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 Tunisia starts from about $3600. There many TEMOS certified hospitals in Tunisia that offer Pacemaker Implantation Surgery
The Pacemaker Implantation Surgery package cost in Tunisia varies from one hospital to another and may offer different benefits. The top hospitals for Pacemaker Implantation Surgery in Tunisia covers all the expenses related to the pre-surgery investigations of the candidate. The Pacemaker Implantation Surgery cost in Tunisia includes the cost of anesthesia, medicines, hospitalization and the surgeon's fee. Extended hospital stay, complications after the surgery or new diagnosis may affect the overall cost of Pacemaker Implantation Surgery in Tunisia.
After discharge from the hospital, the patient has to stay for another 14 days in the country for complete recovery. This duration of stay is recommended to complete all the necessary follow-ups and control tests to ensure that the surgery was successful.
Tunisia is one of the most popular countries for Pacemaker Implantation Surgery in the world. The country offers the best cost of Pacemaker Implantation Surgery, best doctors, and advanced hospital infrastructure. Some of the other popular destinations for Pacemaker Implantation Surgery include the following:
|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.
Some of the best cities in Tunisia 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. 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 3 hospitals that offer Pacemaker Implantation Surgery in Tunisia. Such clinics have the required infrastructure and a dedicated unit where patients can be treated. Such hospitals follow all legal protocols and guidelines as specified by the local medical affairs body when it comes to the treatment of international patients.
We have outlined the most popular multispecialty hospitals in Tunisia for your reference:
It is widely known that hospitals and clinics in Tunisia function with unmatched service delivery and bring a personal touch to the treatment of patients. When it comes to diagnosing health conditions and treating them well to the patients’ satisfaction, the multispecialty hospitals in Tunisia are able to accomplish it with efficiency and finesse. The cutting edge infrastructure of the healthcare institutions in Tunisia is a good reason for you to opt for healthcare in Tunisia.
You must opt for healthcare in Tunisia because of the cutting edge infrastructure of its hospitals and clinics. The hospitals and clinics in Tunisia have not only the most qualified medical and paramedical personnel but quality administrative professionals as well making Tunisia a good choice for your healthcare. A 360* approach from consultation to post treatment rehabilitation or follow ups, short waiting times and competitive costs make Tunisia the right choice for you to get your healthcare from. You must opt for your healthcare in Tunisia because of the high cleanliness standards of the hospitals and clinics in Tunisia and the safe and secure environment of the country.
The practical training and long term experience of doctors in Tunisia enables them to work well under pressure for long hours which translates to great results. In their quest to learn and apply that knowledge to treat patients satisfactorily, the doctors in Tunisia get the best of education and upgrade their qualifications throughout their career. It must be put forth that the doctors in the Tunisian healthcare system are good in people skills and thus great at managing relationships with fellow doctors and healthcare professionals and in leading teams. The doctors in Tunisia are great at leading medical, surgical teams and are experienced in liaising with doctors and healthcare professionals giving you the confidence as a patient that you are in good hands.
Please find here the list of essential documents that must be with you on your medical travel to Tunisia:
The important documents that are needed for your medical travel to Tunisia are mentioned here for your convenience. The Government of Tunisia is now introducing an online visa application process which would ease your medical travel preparation to Tunisia. An essential document for your medical travel to Tunisia, the medical visa would now be easier to get with the introduction of a more seamless online visa application process.
Please find outlined here the popular procedures done in Tunisia everyday:
It is no wonder that Spine and Orthopaedic procedures are giving the edge to the medical travel industry in Tunisia. The advanced Breast Cancer treatment is making sure that a lot of medical travellers are heading to Tunisia to get a new lease of health and life. Fibroid removal surgery, a gynecological procedure is in a lot of demand in Tunisia, and brings in a lot of medical tourists to Tunisia.
Please find below the vaccinations that are important for you to take before your travel to Tunisia:
Two bodies vis a vis, WHO: World Health Organisation and CDC: The Centers for Disease Control and Prevention, the US agency have suggested that you get vaccinated before heading to Tunisia and these vaccinations are of two kinds, recommended and routine vaccines. There are vaccines that are only suggested for certain potential health hazards such as Hepatitis A, Hepatitis B, Typhoid and Rabies and then there are other vaccines which you must be up to date at any time before traveling to Tunisia. It is always wise to get vaccinated before going on your medical travel to Tunisia whether recommended by any health agency or not.
Whenever you are in the process of deciding to go to Tunisia for medical travel, the many additional facilities extended by the hospitals make the decision easier. We bring to you the additional facilities present for medical tourists in hospitals in Tunisia:
We have outlined for you the various additional facilities that are there in the hospitals in Tunisia. There are various extra facilities for patients and their co travellers in the hospitals in Tunisia such as prayer rooms (for spiritual patients), physiotherapists and dietitians.
There are many great medical tourism destinations in Tunisia which is because of a combination of wonderful tourist places and excellent medical infrastructure. We bring to you the many medical tourism destinations in Tunisia:
In the 2020-21 Medical Tourism Index listing 46 countries, Tunisia has a good ranking of 38. This is because of the focus on healthcare, having good relationships with the European union and Arab nations and a strong tourism industry. Tunisia is on the fast track to growth as a sought after medical tourism destination because it provides excellent healthcare at competitive prices, an easy to get medical visa and warm hospitality shown by the people in Tunisia.
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