Pacemaker implantation is a common surgery and it significantly improves the quality of life led by the patient. The blood-pumping organ, heart, is essentially made of a few groups of muscles. These muscles are controlled by electrical signals to ensure that the heart beats naturally and effectively to circulate blood to all parts of the body. When this electrical signal gets disrupted due to some reason, then an individual may experience tachycardia (where hear beats abnormally slow), heart block, arrhythmia (irregular heartbeat), or a cardiac arrest (abrupt and sudden stopping of the heartbeat).
The contractions happen as a result of triggered electrical pulses generated by sinoatrial node or the SA node. It acts like a pacemaker of the heart. This electrical pulse is then sent to the atrioventricular node or the AV node for relaying the pulse to the ventricles. Pacemaker implantation is suggested when this electrical signaling network is disrupted.The faulty functioning of the natural pacemaker of the heart may lead to the following:
Sick sinus syndrome: It is characterized by a slow heartbeat (bradycardia) or fast heartbeat (tachycardia) or a combination of both. It can happen due to age, a previous history heart attack, and thyroid problem, too much of potassium accumulation in blood, heart surgery, or sleep apnea.
In this case, the impulse is either delayed or absent.
The heart can stop beating. It may result because of the presence of coronary artery disease and muscle problems in the heart, which can happen after the age of 35.
Some of the symptoms observed in patients requiring pacemaker implantation are:
A pacemaker implant is a small device that weighs around 20 g to 50 g and is the size of a matchbox. It has a pulse generator with a battery, a tiny computer circuit and a few wires called pacing leads. This system is attached to the heart and it emits signals through the wires. The pacing rate or the rate of electrical impulses can be adjusted as per the requirement of the body and be accordingly programmed. It can sense if a heartbeat is missed or if the heart is beating too slow. Accordingly, it starts sending a steady signal to normalize the beating of the heart. If the beats are normal, then it simply does not send any signal.
Insertion of a permanent pacemaker is a minimally invasive procedure. Access to heart chambers takes place as transvenous access to local anaesthesia. The most common method is via the subclavian vein or the cephalic vein. In rare cases, it is through femoral vein or the internal jugular vein. Either in an operating room or in a cardiac catheterization laboratory, the pacemaker implant procedure is performed.
In the infraclavicular region, the pacing generator is placed subcutaneously. Via thoracotomy, the pacemaker leads are implanted surgically. The pacing generator is then placed in the abdominal area. Either via left or right pectoral sites, single chamber and dual chamber insertion can be accomplished. The chest is then prepared. Sterile drapes are applied to the incision area to keep it as sterile as possible. Antibiotic prophylaxis is nowadays employed for the implantation. Preoperative antibiotic can reduce the chances of any infection by almost 80 percent. Cefazolin 1g is administered intravenously one hour prior to the procedure. Other antibiotics can be administered if the patient is allergic to cephalosporins, vancomycin, or penicillins.
The central vein is accessed percutaneously. Due to skeletal landmarks being deviated in some patients, there will be a need of fluoroscopic examination to reduce the time and complications in access. At the junction of first rib and the clavicle, the subclavian vein is typically accessed. For the confirmation of deep vein thrombosis, a phlebography is required for visualization of the vein.
Now a guide wire is advanced through the access needle and tip of the guide wire in placed in the right atrium or venacaval area under fluoroscopy. The guide wire is kept in place after the needle is withdrawn. If required, a second guide wire is also placed. Double wire technique may be employed through a sheath which is then withdrawn. Two separate sheaths can be manoeuvred over the two guide wires. During the lead advancement, some friction can be felt.
An incision of one to two inches is made in the area of the infraclavicle, which is parallel to the middle third of the clavicle and a subcutaneous pocket is made with both sharp and blunt dissection. This is for the implantation of the pacemaker generator. In many cases, surgeons prefer the access later and pocket first.
A peel-like special sheath and dilator are advanced over the guide wire. The guide wire and dilator are withdrawn keeping the sheath in place. A stylet is then inserted in the center channel of the pacemaker lead making it more rigid. This lead-stylet combination is then inserted into the sheath and advanced to the concerned heart chamber under fluoroscopy. In order to prevent dislodgement, the ventricular lead is positioned before the atrial lead. For the positioning in the tricuspid valve, a small curve at the tip of the stylet make it more mobile to reach the right ventricular apex. The introducing sheath is peeled once the lead is secured. With a pacing system analyser, the lead impedances are measured after the pacing lead stylet is removed. To prevent diaphragmatic stimulation, the pacing is performed at 10V.
After the confirmation of thresholds and lead position, the proximal end of the lead is secured to the pectoralis tissue with the help of a non-absorbable suture. This suture is sewn to a sleeve which is located on the lead. This is placed in the right atrium is a second lead is required. For patients who have already had a cardiac surgery, the lead tip is positioned medially or in the free lateral wall of right atrium. Same process of stylet withdrawal is followed after this. After positioning and testing of leads, the pacemaker pocket is fed with antimicrobial solution and the pulse generator is connected to the leads. To prevent migration or twiddler syndrome, many surgeons secure the generator to the underlying tissue with non-absorbable suture.
Before final confirmation of lead positioning, a look is taken under the fluoroscope. With the help of adhesive strips and absorbable sutures, the incision is closed. A sterile dressing is then applied on the surface. To limit movement for 12 to 24 hours, an immobilizer or arm restraint is applied. The chances of pneumothorax are ruled out with the help of a postoperative chest radiograph.
Usually, a patient is kept under observation for more than a day after the pacemaker implantation surgery. It takes around six weeks before the patient to get used to the implanted device. Heavy works must be avoided initially. One should ensure that the concerned arm is not rendered immobile during this time to prevent a frozen shoulder. A physiotherapist can exactly show the movements that you need to perform to keep your arm healthy. Carry the duly filled pacemaker implant card for emergency to avoid any unwanted situation.
The cost of Pacemaker Implantation Surgery procedure starts from USD 5000 in Poland. While there are wide range of hospitals offering Pacemaker Implantation Surgery, international patients should always seek JCI, TEMOS, OECI-Certified Hospitals in Poland for the best results.
The Pacemaker Implantation Surgery package cost in Poland varies from one hospital to another and may offer different benefits. There are many hospital that cover the cost of pre-surgical investigations of the patient in the treatment package. The Pacemaker Implantation Surgery cost in Poland includes the cost of anesthesia, medicines, hospitalization and the surgeon's fee. A prolonged hospital stay due to delayed recovery, new diagnosis and complications after surgery may increase the cost of Pacemaker Implantation Surgery in Poland.
Upon discharge from the hospital after Pacemaker Implantation Surgery in Poland, the patients are advised to stay for about 14 days for recovery. This period is important to conduct all the follow-up tests to ensure that the surgery was successful and the patient can go back to the home country.
Poland is undoubtedly one of the best countries for Pacemaker Implantation Surgery in the world. It offers the best medical expertise and good patient experience at an affordable cost. However, there are other countries as mentioned below that are popular for Pacemaker Implantation Surgery as well:
|South Africa||USD 12500|
|United Arab Emirates||USD 6000|
Apart from the Pacemaker Implantation Surgery cost, the patient may have to pay for additional daily expenses such as for guest house after discharge and meals. The per day cost in this case may start from USD 50 per person.
Pacemaker Implantation Surgery in Poland is offered in almost all metropolitan cities, including the following:
After the Pacemaker Implantation Surgery takes place, the average duration of stay at the hospital is about 3 days. This phase is important to ensure that the patient is recovering well and is clinically stable. During this time, several tests are performed before the patient is deemed suitable for discharge.
There are more than 2 hospitals that offer Pacemaker Implantation Surgery in Poland. Such hospitals have the required infrastructure and a dedicated unit where patients can be treated. Additionally, these hospitals are known to comply with the international standards as well as local legal requirements for the treatment of patients.
Some of the world-class multispecialty clinics in Poland are:
These hospitals house highly experienced and well-trained doctors who can handle even the most complicated cases. All kinds of surgeries are offered at these multispecialty hospitals and they follow strict medical protocols. The hospitals offer the best possible treatments at an affordable cost. They also provide all modern facilities to ensure comfort and patient satisfaction.
The National Committee for Quality Assurance (NCQA) is the main healthcare accreditation body in Poland (NCQA). Launched in 1998, Poland’s Hospital Accreditation Programme focuses on uplifting the quality of care provided by healthcare and improving patient safety standards. The clinics are bound to follow well-defined procedures in order to receive accreditation. NCQA has a comprehensive framework for evaluating the hospitals and the quality parameters are quality of patient care and adherence to international standards.
Poland has emerged as one of the major medical tourist destinations in the world and has gained popularity among patients who come here mainly from Western Europe. Some of the main important reasons for the popularity of Poland's tourism sector are the superior quality of services, well-trained medical staff, short waiting times for surgeries, and cheap prices of treatments. Poland has the superior medical infrastructure and some of the best hospitals which provide world-class medicine with a personal touch to patients. The hospitals in Poland follow strict rules framed by the Polish Ministry of Health to maintain high standards of hygiene and patient care.
You need to apply for a Schengen visa if you wish to travel to Poland to seek medical treatment. A short-stay Schengen Visa lets an individual stay in Poland for a maximum period of 90 days. You need to submit the below documents for applying for a medical visa:
Poland embassy reviews the submitted documents and will make a decision on granting a medical visa.
A large number of people visits Poland to avail the below-listed procedures:
Cosmetic surgery is the most popular procedure availble in the country, with a high success rate. The credit mainly goes to the highly trained cosmetic surgeons who have worked for years in European clinics and are in a regular contact with surgeons from all over the world. Poland has reported the highest sucess rate in IVF in whole Europe. Around 32 percent of IVF are successful per treatment cycle. People select Poland to avail these popular procedures due to several reasons, such as world-class hospitals with superior infrastructure and highly-skilled doctors, fast recovery, and use of cutting-edge medical technology.
Poland has some major cities that are considered epicentres of medical tourism. Most of the these cities are accessible by planes. Some of the top cities in Poland that are most favored by medical tourists are Warsaw, Gdansk, Krakow, Szczecin and Wroclaw. Most of these cities have an efficient public transportation system, language assistance, cheap accommodation options, and connectivity. Warsaw is medical tourist heaven due to its excellent scenic value which helps in the speedy recovery of patients through relaxation and rejuvenation.
Clinics in Poland offer world-class healthcare facilities to patients across the globe. With an aim to improve patient experience, clinics in Poland offer excellent facilities, such as:
Clinics in Poland help international patients at all stages of their treatment journey, right from queries, preparations for their travel, arrival, visit of the hospital, and follow-up care. The hospitals are committed to meeting all the needs and requirements that you or your family members may have during your stay at the hospital.
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