

• Medanta – The Medicity is amongst India’s largest and most renowned multi-super speciality healthcare centre with 1250 beds, 29 super speciality units and more than 800 accomplished doctors.
• Supported by state-of-art infrastructure, all the departments in the hospital are fully equipped with cutting-edge technology, modular Operation Theatre and modernized monitoring systems in ICUs.
• The panel of doctors from Medanta, headed by A.S.Soin performed the first successful intestinal transplant in India.

Max Hospital Saket

Number of beds:   500
ICU Beds:                 267
Airport Distance: 13 KM

Brief About:

• Max Super Speciality Hospital at Saket is one of the topmost healthcare service
• Providers in India. The multi-super speciality hospital has a capacity of over 500 beds, 250 functional beds. It is equipped with state-of-the-art facilities, advanced technologies.
• With the help of over 300 leading specialist Doctors, strong nursing staff, and state-of-the-art innovative medical tools.

BLK-Max Hospital

Number of beds: 700
ICU Beds:               175
Airport Distance: 13 Km

Brief About:

• BLK Super Speciality Hospital was established by Dr. B.L. Kapur  in 1959. It was inaugurated by the then Prime Minister of India, Pandit Jawahar Lal Nehru.
  
• BLK Super Speciality Hospital was established by Dr. B.L. Kapur  in 1959. It was inaugurated by the then Prime Minister of India, Pandit Jawahar Lal Nehru.
• BLK has a unique combination of the best in class technology, put to use by the best names in the professional circles to ensure world-class health care to all patients.

Artemis Hospital Gurgaon

Number of beds:  600
ICU Beds:                185
Airport Distance: 19 Km

Brief About:

• Artemis Hospital, established in 2007, spread across 9 acres, is a 600plus bed; state-of-the-art multi-speciality hospital located in Gurgaon, India.
• Artemis Hospital is the first JCI and NABH accredited hospital in Gurgaon.
• Designed as one of the most advanced hospitals in India, Artemis provides a depth of expertise in the spectrum of advanced medical & surgical interventions, a comprehensive mix of inpatient and outpatient services.

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Fortis Memorial Research Institute

Number of beds:    1000
ICU Beds:                  298
Airport Distance:  17 KMs

Brief About:

• Fortis Memorial Research Institute was established in 2001.
• It is an outstanding multi-speciality quaternary care hospital,having the top-notch infrastructure, advanced equipment, highly qualified and experienced medical professionals and super sub-specialists.
• Fortis Hosptial Gurgaon is an advanced centre of excellence in Robotic Surgery, Neurosciences, Oncology, Renal Sciences, BMT, Organ Transplants, Orthopaedics, Cardiac Sciences and Obstetrics & Gynaecology.

Indraprastha Apollo Hospital

No. of beds: 900
ICU Beds:     262
Airport:        20kms

Brief About:

• Indraprastha Apollo Hospital is a flagship hospital of India’s foremost healthcare groups,the Apollo Group. It is a highly renowned multi-speciality facility that offers tertiary and quaternary care services to domestic and international patients.
• The 900 bedded hospital is outfitted with the most modern technology for diagnostics as well as therapeutic purposes.
• A team of highly trained medical professionals work under all the 52 specialities at the hospital.

Sanar International Hospital

Number of beds:   130
ICU Beds:                  35
Airport Distance:  20 Km

About Hospital:

• Sanar International Hospital was established in 2018.
• Sanar International Hospital founded by Mr. Naresh Kapoor.
• Sanar International Hospital offers comprehensive advanced surgical care in specialties like Cancer, Heart, Blood and Marrow Transplant, Lung, Liver, and Neurosciences along with other major departments with advanced state-of-the-art facilities.

W Pratiksha Hospital

Number of beds: 110
ICU Beds:                 31
Airport Distance: 19 KMs

About Hospital:

• Established in 1995, W Pratiksha Hospital is a 110+ bedded flagship hospital of the Pratiksha group.
• W Pratiksha Hospital in Gurgaon, the flagship hospital of Pratiksha Group is a one-of-its-kind facility in Gurgaon that brings to you 30 years of experience.
• The hospital has treated more than 25,000 people In 2018.
  

Aakash Health Care Delhi

Number of beds:  230
ICU Beds:                70
Airport Distance: 10 Km

About Hospital:

• Aakash Healthcare Super Speciality Hospital is a tertiary care facility, with 15 Dialysis, and 70 Critical care beds for treating the most complex cases in the National Capital Region (NCR) of Delhi, Dwarka.
  
• The hospital is equipped with state of the art infrastructure, latest technology, competent clinicians and compassionate staff.
  
• Aakash Healthcare Super Specialty Hospital is known for its leading care in Orthopaedic and Joint replacement surgery.
  

Accord Superspeciality Hospital

Number of beds:   380+
ICU Beds:                  41
Airport Distance:  46 Km

About Hospital:

• The story of Accord began with the thought of leveraging the new age technology with the healthcare infrastructure to serve the patients, rightly, effectively, and timely.
• Accord Superspeciality Hospital (A Unit Of SCL Healthcare Pvt. Ltd) is India’s first smart hospital and one of the first of its kind in the world.
• Accord Superspeciality Hospital aims at providing technologically advanced healthcare services to international patients who are looking out for medical tourism in India.

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