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PACEMAKER IMPLANTATION

All you need to know..

 

1. What is the cost of a pacemaker?

The cost of a pacemaker depends on the model used. It can range from Rs.85,000 to Rs.1,80,000 depending on the model you opt for. The cost of the entire package including getting admitted, having the pacemaker fixed, bed charges, nursing care, and doctor's fees will cost you approximately Rs.1,00,000 to Rs.2,35,000.

2. How long will I need to stay in Vellore to get the pacemaker done?

Once you have the date of the procedure fixed, you will need to plan for 4-days stay in Vellore which will include 3-days stay in hospital to get the pacemaker done.

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

The pacemaker helps to maintain your heart rate and rhythm.  It will prevent you from fainting or feeling like passing out. It will take away your tiredness and make you feel more energetic.

4. What are the types of pacemakers?

Pacemakers can either be a single or dual-chamber pacemaker. They can be MRI compatible or not. The more advanced pacemaker models have few extra features that your doctor will explain to you at the time of you choosing your device.

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.

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

       The most recent advance in the field of cardiac pacing is termed conduction system pacing. In this           mode of pacing, the lead going to the lower chamber of the heart is screwed into the cardiac                     conduction system. This helps the current delivered from the pacemaker to simultaneously                       activate both the left and the right ventricle. It is believed that by doing so, the chance of the                     heart getting weak due to pacing is eliminated.

7. Would it hurt me when I undergo the procedure of having a pacemaker implanted? 

No, it will not hurt you as the procedure will be done under local anesthesia It will only hurt as much as a mosquito bite, the moment when the local anesthesia injection is given. After that injection is given, the medicine will act, and you will not have any pain.

8. How long will the procedure take?

The procedure will take around 2 to 4 hours which includes a great deal of time that is devoted to doing it in a sterile fashion so as to minimize the risk of infection.

9. Who will do my procedure? 

Your procedure will be done by one of the six consultants in the cardiac electrophysiology unit. They include Dr. David Chase, Dr. John Roshan, Dr. Sirish Chandra Srinath, Dr. Anand, Dr. Hariharan and Dr. Javaid. All of them have vast experience in doing these procedures. If you have been a private patient of one of them then the particular doctor you saw will do your procedure. In case your doctor is unwell and not available your procedure will be done by one of the other five so as to not keep you waiting.

10. Will I be awake during the procedure?

You will be awake for the procedure and can have a chat with your doctor as he does it. However, you may feel sleepy due to the medicines given and you are welcome to take a nap if you feel inclined to doing so. We will wake you up after it is over.

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.

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.

13. Can we take 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 bath by wiping gently over the operated area.

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

No, there is no need for 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 they should not be kept over the implanted site (Shirt Pocket).

You can use bluetooth earphones even after pacemaker implantation. The mobile phone should be used with the ear on the opposite side of the pacemaker.

 

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

Yes, electronic devices can be handled after pacemaker implantation. You can use all household electrical appliances like hot plate, grinder, mixie and geyser. There is no risk involved in pressing switches on or off.

 

18. 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. 

 

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

Yes, you can pass through a Metal detector/Body scanner. It will not harm your device. It is good to carry the International Pacemaker Identification Card to convince the security officials that you are not carrying a weapon on you.

 

20. 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 is equal to that of one without a pacemaker.

21. 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 Diathermy, Trans-cutaneous nerve-stimulation (TENS), arc-welding equipment. Hence these equipment are best avoided. If you have an MRI compatible device then you may undergo an MRI if required after turning the MRI mode on.

22. 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.

 

23. 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 in ensuring that there is strict asepsis maintained during the procedure. It is important for patients particularly those with diabetes 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.

24. 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.

25. 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. 

26. What is a leadless pacemaker?

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

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

        It is approximately 8 years.

28. 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.

29. 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.

30. What is the disadvantage of a leadless pacemaker?

       The currently available leadless pacemakers cannot be used in patients where there is a need to               pace the top chamber. It is also not ideal for young patients who are likely to need multiple                       pacemaker battery changes in a lifetime. 

31. When should I come for my next check-up after the pacemaker's 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.

32. 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, it is possible that your doctor will call you for more frequent monitoring so that the battery is changed at the right time.

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