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 Switzerland may differ from one medical facility to the other. The top hospitals for Pacemaker Implantation Surgery in Switzerland covers all the expenses related to the pre-surgery investigations of the candidate. The comprehensive Pacemaker Implantation Surgery package cost includes the cost of investigations, surgery, medicines and consumables. Extended hospital stay, complications after the surgery or new diagnosis may affect the overall cost of Pacemaker Implantation Surgery in Switzerland.
Upon discharge from the hospital after Pacemaker Implantation Surgery in Switzerland, 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.
Switzerland 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. Some of the other destinations that are popular for Pacemaker Implantation Surgery include the following:
|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.
Some of the cpopular cities in Switzerland that offer Pacemaker Implantation Surgery include 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 2 hospitals that offer Pacemaker Implantation Surgery in Switzerland. These hospitals have proper infrastructure for the treatment of patients who require kidney transplant. Also, these hospitals follow the necessary guidelines as required by the medical associations for the treatment of Pacemaker Implantation Surgery patients.
Switzerland has some world-class multispecialty hospitals, including:
With more than 500 hospitals, the country has some of the biggest private hospitals in the world. More than 12 hospitals are JCI accredited and they strictly follow international standards. The hospitals provide up to 70 percent of all out-patient services in a location. The growing number of hospitals has helped in developing the center of competence for outpatient diagnostic and therapy. Equipped with modern equipment and the latest medical technologies, the multispecialty hospitals in Switzerland are backed by the modern infrastructure to provide world-class treatment.
In order to ensure that international health standards are met, the hospitals in Switzerland need to sign contracts on quality care. Healthcare accreditation is based on the model of the International Standards Organization. Standard EN 45001 acts as a benchmark for the accreditation of healthcare providers. The quality of test results is decided after the assessment of the accepted values and requirements. Healthcare standards help hospitals to evaluate, control, and improve the standards of quality healthcare.
Switzerland is one of the most popular medical tourism destinations in the world because of several reasons like its highly qualified trained staff, traditional values of quality, and research-focus. Switzerland has some of the best infrastructure available, which naturally reflects in its medical tourism sector. Travelers have flocked to the country to take the advantage of healing waters. Their exceptional research institutes offer medical care of the highest quality. Switzerland has received worldwide recognition for its contribution to medical innovation and new treatments. Several renowned research institutes have come up with medical breakthroughs and new treatments.The Swiss are well known for their excellence in medical innovation and new treatments. Several world-famous research institutes have contributed to medical breakthroughs and new treatments. Switzerland’s popularity in medical tourism is also attributed to some other factors like high level of privacy, quality and safe treatments, and a wide range of treatment specialties.
Hospitals in Switzerland generally accept health insurance but always connect with your insurance company to check whether the treatment you want to undergo is covered at the hospital in the country. In case of an approved insurance provider, the hospital can start cashless treatment once it receives the Guarantee of Payment from the insurance. You should know that the expense of many treatments and processes are not covered by insurance plans, such as cosmetic surgery, pregnancy and abortion, and diagnostic tests. If a treatment is not covered under a health insurance plan in Switzerland, you can initially pay for the treatment and apply for reimbursement after you are back in your country.
Switzerland has received worldwide recognition for reporting high success rates in the following procedures.
These procedures are performed with high precision and accuracy at high-standard clinics and hospitals backed by advanced technology, and well-trained doctors. With such a wide variety of treatments available, Switzerland is truly a hub for medical tourists. Its reputation for cosmetic surgery and medical health spas have also made it a preferred spot for many people. The credit for the high success rate of IVF mainly goes to Swiss fertility experts who have been regarded as ‘artists’ due to their skills in fertility treatment and their commitment towards personalized care.
Some popular cities of Switzerland that attract a huge number of medical tourists every year are Zurich, Lucerne, Bern, Basel, Geneva, Lausanne, Lugano. With highly trained and qualified doctors and a large pool of multispecialty hospitals, Switzerland offers a great medical travel experience. Zurich and Geneva are the most popular destinations for medical tourism in Switzerland as these cities have an amazing public transportation system, a number of cheap hotels, and connectivity through airlines. These cities are most preferred by medical tourists because of many other reasons like a large number of hospitals, rich culture, scenic value, availability of translators, and safety of tourists.
Yes, you need to get vaccinated before traveling to Switzerland. WHO and the CDC have suggested the following vaccinations:
Make sure you have MMR and other routine vaccinations as some parts of Switzerland have routine disease outbreaks. The recommended vaccinations for travelers to Switzerland vary according to the traveler's age, immunization history, and existing medical conditions. Before a trip to Switzerland, you should get pre-exposure vaccination against rabies and yellow fever.
Anyone traveling to Switzerland to seek treatment needs to have Schengen Visa. You are allowed to stay for a maximum of 90 days in Switzerland if you hold this visa. You should apply for a National Visa for Medical Treatment if you are suffering from a serious medical condition and need to stay longer for treatment. You need to produce the below documents to apply for a medical visa:
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