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 in South Africa starts from $12500. While there are wide range of hospitals offering Pacemaker Implantation Surgery, international patients should always seek COHSASA-Certified Hospitals in South Africa for the best results.
The Pacemaker Implantation Surgery package cost in South Africa 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 procedure in South Africa includes the fees of the surgeon, hospitalization and anesthesia as well. Post-surgical complications, new findings and delayed recovery may have an impact on the total Pacemaker Implantation Surgery cost in South Africa.
After Pacemaker Implantation Surgery in South Africa, the patient is supposed to stay in guest house for another 14 days. During this time, the patient undergoes medical tests and consultations. this is to ensure that the treatment was successful and the patient us safe to return.
One of the topmost destinations for Pacemaker Implantation Surgery is South Africa. It has a variety of accredited hospital, affordable cost of treatment and some of the best medical fraternity. Some of the other destinations that are popular for Pacemaker Implantation Surgery include the following:
|South Africa||USD 12500|
|United Arab Emirates||USD 6000|
There are certain additional cost that the patient has to pay apart from the Pacemaker Implantation Surgery cost. The extra charges may start from USD 50 per person.
Some of the best cities in South Africa which offer Pacemaker Implantation Surgery are:
After Pacemaker Implantation Surgery, the patient is supposed to stay for about 3 days in the hospital for recovery and monitoring. 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.
The average rating for Pacemaker Implantation Surgery hospitals in South Africa is 2.9. This rating is automatically calculated on the basis of several parameters such as the infrastructure of the hospital, quality of services, nursing support and other services.
There are more than 3 hospitals that offer Pacemaker Implantation Surgery in South Africa. The above mentioned clinics have the required infrastructure and a dedicated unit where patients can be treated. Also, these hospitals follow the necessary guidelines as required by the medical associations for the treatment of Pacemaker Implantation Surgery patients.
The popular multispecialty hospital groups in South Africa are:
Most of these hospitals have effectively met the below quality parameters:
South Africa is known to have strict government regulations for controlling the quality of care provided by the government and private hospitals. Supported by state-of-art infrastructure, advanced medical equipment, and highly qualified doctors, the hospitals offer various facilities to improve the patient experience.
In South Africa, the healthcare system is bound to follow standards set by the Joint Commission International (JCI) and Council for Health Service Accreditation of Southern Africa (COHSASA). COHSASA develops and evaluates standards in all areas and departments of a healthcare facility in order to make sure that integrated and coordinated care is provided. SafeCare program has been introduced by COHSASA, JCI, and SafeCare Foundation to use internationally recognized standards to improve health care delivery. Initially, a two-year accreditation is awarded to hospitals and clinics that adhere to standards and the period can be extended if the hospitals continue to deliver expected quality care.
Affordable healthcare and superior infrastructure are the main reasons for the popularity of South Africa in the medical tourism sector. South Africa’s growing popularity in medical tourism is also attributed to factors like a large pool of accredited hospitals, advanced technology, world-class facilities provided by hospitals, global exposure of doctors. South Africa has also liberal laws for the application of stem cells in medical practice, making the country a leading destination for patients who need advanced medical treatment. The hospitals in South Africa aim to destress your medical holiday by dealing with all of the organization and administrative tasks, as well as provide intensive care and assistance on a 24/7 basis.
With quality at their core, the well-trained and highly qualified doctors in South Africa provide world-class treatment. Most of the doctors in South Africa are trained in foreign countries like Cuba and Australia which orientate them towards quality health care. Doctors in South Africa are known for their deep expertise in dental procedures and fertility treatments. South Africa has world-class doctors due to several reasons like their education at reputed colleges, adherence to global standards, patient-centric approach, and incorporation of the human touch in treatment.
A person can apply for a medical visa to South Africa for a period of 90 days. The High Commission helps one decide for how long a visa can be extended. People need to apply for a temporary residency permit in case they have to stay in the country for more than three months. The validity of a visa starts the day it is granted by the High Commission and not on the date of departure. Also, visa applications will not be accepted more than 30 days prior to departure. You need to produce the below documents to apply for a medical visa:
South Africa is known to offer some procedures with high success rates, such as total knee replacement, meniscus repairs, hip replacement, anterior cruciate ligament (ACL) reconstruction. South Africa has also gained popularity for delivering excellent results in cosmetic surgery and infertility treatment. Egg donation program is available in South Africa and it is even possible to select your donor, as well as gives you the option of having a surgical or non-surgical procedure, all with very low waiting times. The reasons for the popularity of these procedures are affordable treatment cost, speedy recovery, use of advanced technology, and highly trained doctors.
The top-ranked cities that are most preferred by medical tourists in South Africa are Cape Town, Johannesburg, Pretoria, and Durban. Cape Town, which attracts a wide variety of people from different ethnicity and cultures, has world-class doctors and state-of-the-art medical facilities. The reasons for the popularity of these cities are multiple food options, connectivity through airlines, and cheap accommodation. Johannesburg’s healthcare system is on par with Great Britain and the city’s public and private healthcare industry works closely with South Africa's medical schools to create internationally recognized medical specialists.
Yes, vaccination is compulsory before visiting South Africa. The vaccines recommended by WHO and the National Travel Health Network and Centre are Rabies and tetanus, hepatitis B, typhoid, cholera, Yellow fever, hepatitis A. Make sure that infants of age 6 to 11 months get measles-mumps-rubella (MMR) vaccine before they travel to South Africa. People staying with friends or relatives or visiting smaller cities or rural areas should get typhoid vaccine. You need to keep yourself updated with vaccination guidelines issued by the government. Also, check with the doctor, the government authority, or hospitals in South Africa as to what vaccination should be taken.
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