1. What is the cost of a pacemaker?

The cost of a pacemaker varies depending on the model chosen, with prices ranging from Rs. 85,000 to Rs. 1,80,000. Additionally, the total package—which includes hospital admission, the installation of the pacemaker, bed charges, nursing care, and doctor's fees—typically amounts to between Rs. 1,00,000 and Rs. 2,35,000.  It is essential to budget accordingly for these expenses.

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2. How long will I need to stay in Vellore for the pacemaker procedure?

Once the date for the procedure is confirmed, please plan for a 4-day stay in Vellore, which will include 3 days in the hospital for the pacemaker installation.

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3. What is the benefit of having a pacemaker implanted?

The pacemaker plays a critical role in regulating heart rate and rhythm. It effectively prevents episodes of fainting and the sensation of near-fainting. Additionally, it alleviates feelings of fatigue, contributing to an overall increase in energy levels.

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4. What are the types of pacemakers?

Pacemakers can be either single-chamber or dual-chamber devices. They may also be MRI-compatible or not. Advanced models of pacemakers come with additional features, which your doctor will explain to you when you select your device.

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5. Are dual-chamber pacemakers better than single-chamber pacemakers? 

Dual-chamber pacemakers help to promote the synchrony or relationship between the top chamber atrium and the lower chamber ventricle of the heart. In younger and more active individuals dual-chamber pacemakers are most often preferred. Single-chamber pacemakers are used in patients who have uncorrectable abnormal rhythms like atrial fibrillation in their top chamber.

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6. What is the most recent advance in pacing technology?

The latest advancement in the field of cardiac pacing is known as conduction system pacing. In this approach, the lead connecting to the heart's lower chamber is securely implanted within the cardiac conduction system. This technique enables the electrical impulses delivered by the pacemaker to activate both the left and right ventricles simultaneously. It is believed that this method reduces the risk of the heart weakening as a result of pacing.

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7. Will it hurt when I have a pacemaker implanted?

The procedure will be performed under local anesthesia. You may feel a slight discomfort similar to a mosquito bite when the local anesthesia injection is given. Following this initial discomfort, the anesthetic will take effect, and you will not experience any pain during the procedure.

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8. How long will the procedure take?

The procedure is expected to take approximately 2 to 4 hours. A considerable portion of this time is allocated to conducting the procedure in a sterile manner, thereby minimizing the risk of infection.

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9. Who will do my procedure? 

Your procedure will be performed by one of the six consultants in the cardiac electrophysiology unit. They include Dr. John Roshan, Dr. Sirish, Dr. Anand, Dr. Hariharan, Dr. Yogesh, and Dr. Haynes, all of whom possess extensive experience in performing these procedures. If you have previously been a private patient of one of them, that particular doctor will perform your procedure. However, if your doctor is unavailable due to illness, one of the other five consultants will take over, ensuring that there are no delays.

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10. Will I be awake during the procedure?

You will be awake for the procedure and can talk with your doctor while it is being performed. However, the medications provided may make you feel drowsy, and you are welcome to take a nap if you wish. We will wake you up once the procedure is complete.

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11. Can we resume normal day-to-day activities after pacemaker implantation?

Yes, you can do all your activities normally (Except minimal restriction for 4 weeks of not repeatedly lifting your arm above shoulder level over the implanted side). It is preferable to avoid driving for the first 4 to 6 weeks after pacemaker implantation.

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12. Can we sleep on the left side/implanted side?

Yes, you can sleep on the same side after pacemaker implantation. However, initially, you may avoid doing so because of the pain.

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13. Can we take a bath/pour water over the implanted side?

Yes, you should take a bath using soap and water over the implanted side after 48 hours. Dry the area immediately after the bath by wiping gently over the operated area.

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14. Is there a need for the removal of sutures after a week?

No, there is no need for the removal of sutures. The material used is self-absorbed.

 

15. Is there any diet restriction after pacemaker implantation?

No, there is no specific dietary restriction after pacemaker implantation. However, you may have restrictions based on other comorbidities like diabetes or hypertension  (Eg: Diabetic Diet for Diabetic patients, Low fat, Low Cholesterol Diet for Dyslipidemia patients, Salt restricted diet for Hypertensive patients).

 

16. Can we use mobile phones after pacemaker implantation?

Yes, mobile phones can be used but should not be kept within 6 inches of the pacemaker. They should not be placed in the shirt pocket on the side of the pacemaker. The mobile phone should be used with the ear on the opposite side of the pacemaker.

You can use Bluetooth earphones even after pacemaker implantation. However, they should be kept 6 inches or 15cm away from the pacemaker, as their magnets can interfere with normal pacemaker function. One must avoid placing headphones or earbuds in a shirt pocket or draping them around the neck, which could put them too close to the pacemaker. 

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17. Can we use household electronic items after pacemaker implantation?

        Yes, you can use electronic items like remote controls, computers, CD players, GPS devices, iPads,          and fax machines as they cause minimal electromagnetic interference. These gadgets should be 6             inches away from the pacemaker.

 

18. Can we use household electrical items after pacemaker implantation?

Pacemakers are designed to be relatively resistant to electromagnetic interference (EMI) from common household appliances, including water heaters, electric ovens, hot plates, toasters, refrigerators, blenders, hair dryers, stoves, and microwaves. Induction cookers use electromagnetic fields to heat food, and these fields can potentially interfere with the operation of pacemakers and other implanted cardiac devices. Hence, individuals with pacemakers should maintain a distance of at least two feet (60cm) from induction cookers.

 

​​19. Can we travel by Air/Train after pacemaker implantation?

Yes, you can travel back by Air/Train after the procedure. It may be wise to carry the International Pacemaker Identification Card which may be produced while you go through the security metal detectors; so that they know that you are not carrying a weapon on your person. In the rare event that you had suffered a pneumothorax as a complication of the implantation procedure then you will not be fit for air travel for about 2 months. Since we use an extrathoracic axillary approach to implant our pacemaker leads, the potential for a pneumothorax virtually doesn’t exist. 

 

20. Can we pass through the Metal Detector/Body scanner?

While standard airport metal detectors are generally considered safe for people with pacemakers, it's wise to inform security personnel and request alternative inspection methods, such as a pat-down, if you have a pacemaker. It is best to avoid standing near a metal detector or leaning on one any longer than is necessary. If the security insists on using a handheld metal detector, ask them not to hold the wand near your device any longer than necessary. Passing through a metal detector or scanner is unlikely to harm your device. However, the metal in the device will cause their detector to alarm. So, It is good to carry the International Pacemaker Identification Card to convince the security officials that you are not carrying a weapon on you.

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21. Is the pacemaker function affected during lightning or thunder?

No, it does not cause any damage to the device unless the lightning strikes you. The odds of lightning striking an individual with a pacemaker are equal to that of one without a pacemaker.

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22. Is there any equipment I must avoid or be wary of after pacemaker implantation?

Pacemaker function can be affected by powerful magnetic or electro-magnetic fields such as found to occur with MRI, Surgical Shortwave Diathermy, Trans-cutaneous electrical nerve-stimulation (TENS), induction cookers, electric fences, electric power drills, motor boat engines, arc-welding equipment, jumper cables, 15-30W wireless radios, magnet therapy that requires the wearing of magnets, Ab stimulators with current, electronic body fat scales. Hence all this equipment is best avoided.

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Electric shavers and electric blankets should be kept at least 6 inches away from the device.

If you have an MRI-compatible device then you may undergo an MRI if required after turning the MRI mode on. CT scanning can be safely done in people with pacemakers. Gasoline ignition systems need to be atleast 12 inches away which means driving a car is not an issue. Lithotripsy for kidney stones should be avoided if the pacemaker is implanted in the abdomen. It should be used with caution if the device is implanted elsewhere, with frequent periodic monitoring thereafter for several months to ensure appropriate pacemaker function.

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Radiation therapy used for cancer treatment can damage the circuitry of pacemakers. The degree of damage is unpredictable – and may vary with different systems – but the risk builds with increased radiation. The implanted pacemaker should be shielded from radiation as much as possible. It may need to be relocated if it lies directly in the targeted radiation field.

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23. How long does the battery last? Does it need to be changed?

The pacemaker battery life is usually between 8 to 12 years. However, the battery life varies depending on individual use. It gets over early if it is used a lot due to the individual's heart needing more current from the battery to keep it going.

 

24. What are the possible complications?

The chance of having a complication during or after pacemaker implantation is very rare. The complications can include swelling in the operation area due to bleeding, a tear in the heart due to the pacemaker leads causing perforation, and a pneumothorax (collection of air outside the lung). The most important and dreaded complication is an infection. We take a lot of pains to ensure that there is strict asepsis maintained during the procedure. Patients particularly those with diabetes need to get their dental, skin, or urinary infections promptly treated. If an infection in any part of the body is neglected it spreads to the pacemaker.

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25. When can I resume driving? 

We usually recommend driving 6 weeks after the pacemaker implantation. This gives enough time for the leads to be properly fixed in the heart so they don't get dislodged with your physical activity.

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26. Can my doctors monitor my heart rhythm through the pacemaker and check my pacemaker from far away? 

Yes, it is possible to monitor your heart rhythm through a remote monitoring device. This device is the size of a mobile phone and it can continuously transmit your heart rhythm to the hospital where it can be monitored. This remote transmitting device needs to be purchased separately and costs approximately Rs. 50,000 to Rs.85,000 depending on the company. 

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27. What is a leadless pacemaker?

        It is a pacemaker that has no wires and is directly implanted inside the heart.

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28. What is the battery life of a leadless pacemaker?

        It is approximately 8-20 years depending on the brand used.

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29. What is the advantage of a leadless pacemaker?

It is inserted through a vein in the leg. This means the procedure time is less than 45 minutes and it takes just a day for you to return to normal activities. The chance of infection is greatly reduced by implanting a leadless pacemaker as against a regular pacemaker. Since the leadless pacemaker has no wires, the possibility of wire damage is also avoided.

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30. What is the cost of the leadless pacemaker?

It will cost approximately Rs. 10,00,000 to have a single chamber leadless pacemaker done. A        more advanced model that can sense the upper heart chamber and pace the lower chamber will cost approximately Rs. 15,00,000.

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31. What is the disadvantage of a leadless pacemaker?

The currently available leadless pacemaker that is implanted in the ventricle [lower chamber] cannot be used in patients where there is a need to pace the top chamber. This will need an additional pacemaker to be inserted into the atrium [top chamber]. The leadless pacemaker is also not ideal for young patients who are likely to need multiple pacemaker battery changes in a lifetime because each of them will fill the space in the lower chamber thereby reducing the space available for blood. There is currently ongoing research into making leadless pacemakers that can be easily removed once the battery expires and replaced by a new device in its place.

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32. When should I come for my next check-up after the pacemaker is implanted?

You ideally need to come 6 weeks to 3 months after your procedure, for us to make sure that the device is properly fixed and functioning to our satisfaction.

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33. How frequently do I need to have my pacemaker checked? 

You need to have a yearly checkup after the pacemaker is implanted. Towards the end of the battery's life, your doctor may call you for more frequent monitoring so that the battery is changed at the right time.