A pacemaker is a device that is implanted in the chest to regulate an abnormal or irregular heartbeat. It consists of two components a pulse generator that helps in generating the electric pulse to stimulate the heart and a lead which helps in carrying the electrical impulse to the required chambers of the heart. Pacemakers recommended for people having a slow heartbeat which can lead to symptoms of dizziness, blackouts, feeling lethargic or feeling breathlessness.
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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.
In the United Arab Emirates, the average starting cost for Pacemaker Implantation Surgery is USD 6000. Only some of the best and certified hospitals in the United Arab Emirates perform Pacemaker Implantation Surgery for international patients.
The cost of Pacemaker Implantation Surgery in the United Arab Emirates may differ from one medical facility 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. A prolonged hospital stay due to delayed recovery, new diagnosis and complications after surgery may increase the cost of Pacemaker Implantation Surgery in the United Arab Emirates.
There are several best hospitals for Pacemaker Implantation Surgery in the United Arab Emirates. The following are some of the most renowned hospitals for Pacemaker Implantation Surgery in the United Arab Emirates:
After Pacemaker Implantation Surgery in the United Arab Emirates, the patient is supposed to stay in guest house for another 14 days. This duration of stay is recommended to complete all the necessary follow-ups and control tests to ensure that the surgery was successful.
While the United Arab Emirates 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 Pacemaker Implantation Surgery cost, there are a few other daily charges that the patient may have to pay. These are the charges for daily meals and accommodation outside the hospital. The per day cost in this case may start from USD 50 per person.
Some of the best cities in the United Arab Emirates which offer Pacemaker Implantation Surgery are:
It is possible for patients to opt for video telemedicine consultation before they come for Pacemaker Implantation Surgery in the United Arab Emirates. Some of the surgeons offering this service include the following
|Doctor||Cost||Schedule Your Appointment|
|Dr. Kamal Al Abdi||USD 173||Schedule Now|
|Dr. Girishchandra Varma||USD 173||Schedule Now|
|Dr. Luc J M T Tambeur||USD 173||Schedule Now|
|Dr. Ala Eldin Farasin||USD 173||Schedule Now|
The patient has to spend about 3 days in the hospital after Pacemaker Implantation Surgery for proper recovery and to get clearance for discharge. 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.
The average rating for Pacemaker Implantation Surgery hospitals in the United Arab Emirates is 4.5. 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 20 hospitals that offer Pacemaker Implantation Surgery in the United Arab Emirates. These hospitals have proper infrastructure for the treatment of patients who require kidney transplant. These hospitals comply with all the rules and regulations as dictated by the regulatory bodies and medical association in United Arab Emirates
DHCA (Dubai Healthcare City Authority) and JCI (Joint Commission International) are the standard accreditation followed by UAE hospitals. In UAE, the excellent hospital infrastructure, medical care quality and service delivery quality is overseen by Dubai Healthcare City Authority and Joint Commission International. A governing body of Dubai Healthcare City, DHCA accredition is well sought after whereas JCI as a non profit organisation is an international accreditation body. The Dubai Healthcare City Authority was established in May 2011 whereas Joint Commission International was founded in 1998 as a division of The Joint Commission (est. 1951).
The multispecialty hospitals in UAE are known for providing exceptional care at affordable prices. The multispecialty hospital groups in UAE enable you to get all your intended treatments done at one place owing to the availability of all kinds of specialties under one roof. The multispecialty hospitals in UAE promise to be easy to navigate for any medical traveller because of the innate hospitable nature of the both the administrative and the medical personnel.
The healthcare sector in UAE has expanded dramatically since the 1970s to include more number of hospitals, healthcare centers, clinics, rehabilitation centers and related infrastructure making it a natural choice for any person wanting to get their treatment done. The UAE government is focusing on the healthcare sector to drive growth and ensuring the availability of quality healthcare to all. UAE healthcare organisations provide a high standard of care as they function seamlessly in a well organised manner. A good reason for you to seek treatment in the UAE is not just because of the strong healthcare sector but also because of the strong network of tourism system in the country including hotels, transport logistics and aviation.
The stringent requirements of obtaining a license to practice medicine gives credibility to the quality of doctors working in the UAE. The doctors in UAE are not only well versed in their area of expertise but they also keep abreast of the latest developments. The doctors here bring a personal touch to the way they treat patients everyday. The doctors in UAE have international exposure as their patient base is composed of various ethnicities and nationalities.
You need to carry all required documents when you are coming to UAE for your treatment. Your journey to UAE as a medical traveller is a seamless and easy process if all your documents are kept ready at one place. The documents required for medical travel to UAE are related to your travel and for the medical treatment that you are undergoing. Please ensure that you carry essential documents to UAE as mentioned below.
Popular procedures being performed in UAE are as follows.
It is heartening that cosmetic surgery has found a place in the list of popular procedures in UAE and among these botox and fillers are most common. Another procedure for which the government in UAE is changing laws and building a positive environment are Fertility treatments. The popular procedures in UAE are being done by accompished doctors and at economical costs.
Pre travel vaccinations are important before your UAE travel. Also, the vaccinations should be administered one month prior. The country of origin or destination (if going from UAE), length of stay, health conditions and current doctors' prescriptions are the major factors in the kind of vaccines and their dosage. Do get the yellow fever vaccination for Central African for South American countries.
Medical tourism in UAE is made attractive by many factors and one of them includes the facilities provided by hospitals. Public and private healthcare systems together strengthen the hospital infrastructure in UAE. Major hospitals in UAE have an international patient center which helps coordinate the visit of medical tourists to UAE. International patient centers are making the medical travellers lives easy by helping them in many ways such as:
Medical tourism is a strong forerunner among the industries which are growing fast in United Arab Emirates. Abu Dhabi, the island city and also the capital of United Arab Emirates and Dubai, where real estate and tourism are the backbone of the economy are both important medical tourism destinations in UAE. The healthcare infrastructure which is being continually upgraded has given Dubai and Abu Dhabi the advantage as medical tourism destinations. In UAE, investment in the healthcare sector from private firms and the government with a strong framework in health regulation is an advantage for medical tourism.
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