Pacemaker is an electronic device that is implanted via different types of medical approaches. Its purpose is to prevent the heart from beating extremely slow. Another name for a pacemaker is a cardiac pacing device.

If you are researching "heart pacemaker surgery”, this blog will help you get all the necessary information related to the subject. Keep reading to know more.

Pacemaker surgery is a medical process of positioning a pacemaker in an individual’s heart. It is a 2-part electronic device consisting of an electrode lead and electric pulse generator device. This surgery is applicable on those people with slow or irregular heartbeats. This device's main function is to stabilise abnormal heart rhythms and prevent further heart problems.

• Bradycardia

Pacemaker implantation eliminates the symptoms of bradycardia. So, now they will have more energy and less breath-shortness. Moreover, this means a pacemaker regulates the heart's rhythm.

• Arrhythmia

Those who have untreated arrhythmia do not get the required oxygen in their brain because adequate blood flow is disrupted. A pacemaker helps the heart to beat at the appropriate rhythm and minimises symptoms like dizziness, chronic fatigue, or fainting.

• Heart Failure

For people with a heart condition which is slowly developing into heart failure, pacemaker surgery would slow its progression. With a pacemaker, you may need less hospitalisation, and your heart performs better than before.

• Ventricular Fibrillation

If someone is at risk of ventricular tachycardia, it is only possible to save their life if they have a pacemaker. In this special condition, they can go through ventricular fibrillation. In other words, your ventricles get out of sync and contract fast and haphazardly in this situation.

The surgical approach differs on the type of pacemaker you are getting inserted. With more advanced medical sciences, these surgical processes have become more refined. Below mentioned are the different approaches to pacemaker implantation:

1. Catheter-based Surgery

Suppose you have heart conditions that only involve a single chamber of your heart, experts would prefer this approach. In this type of surgery, a catheter is inserted into an artery near the groin and guided to reach the heart. After reaching the right position, leadless pacemakers are attached to your heart wall.

Benefits -

• Takes less time than the traditional method
• No limitation in upper body activity

2. Transvenous Approach

This approach to pacemaker operation is more common. In this approach, a surgeon makes a minor incision to find a vein beneath your collarbone. Experts use fluoroscopy to thread the leads through the vein and attach them to your heart. After attaching the leads to the device, it is placed under the skin of your upper chest.

Benefits -

• Definitively control heart rate
• Effective myocardial contractility

3. Epicardial Approach

In this procedure, a surgeon makes a small incision in your chest to insert the leads and attach them to your heart. Then the other end of the leads is connected to the pacemaker body. The pacemaker is then hidden in a skin pocket under the abdomen.

Benefits-

• Long-term performance
• Durable approach than others

Before your operation, doctors will prescribe a number of tests to identify the cause of irregular heartbeat. Prior to the surgical process, there are some tests that doctors prescribe, which includes:

• Electrocardiogram (ECG or EKG)

In this test process, experts stick patches on certain parts of your body which are connected to wires. ECG or EKG checks whether the heart is beating too fast or too slow.

• Holter Monitoring

This is a wearable device, which your doctor may ask you to wear for 1-2 days. These days, the machine will read your heart rates and keep track. It is useful to monitor unpredictable heartbeat problems.

• Echocardiogram

An echocardiogram is a procedure that uses sound waves to produce images of a heart’s size, structure and motion.

• Stress Test

There are instances where heart problems occur only during exercises. So, an echocardiogram is taken immediately after walking on a treadmill or riding a stationary bike for a stress test.

Although implanting a pacemaker has incredible success rates and benefits, it has certain risk factors too. Here are some of the possible risks of pacemaker surgery you can encounter -

• Blood clotting is common and for that doctors prescribe blood thinning medications.
• Swelling or bleeding at the operated site.
• Blood vessels may get damaged near a pacemaker.
• Allergic reaction to certain medicines or the material of pacemaker.
• Pneumothorax or collapsing of lungs.
• Blood between the lung and chest wall is known as haemothorax.
• Pacemaker lead malfunction can be caused due to heavy physical activity.
• Rare and unexpected heart issues can occur even if there is a pacemaker.
• Malfunction due to electrical interference from outside.
• The shift in the device or leads can cause cardiac perforation.

Healthcare providers will give you a sedative through an IV to help you relax. Then your chest will be cleaned with a specific soap so that there are no foreign particles that can cause infection. Doctors generally use local anaesthesia to numb the operative area for pacemaker surgery.

Nevertheless, the amount of sedative depends on the surgery type, age, and health conditions. Based on these, you will either be awake but feel nothing on your chest or lightly sedated. In certain situations, the surgeon may order general anaesthesia.

A few wires will be inserted into a major vein which is located near or under the collarbone to reach the heart. These wires are the major part as they connect the heart on one end and the pulse generator on the other. This pulse generator is usually positioned under your skin below the collarbone.

In the case of a leadless pacemaker, the surgery becomes less invasive. Here, the different parts of a pacemaker and the pulse generator are combined in a single capsule. A surgeon will put a catheter in a vein in the groin and guide this single component pacemaker to reach the heart.

After the pacemaker is implanted, you will stay in the hospital for a while. Experts would programme it to fit with the heart rhythm that you need.

You must consult with your doctor about any restrictions after pacemaker surgery. Generally, they recommend not to do vigorous physical movements for a month or so. If you develop any pain in the operated area, consult your doctor for medications.

A patient facing the following symptoms must call the doctor immediately.

• Trouble in breathing
• Unexpected weight gain
• Swollen ankles or lower legs
• Feeling dizzy, fainting or confuses with the surrounding
• Signs that you had before inserting a pacemaker.

Similar to a pacemaker, there is another device called ICD or Implantable Cardioverter Defibrillator. Doctors insert this device in your body via similar surgical procedures. Inside this device, there is a computer that tracks your heart rate and rhythm.

However, there is only one difference between a pacemaker and an ICD. If your heart beats too fast, ICD will send a shock to get it back on its fixed rhythm.

The average pacemaker surgery cost in India in 2022 is around ₹50,000. However, this can vary in different cities and hospitals. Minimum cost of pacemaker surgery is around ₹40,000.

A pacemaker is a life-saving device that millions of people rely on due to their heart conditions. However, people still wonder if pacemaker surgery is safe. The answer to this question is yes, but you must remember pacemakers are not the cure. It is merely a device that supports your heart and prevents some situations.