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.
Pacemaker Implantation Surgery cost in South Korea varies from one hospital to the other. There are many hospital that cover the cost of pre-surgical investigations of the patient in the treatment package. The comprehensive Pacemaker Implantation Surgery package cost includes the cost of investigations, surgery, medicines and consumables. There are many things that may increase the cost of Pacemaker Implantation Surgery in South Korea, including prolonged hospital stay and complications after the procedure.
There are many hospitals across the country that offer Pacemaker Implantation Surgery to international patients. For quick reference, the following are some of the leading hospitals for Pacemaker Implantation Surgery in South Korea:
After discharge from the hospital, the patient has to stay for another 14 days in the country for complete recovery. This is important to ensure that the surgery was successful. During this time, control and follow-up tests take place to check for medical fitness.
While South Korea is considered to be one of the best destinations for Pacemaker Implantation Surgery owing to the standard of Hospitals, and expertise of doctors; there are a select few destinations which provide comparable quality of healthcare for the procedure 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 cost of Pacemaker Implantation Surgery, the patient is also required to pay additionally for daily meals and guest house accommodation. The per day cost in this case may start from USD 50 per person.
There are many cities that offer Pacemaker Implantation Surgery in South Korea, including the following:
The average duration of stay at the hospital after Pacemaker Implantation Surgery is about 3 days for proper care and monitoring. During the recovery, the patient is carefully monitored and control tests are performed to see that everything is okay. If required, physiotherapy sessions are also planned during recovery in hospital.
There are more than 1 hospitals that offer Pacemaker Implantation Surgery in South Korea. These hospitals have propoer infrastructure as well as offer good quality of services when it comes to Pacemaker Implantation Surgery Also, these hospitals follow the necessary guidelines as required by the medical associations for the treatment of Pacemaker Implantation Surgery patients.
The healthcare systems in South Korea are accredited by Commission International (JCI) and Korea Institute for Healthcare Accreditation (KOHIA). JCI, which has certified around 29 hospitals in South Korea, has set strong quality parameters based on which hospitals are evaluated. KOIHA has a comprehensive framework for evaluating the hospitals and the quality parameters are administrative management and quality of patient care and performance management. The certified hospitals are strictly monitored by the accreditation bodies to ensure the quality of healthcare is as per the international standards.
With advanced infrastructure and most advanced medical technologies in place, South Korea is one of the leading medical tourism destinations in the world. Backed by world-class hospitals, South Korea has well-qualified doctors who are highly trained and skilled to handle even the most complicated cases with a high success rate. Proving quality care at an affordable cost, South Korea is declared most innovative in healthcare practices which helps the country to offer a wide range of procedures with excellent results. South Korea is one of the most preferred medical tourism destinations in the world due to many other reasons, such as a wide range of food options, scenic value, affordable accommodation, visa availability, transportation facilities, and language assistance.
Handling a large number of successful procedures, the talented doctors in South Korea use their deep expertise in performing various procedures with high precision and accuracy. The world-class doctors in South Korea have earned degrees from reputed universities and have experience of working in different countries, which makes them efficient in handling even the most complicated cases with high success rates. The doctors aim to provide quality care with complete patient satisfaction by following medical protocols and international standards. The doctors acknowledge the power of the human touch in providing an effective treatment and also believe in personalized care for getting desired results.
Always get in touch with the concerned authority to know if you require any other document other than those mentioned here. In order to make sure that you do not miss any essential documents, make a list of all the documents you might need during your stay in South Korea. Some other things documents you may need are currency/forex card, travel insurance paper, international SIM card. Make sure that you carry all the essential documents when traveling to South Korea, such as passport copies, test reports, residence/ driver’s license, bank statement, doctor referral notes, medical history, details of health insurance, visa, credit/debit cards.
A large number of people visit South Korea every year to avail procedures like:
. South Korea is known as the world capital of plastic surgery with many cosmetic surgery clinics scattered all across the country. Some other procedures that have seen high success rates in the country include cancer treatment, organ transplant, cardiovascular surgeries and hip and shoulder replacement. South Korea has also made major advances in cancer treatment and the latest technology used to remove cancer cells are robotic surgeries and proton therapies.
Some of the most visited cities offering quality treatment in South Korea are Seoul, Busan, Incheon, Daegu, Cheonan, and Cheonan. These cities are backed by a number of multispecialty hospitals, the modern infrastructure, and highly skilled and trained doctors. Several other reasons that contribute to the popularity of these cities are transportation facilities, affordable accommodation, more food options, language assistance. Seoul boasts of having the world’s highest per-capita rate of cosmetic surgeries and Gangnam district has around 500 cosmetic and aesthetic centers.
A person willing to visit South Korea for treatment has to adhere to strict protocols set by the Korean embassy. A candidate has to produce medical records citing medical reasons and the referral certificate signed by the registered medical expert. A medical dependent visa is given to people who are accompanying the patient traveling to South Korea for medical treatment. All necessary documents or letters providing the details of the treatment and signed/stamped by the hospital/doctor, a declaration from the patient or any family member is also required.
South Korea is known to have world-class multispecialty hospitals, such as:
Backed by state-of-art infrastructure and advanced medical technology, the world-class multispecialty hospitals in South Korea are able to provide unmatched treatment of international standards. With quality at the core, the hospitals dedicatedly follow quality standards and medical protocols in order to provide safe and quality medical care. With a wide range of specialities, the hospitals have reported high success rates with the help of highly-experienced doctors who are capable of performing even the most complex surgeries with high accuracy and precision.
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