Pacemaker Implantation Surgery Cost in India – Procedure, Best Hospitals, and Doctors

Posted on December 16th, 2019 by Hiba Farzin

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What is the cost of pacemaker implantation surgery in India?

The estimated cost of Pacemaker implantation surgery in India is around 2,500 – 4,500 USD for Single Chamber Pacemaker implantation and 4,000 – 7,000 USD for Dual Chamber Pacemaker implantation.

If you are a foreigner, planning for pacemaker implantation surgery in India, having information about the best surgeons, hospitals and the overall expense for the treatment including your travel and accommodation would be helpful.

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The cost variation depends on the following factors:

  1. Choice of Hospital
    The charges for the procedure, doctors, nursing services, operating room,  ICU, hospital room rent, etc changes drastically as we go from an economy hospital to a premium hospital.
  2. Choice of the City
    The city in which the hospital lies also makes a big difference in the overall price. The cost of food, accommodation, and transportation are much higher in metro cities. You can save around 1,000 USD if you choose tier-2 cities such as Cochin, Calicut, etc. In addition, the cost of health care is also higher in tier-1 cities, compared to other cities in India.
  3. Cost of the implant device
    The cost of the device varies according to the specific model required for the patient and the device manufacturer. Discuss with your doctor about your needs and financial affordability to choose the best device for you.

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Treatment duration and number of days in India

Pre-surgery Evaluation2 Days
Hospital Stay2 to 5 Days
Recovery Period Outside Hospital5 to 10  Days

Table of contents

Conduction system of the heart

Artificial Pacemaker

Who needs a Pacemaker

How Pacemaker works

Types of Pacemaker

Before Pacemaker Implantation Surgery

Procedure

After Pacemaker Implantation

Living with a Pacemaker

FAQs

Best Hospitals for Pacemaker Surgery in India

Best Doctors for Pacemaker Surgery in India

The human heart is a wonder-machine, that beats over 2.5 billion times along the average lifetime of a person, pumping millions of liters of blood through all parts of the body. The steady rhythm of the heart is responsible for the transport of oxygen and other vital components to each and every cell in the body and flushing off the waste products of the metabolic activities of the cells. Maintaining the normal rhythm of the heart is essential for the proper functioning of all other organs and organ systems of the body.

Electrical conduction system of the heart

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The heart is a four-chambered pump, which is made up of specialized muscle tissue. The upper chambers of the heart are called the atrium (Right Atrium and Left Atrium) and the lower chambers are called ventricles (Right Ventricle and Left Ventricle). The cardiac conduction system is constituted by a group of specialized cardiac muscle cells and conducting fibers in the walls of the heart.

heart-electrical-system

The main components of the cardiac conduction system are:

  • SA node (Sinoatrial node)
  • AV node (Atrioventricular node)
  • Bundle of His
  • Bundle branches
  • Purkinje fibers

The SA node is the natural pacemaker of the heart. It is a collection of highly specialized cells, located on the right atrium. The SA node contains a special type of cardiac cells with the ability to generate electricity spontaneously. It initiates the sequence of conduction by causing the atrial muscles to contract. This signal then travels through the right atrium to the AV node, along the Bundle of His, through the bundle branches, and the Purkinje fibers to cause ventricular contraction.

The electrical current resulting from the conduction can be seen on an ECG (Electrocardiogram). ECG can be used to monitor the electrical activity of the cardiac conduction system. The dysfunction of the conduction system causes abnormal heart rhythm.
The SA node normally generates the electrical stimulus 60 to 100 times per minute, causing the normal rate of heartbeat. There is a steady and continuous rhythm of conducting signals, heartbeat and the pumping of blood maintained by a healthy heart.

What is a pacemaker?

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pacemaker

A Pacemaker, which is also referred to as ‘Artificial Pacemaker’, is a small implantable device, that helps to regulate the heart rhythm, and manages problems associated with the electrical system of the heart. It ensures that the heartbeat does not slow down to an extremely lower rate or speeds up to a dangerously higher rate. However, Pacemaker implantation surgery is most commonly recommended for patients diagnosed with lower heart rates. For patients with other heart rhythm abnormalities and heart failure, therapy using ICDs or CRTs may be recommended according to their respective conditions.

An implantable pacemaker is required when any part of the conduction system of the heart fails. In such cases, an external pacing device will be needed to help the heart to beat at the right rhythm.

The device is usually placed under the skin in the chest region just below the collar bone and connected to the heart chambers by lead wires running through a blood vessel.
The pacemaker system consists of the following parts:

1. Pulse Generator (PG)

pacemaker-pulse-generator

The Pulse Generator or PG is the heart of the system. It can be considered a mini-computer with complex circuitry capable of analyzing information and responding appropriately by delivering output signals. It understands the patient’s requirements by continuously monitoring how the patient’s heart is working. It delivers pacing signals whenever necessary and generates no signals when the heart rhythm is normal.

The PG also has an in-built memory to store information about the functioning of the heart as electrograms. This information can be later downloaded by the clinician during the follow-up visits.

The PG is powered by a lithium-iodine cell. The main advantage of this type of battery is that it depletes over a predictable course. Abrupt variations or sudden depletion rarely happens. Depending on the type of device, patient requirements, how often it has to pace, and various other factors, a PG may last 5 to 10 years. There is no predefined period for this, it varies according to the working of the device.

The battery status will be shown on the programmer during routine follow-up interrogations. When the battery approaches its end of life, an indication will be given so that a pacemaker replacement surgery can be scheduled appropriately.

2. Lead wires

pacemaker-leads2

The lead wires connect the Pulse Generator to the heart chambers. It is an insulated wire with a non-insulated termination known as an electrode. The Pulse Generator receives input from the heart through these lead electrodes which are in direct contact with the heart. Also, the electrical impulses generated by the PG are delivered to the heart muscles through the electrode.

Depending on the condition of the heart, the patient may require one or two leads connecting to different heart chambers. Accordingly, there are Single Chamber Pacemakers and Dual Chamber Pacemakers (Explained in detail in the following sections).

3. Programmer

pacemaker-programmer

The programmer, also referred to as the Patient Care System, is a tabletop computer that can communicate with the implanted Pulse Generator. This will be possessed by the pacemaker technician (An employee of the device manufacturer or distributor) or the hospital.

The parameters and mode of working of the implanted device can be set up using the programmer. This is used for testing, analyzing, and altering the mode of working of the Pulse Generator during and after the Pacemaker implantation surgery. The routine follow-up interrogations of the patient will be carried out using the programmer.

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Who needs a pacemaker implantation surgery

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A cardiologist may recommend a Pacemaker implantation surgery for the following conditions:

  • Bradycardia
    The normal heart rate of adults is 60 to 100 beats per minute. When the heart rate is lower than 60 bpm, the condition is called Bradycardia. The heart will not be able to pump enough oxygen-rich blood to the body in this condition.
    The treatment for bradycardia depends on the root cause of the condition and the symptoms of the patient. If it is caused by the damage within the electrical system of the heart, pacemaker therapy may be an effective treatment option.
  • Heart Block
    The electrical signal of the heart becomes slowed or disrupted. Heart block may occur as a result of aging, damage caused by a heart attack, or other conditions. Some nerve and muscle disorders like muscular dystrophy may also cause heart block.
  • Congenital heart diseases
  • Patients who have undergone a heart transplant surgery may need a pacemaker for supporting the normal functioning of the transplanted heart.
  • Damages to SA node due to aging or heart disease
  • Long QT Syndrome – shows wider QT interval on ECG

How pacemaker works

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When the natural pacemaker of the heart does not work properly, the heart may beat irregularly and slower or faster than the normal rate of heartbeat. Implanting an artificial Pacemaker helps to restore the natural rhythm of the heart.

The Pulse Generator of the Pacemaker is usually implanted under the skin in the upper chest, just below the collar bone. This is connected to the heart by the lead wires running through a large blood vessel called the subclavian vein. The Pulse Generator maintains the normal rhythm of the heart through two major functions or modes:

  • Sensing
    The natural electrical activity of the heart is monitored continuously through sensing. When it senses a normal heartbeat, no impulse signal will be initiated. It waits and continues sensing.
  • Pacing
    The Pacemaker generates an impulse signal or pacing signal when it senses a slow heart rate or an interrupted rhythm. This impulse signal initiates a heartbeat.

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Types of pacemakers

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Depending on the symptoms and the functioning of the patient’s heart, the doctor will decide which type of Pacemaker can be best to support their heart. Some patients may require pacing support only for one chamber of their heart, whereas some others may need pacing support for multiple chambers of their heart. For more complicated conditions like Tachycardia or Ventricular fibrillation, the patient may need an ICD or CRT implantation.

1. Single Chamber Pacemaker Implantation

Single Chamber Pacemaker implantation involves only a single lead connecting the Pulse Generator to one chamber of the heart. This type of Pacemaker is usually used for patients who require pacing support only for their right ventricle.

2. Dual Chamber Pacemaker Implantation

Dual Chamber Pacemaker implantation involves two leads connecting the Pulse Generator and two of the heart chambers. This usually connects the right atrium and right ventricle to the Pulse Generator, which helps to coordinate the contractions of both the chambers. Dual Chamber Pacemaker ensures that the contraction and relaxation of both chambers are in the proper rhythm.

Before pacemaker implantation

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Symptoms of abnormal heart rhythm such as dizziness, fainting, difficulty to breath, etc are considered as indications for the need for Pacemaker implantation. If these symptoms appear with unexplained causes, the doctor may recommend diagnostic tests for heart arrhythmia.

The following are some of the common diagnostic methods to identify cardiac arrhythmia:

  1. ECG (Electrocardiogram)
    ECG is a simple test to analyze the electrical activity of the heart. ECG shows the rhythm and the strength of the electrical signals passing through the heart. It is very useful for the diagnosis of Bradycardia and heart blocks.
    However, the ECG can only show cardiac activity during the test, which is only a few minutes. In order to analyze cardiac rhythm for a longer duration (say a day or two) portable ECGs like Holter and Event monitors may be used.
  2. Holter and Event Monitors
    A Holter monitor is a portable ECG device that can record the electrical activity of the heart for a period of 24 or 48 hours. It continuously records the heart rhythm during this period. The patient will have to wear the device during normal daily activities.
    An event monitor is also a portable ECG similar to a Holter monitor, which is to be worn during the patient’s normal activities. Unlike the Holter monitors, an event monitor records the heart’s electrical activity only at certain times. In some event monitors, the patient will have to press a button when they feel symptoms of an abnormal heart rhythm so that the device starts recording. Some other types of event monitors start recording automatically when they detect abnormal rhythms. The patient will have to wear the monitor for several days until the symptoms are recorded.
  3. Echocardiography
    Echocardiography, also known as the Echo test, creates a moving picture of the heart using sound waves. It shows the size and shape of the heart and how well the heart chambers and valves are functioning. The test also shows the areas of the heart where the muscles are not contracting normally, areas of poor blood flow, and injury caused to the heart muscles due to the poor blood flow.
  4. Electrophysiology study
    The Electrophysiology study is conducted by electrically stimulating the heart to see how it responds to such stimulation. A thin, flexible wire is passed through a vein in the upper thigh or arm to reach the heart and record the electrical signals of the heart. This test is helpful to pinpoint where exactly the electrical system of the heart is damaged.
  5. Stress test
    Some heart problems are easier to diagnose when the heart is beating fast. The stress test is the method of performing ECG or Echocardiography while the patient is asked to do some kind of physical activity or exercise to make the heart beat faster. If the patient cannot exercise, medicines may be given to raise the heart rate.

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Pacemaker implantation procedure

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The general steps in a Pacemaker implantation surgery are as follows:

  • The procedure may be performed under local or general anesthesia according to the choice and preferences of the surgeon. Laying down steadily throughout the procedure is necessary for the smooth and successful completion of the surgery. If the patient is nervous about being through the procedure in a conscious state, the surgeon may recommend general anesthesia.
  • An intravenous line will be connected to the hand or arm of the patient to provide medications and for the administration of IV fluids, if necessary.
  • The patient will be connected to an ECG monitor that displays the electrical activity of the heart using small electrodes.
  • The pacemaker insertion site (usually upper chest, just below the collar bone) will be cleansed and sterile towels and a sheet will be placed around the area.
  • The surgeon will then make a small incision at the site of insertion.
  • A guidewire called a sheath is then inserted into a blood vessel under the collar bone.
  • The lead wire will then be inserted through the sheath to reach the heart.
  • Now, the lead wire/wires will be placed at different possible locations to find out the most appropriate position.
  • A special type of X-ray called Fluoroscopy may be used to assist in determining the best position to place the leads.
  • Once the most suited position for the leads is located, the lead wires are screwed firmly in their respective positions.
  • The outer ends of the lead wires are attached to the Pulse Generator. The Pulse Generator is then inserted under the skin through the incision.
  • The Pulse Generator is generally placed on the left side of the chest for a right-handed person and on the right side of the chest for a left-handed person. This is to ensure that minimum stress is given on the implant site.
  • The proper working of the device is ensured by observing the ECG.
  • The incision will be sutured and a sterile bandage will be applied over it.

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After pacemaker implantation

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  • The Pacemaker Implantation surgery usually involves 2 to 3 days of hospital stay.
  • The patient will be shifted to the recovery room immediately after the procedure, where the vital signals and responses will be monitored continuously.
  • If the patient feels discomfort or pain in the chest, it should be immediately reported to the nursing staff.
  • When the patient gets up from the bed for the first time after the procedure, the nurse will check blood pressure during the different positions like lying on the bed, sitting, and standing.
  • The patient will then be able to eat and drink.
  • The patient may feel pain at the site of pacemaker insertion. Pain medications will be provided as per the requirements.
  • Once the blood pressure, breathing, and pulse of the patient are stable, he/she may be shifted to a hospital room or discharged from the hospital.
  • However, it is recommended to stay overnight in the hospital after the procedure for observation.
  • The patient will have to avoid lifting or pulling objects to encourage smooth healing of the wounds.
  • Most patients will be able to return to their normal activities within a few days after the surgery.
  • The patient will have to avoid vigorous activities and heavy lifting for about a month after the surgery.
  • The insertion site should be kept clean and dry. The patient will be given certain instructions to follow while bathing.
  • The doctor may also provide certain instructions regarding driving after the pacemaker implantation surgery.
  • The patient should immediately inform the doctor if any of the following symptoms show up:
    • Severe pain at the insertion site
    • Redness, swelling, fluid discharge or bleeding at the insertion site
    • Persisting fever or chills
    • Chest pain
    • Vomiting
    • Nausea
    • Profuse sweating
    • Fainting
    • Dizziness
    • Palpitations
  • The doctor may adjust the settings or mode of the implanted device to avoid discomfort and give better results for the patient.
  • The patient will have to do regular follow-up visits to analyze the functioning of the heart and the implanted pacemaker.
  • The follow-up visits will be recommended more frequently during the initial stages after the surgery. However, the need for follow-up visits become less frequent later on.
  • For international patients who have undergone Pacemaker implantation surgery in India, they can easily arrange follow-up visits at their home city with the help of the device manufacturer’s sales and service staff. Also, the follow-up details can be easily forwarded to the surgeon who performed the implantation.
  • Most Pacemaker manufacturers offer remote monitoring devices that allow patient monitoring and follow-up using automatic wireless communication.

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Living with a pacemaker

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The working of an implanted pacemaker is rarely affected by the electromagnetic interference of small electrical and electronic devices. However, it is recommended to take some precautions while using certain devices.

  • It is safe to use cell phones, but make sure to follow these instructions.
  • Keep cell phones at least 6 inches away from the implanted device.
  • If the PG is implanted on the right side of the chest, use cell phone on the left ear, and vice versa.
  • Avoid keeping the cell phone in the shirt pockets.
  • Passing through security gates and metal detectors may cause the alarms to beep on detecting the implanted device. So, inform the security staff about the pacemaker and also make sure to carry the implanted device identification card during such situations. (The identification card will be provided by the device manufacturer. Make sure to collect it from the hospital.)
  • When the patient has to seek medical treatment for any other purpose like dental care, eye care, or other medical conditions, make sure to inform the consulting physician about the implanted device.

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FAQs

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Here are some frequently asked questions related to Pacemaker implantation surgery.

What happens when the pacemaker’s battery reaches the end of life?

The battery status will be displayed on the programmer screen during all the routine interrogations. It shows an alert signal when the battery reaches below a specific level. If the battery reaches the end of life, the interrogator informs the patient as well the doctor and plan a replacement surgery immediately.

During the replacement surgery, the pocket where the device is placed will be opened up. The old device will be removed and disconnected from the leads. The new device will then be placed after confirming the leads are in the proper position.

Is it safe to use household electrical appliances after Pacemaker implantation?

Yes. Most of the household appliances are safe to use. But it is important to make sure that these appliances are properly maintained and in good working condition.

Will magnets affect the working of the implanted pacemaker?

Yes,  some magnetic devices, such as stereo speakers, magnetic therapy products, and hand-held massagers can temporarily affect the working of a pacemaker. Therefore, it is recommended to keep such items at least six inches away from the implanted device. It is better to avoid the use of magnetic mattress pads and pillows as it is difficult to maintain a six-inch distance while using these items.

Top 10 hospitals in India for pacemaker implantation surgery

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  1. Medanta – The Medicity, Gurgaon
  2. Manipal Hospital, New Delhi
  3. Apollo Hospitals, Chennai
  4. Fortis Escorts Heart Institute, New Delhi
  5. BLK Super Speciality Hospital, New Delhi.
  6. Indraprastha Apollo Hospital, New Delhi.
  7. Max Superspeciality Hospital, New Delhi.
  8. Narayana Multispeciality Hospital, Bangalore.
  9. Artemis Hospital, Gurgaon.
  10. Global Hospitals, Chennai.

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Top 10 doctors in India for pacemaker implantation surgery

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  1. Dr. Rajiv Bajaj
  2. Dr. Anil Saxena
  3. Dr. Kartikeya Bhargava
  4. Dr. Rajnish Sardana
  5. Dr. Ranjan Shetty
  6. Dr. Gopi Aniyathodiyil
  7. Dr. K Chandrasekaran
  8. Dr. Mandar Mahavir Shah
  9. Dr. Ameya Udyavar
  10. Dr. Sameer Mehrotra

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