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Pacemaker Implantation Surgery

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Pacemaker Implantation Surgery

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Pacemaker is a battery operated small electronic medical device used in the treatment of rhythm disorders of the heart or Cardiac Arrhythmia. It is implanted under the skin of the chest or abdomen. It generates electrical impulses that stimulates the heart to contract normally or in other words, it regulates the abnormal rhythm of the heart. 


Abnormalities in the rhythm of the heart may be seen as too slow, too fast or irregular heart rhythm abnormalities. These rhythm disorders of the heart may lead to inefficient pumping of the blood by the heart and the patient may experience symptoms such as fainting, fatigue or shortness of breath. In severe cases of arrhythmia, patient may lose consciousness or it may even cause death.


Pacemaker ensures an active life style for the patient and offers relief in his symptoms.


Heart has its own electrical conduction system that comprises of specialized heart cells which are capable of generating electrical impulses and conducting them throughout the heart. This electrical activity within heart stimulates the heart muscles to contract and allow it to effectively function as a pump that eventually ensures adequate supply of oxygen rich blood to all the organ and tissues of the body.


Any fault with the generation or conduction of these electrical impulses will lead to the rhythm disorders of the heart. This conduction system in the heart has SA node, AV node, Bundle of His, Bundle branches-Right and Left and Purkinje fibres as its components. 


Heart has four chambers or compartments. First, electrical impulse spreads in the upper chambers i.e., Atria causing them to contract and then travel down causing lower chambers or ventricles to contract.


Pacemaker used in the treatment of arrhythmia, delivers low energy electrical impulses to regulate the heart rhythm and help it to pump the blood efficiently.



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All you need to know about Pacemaker


Q1 How does pacemaker help in rhythm disorders of the heart?

A1  Pacemaker helps in the following ways:

  • Increase the slow heart rate to normal.

  • Control the fast heart rate and bring it down to normal.

  • In case the atria (upper chambers) are quivering, it ensures the normal functioning of the ventricles or the lower chambers of the heart.

  • Coordinate the atrial and ventricle electical activity

  • Helps ensure coordination and synchronization of electical activity of both ventricles. Pacemakers which do this are referred to as Cardiac Synchronization Therapy devices, or CRT devices.

  • Prevent dangerous fatal arrhythmias

Furthermore, ​Pacemaker also monitors and records the heart electrical activity or heart rhythm. Newer pacemakers have added functions, besides the above.

​Q2 What are temporary pacemakers and permanent pacemakers?

A2 Temporary Pacemaker, as the name suggests, are used temporarily, only for short period of time, to treat short term heart disorders such as slow heart rate due to Heart surgery, Heart attack or due to overdosage of a medicine. Furthermore, they are used in case of emergency until the temporary heart condition is taken care of or until a permanent pacemaker is implanted. You will have to be in the hospital till the temporary pacemaker is in place.


If you have long standing rhythm disorder of the heart, your doctor will use Permanent pacemakers which will be there throughout your life.


Q3 What is the life span of a Permanent pacemaker?

A3 The life of a permanent pacemaker is usually 4 to 8 years. However, the life span of the pacemaker varies from person to person.


In case Biventricular pacemaker is used alongwith an ICD (Implantable Cardioverter Defibrillator), then its life span will be little less, whcih could be somewhere between 2 to 4 years.


Q4 What is the difference between a Permanent pacemaker and ICD (Implantable Cardioverter Defibrillator)? 

A4 Like pacemaker, ICD are also used in the treatment of Heart rhythm disorders. However, unlike Permanent pacemaker that uses low energy electrical impulses, ICD besides using low energy electrical impulses, can also use high energy electrical impulses, to treat life threatening cardiac arrhythmias.

An Implantable Cardioverter Defibrillator is primarily used to prevent cardiac arrest.

Cardiac arrest is a potentially life threatening or fatal medical condition wherein the electrical system of the heart goes in utter chaos, to such an extent that the heart stops beating abruptly and it calls for prompt intervention such as CPR (Cardio Pulmonary Resuscitation)

ICD, a device that helps in detecting the abnormal electrical signals that may be a sign of impending cardiac arrest. Subsequently, it sends a high intensity electrical shock to the heart to restore the normal function of the heart.

ICD is indicated in a patient who has a history of suffering a cardiac arrest in the past and also the patient who is at high risk of getting cardiac arrest anytime in future.

The conditions which put you at high risk of cardiac arrest may be any of the following;

  • Myocardial Infarction (Heart attack)

  • Congenital Heart Disease (Heart diseases right from the birth)

  • Coronary Heart Disease (Reduced blood supply to the heart due to the narrowing and hardening of the blood vessels supplying oxygen and nutrients to the heart)

  • Cardiomyopathy (Heart muscle disease leading to poor heart function)


Q5 Who requires a Pacemaker?

A5 Patients with slower than normal heart rate (Bradycardia) or Heart blocks (in which electrical impulse conduction is impeded in its conduction pathway within the heart) are most commonly advised implantation of a pacemaker.


Heart block may occur due to several causes, from as simple as Ageing to other disorders or ailments such as Heart attack, nerve or muscle disorders that damage the electrical system of the heart.


Heart specialist may also advise pacemaker in case of certain congenital heart conditions (heart conditions present since birth) or in patients with heart transplant. 


Q6 How is the Pacemaker designed to work?

A6 Pacemaker comprises of a battery, computerized generator and wires with electrodes or sensors at their end.


The generator derives the power from the battery and both of them are covered in a thin metal box. The wires connect the generator to the heart.


Pacemaker serves the function of monitoring and controlling your heart's rhythm and rate.


The elctrodes sense the electrical activity in the heart and conveys the information to the computerized generator via wires. The computer in the generator use that information and if something strange or abnormal is detected, it instructs the generator to send the electrical impulses to the heart. This electrical impulse reaches the heart through wires.


Latest versions of the pacemaker have added functions.


Not only does the pacemaker monitors and controls the heart rate and rhythm but it records them also. These recordings come handy for your heart specialist. They analyze the recordings and adjust the pacemaker accordingly to bring out the best from them.


Your heart specialist can program the computer of the pacemaker with the help of an external device. He does not have to do anything with the pacemaker directly.


Pacemaker consists of one to three wires. Each one of them is placed in different chambers or compartments of the heart.

  • Single Chamber Pacemaker

  • Dual Chamber Pacemaker

  • Biventricular Pacemaker


Q7 What are the different types of pacemakers?

A7 The following are the different types of pacemakers:

  • Single Chamber Pacemaker: It has one wire which is connected to either upper right heart chamber (Right Atrium)or lower right heart chamber (Right Ventricle)

  • Dual Chamber Pacemaker: It consists of two wires which are connected to right atrium and right ventricle.

  • Biventricular Pacemaker: It consists of three wires which are connected to right atrium, right and left ventricles.

​Your heart condition will determine the type of pacemaker you will need.


All about Pacemaker Implantation Surgery



Q8 How is Pacemaker Implantation Surgery done?

A8 Before the actual Pacemaker implantation procedure is carried out, you will be assessed (Presurgical assessment) for your fitness for the surgery. This is usually done by carrying out your physical examination, your history taking which may include your chief complaints, presence of any other medical conditons, history of any allergies, any past procedure or surgery, family history of certain medical conditions of importance to you and the surgeon and so on. Furthermore, laboratory work up that consists of blood test and heart specific tests such as ECG will also be performed.


All your concerns and queries related to the procedure will be taken up and pacified by your cardiologist.


You will be instructed to follow certain guidelines as a way of preparing just before the surgery such as when to stop eating or drinking before the surgery, empty bladder or bowel and if any medication you are already taking, need to be stopped. Everything will be clearly explained to you.


This procedure is carried out by:


Interventional Cardiologist (who specializes in catheter based treatment of the heart which may include Angioplasty, Stenting, Valvuloplasty, Congenital Heart Defect correction)


Cardiac Electrophysiologist who specializes in treatment of heart rhythm disorders such as cardiac ablation, pacemaker implantation and ICD implantation.


The actual pacemaker Implantation procedure can be done by one of the following two ways or techniques:


Transvenous Implantation and Epicardial Implantation.

Transvenous Implantation is a more common technique as compared to the Epicardial Implantation.


Transvenous pacemaker Implantation Procedure: 

During this procedure, a 2 inches or 5 to 6 cm incision is made just below the collar bone on your left side of the chest to insert the wires from the pacemaker, into the vein. These wires are referred to as Pacing leads.

These leads are guided through the vein, with the help of X ray scans, into the desired compartment or chamber of the heart

The other ends of the leads are connected to the pacemaker, which is placed into a small pocket created by your heart specialist in between the skin of the upper chest and the chest muscles.

Transvenous Pacemaker Implantation is perfomred under the effects of Local Anesthesia, administered through an injection.

You will be awake during the procedure but will not feel anything since the area to be worked upon has made numb due to the effects of anesthesia given locally.

Medication may be given through Intravenous Catheter or IV line to make you little drwosy which will keep you realxed during the procedure.



Epicardial Pacemaker Implantation Procedure: 

It is not as common as the Transvenous Pacemaker Implantation procedure. Here, the leads from the pacemaker are connected to the outer surface of the heart, Epicardium, through an incision made through the abdomen or belly.

Epicardial Implantation procedure is commonly indicated in children or patients who are undergoing some other heart surgery simultaneously alongwith Pacemaker Implantation Procedure.

This type of pacemaker Implantation Surgery is performed under the effect of General Anesthesia, which means that you or the patient will be put to sleep during the whole procedure.

The pacing lead will be connected to the surface of the heart on one end and the other end of the leads will be connnected to the pacemaker, which is placed in the pocket created by your cardiologist, beneath the skin of your abdomen.

Recovery period is a little longer in case of Epicardial pacemaker Implantation Surgery, in contrast to Transvenous technique.

Before the cardiologist finishes the procedure, he makes sure that the leads are properly placed and the pacemaker is efficiently functioning. He will make certain adjustments in the setting of the pacemaker and the amount of electrical energy needed to stimulate your heart, all depending upon your medical need, this is referred to as pacing.


Q9 How long does the Pacemaker Implantation Surgery take?

A9 Usually, Transvenous Pacemaker Implantation Surgery takes around an hour to perform the procedure. However, it may vary, depending upon if Biventricular Pacemaker is implanted, it may take even 3 hours.


Furthermore, if any other heart procedure is accompanying this pacemaker Implantation procedure, it will also alter the duration of the procedure.


Epicardial Pacemaker Implantation Surgery, takes 1 to 3 hours, but again, the time may vary from person to person, as mentioned above.


Q10 What is the life expectency of a patient with a permanent pacemaker in place?

A10 Several studies have shown survival rates of 93%, 81%, 69% and 61% after 1, 3, 5, 7 years respectively.


Management of certain specific scenarios in a patient with an implanted pacemaker|Living with a Pacemaker


Q11 I have an implanted pacemaker. What things I need to be careful with while handling mobile phones?

A11 Though current mobile phones are highly unlikely to hamper the pacemaker function or cause any kind of health issues, still you need to observe the following precautions, to be on the safer side:

  • Maintain a distance of minimum 6 inches between your mobile phone and your implanted pacemaker.

  • Listen to the mobile phone with the ear opposite to the side of the implanted device.

  • Carry the mobile phone in a pocket away from the side where the cardiac pacemaker is inserted.

​Q12 Am I safe while using office and home equipments, with an implanted pacemaker on?

A12 Most of the domestic and office equipments are unlikely to cause any safety issues or interfere with the normal pacemaker function, as long as the equipment meets current electrical safety standards. Therefore, patients with the most advanced latest generation of pacemakers can safely use computers, electrical typewriters, Fax machines and many household appliances, including Microwave ovens. 

However, it would be advisable to take proper guidelines from your cardiologist or heart specialist regarding the usage of equipments and also go through the user's manual of your appliances and reconfirm.


Q13 How will I get Airport screening done, with a pacemaker inside my body?

A13 Its important for you to know that Airport screening devices are likely to detect your implanted pacemaker and that's okay. They are not going to harm you or your pacemaker function. However, you need to carry your device identification card along in order to get security clearance.

You can go through metal detectors without any adverse effects on your pacemaker function, however, it is always better to request for permission to be scanned with a hand held device or physical pat down. Permission may be granted to you.


Q14 Will pacemaker implant affect my sex life?

A14 Pacemaker implantation does not affect your sex life. However, you have to be cautious during the first four weeks after the pacemaker implantation procedure.


Q15 What effect will the pacemaker have on my quality of life?

A 15 Pacemaker Implantation will certainly improve the quality of your life remarkably. You can live a longer and active life, free of symptoms such as dizziness, breathlessness. 

Your hospital visits will also be reduced which were there prior to the procedure, on accoun t of rhythm disorders of the heart and its associated symptoms.


Follow up frequency for a patient with cardiac pacemaker


Q16 How frequently do I need to follow up with my heart specialist after implantation of a pacemaker?

A16 You will need to follow up with your cardiologist throughout your life, after you get the pacemaker implantation done.

The frequency of follow up will vary from every 3 months to every year. This frequency of follow up with your cardiologist is determined by the type fo the pacemaker implanted and the efficiency of the pacemaker in meeting your medical needs.

Your doctor will test for the efficiency of your implanted pacemaker and make the necessary adjustments or reprogram the pacemaker, if need be.



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Dr (Prof.) Vivek Gupta

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Dr Vanita Arora 

MBBS,MD (Internal medicine), DNB (Cardiology)


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Interventional Cardiology and Electrophysiology, Southampton University Hospital, Southampton (UK)

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Max Super Speciality Hospital, Saket

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Dr Aparna Jaswal

MBBS (Gold Medalist), MD (Medicine), DNB (Cardiology, Gold Medalist)

Certified Cardiac Device Specialist, IBHRE, USA

Additional Director, Cardiology

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Cardiologist|Interventional Cardiologist|Cardiac Electrophysiologist

Dr Rajeev Rathi

MBBS, MD (Medicine), DM (Cardiology)

Director & Head, Transradial Interventional Programme

Max Super Speciality Hospital, saket, New Delhi

Cardiologist|Interventional Cardiologist|Cardiac Electrophysiologist

Dr Praveen Chandra

MBBS,MD (General Medicine), DM (Cardiology)

Chairman, Interventional and Structural Heart Cardiology

Interventional Cardiology, Heart Institute

Medanta Medicity Hospital, Gurugram, Delh-NCR

Cardiologist|Interventional Cardiologist

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MBBS, MD (Internal Medicine), DNB

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MBBS, MD (Internal Medicine), DNB (Cardiology)

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Medanta Medicity Hospital, Gurugram, Delh-NCR

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Dr Balbir Singh

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