The biventricular pacemaker is a surgical procedure applied for cardiac resynchronization therapy for the cases of heart failure.
In the normal heart, the heart's lower chambers (ventricles) pump at the same time and in sync with the heart's upper chambers (atria). During the heart failure of a person, his/her right and left ventricle don’t perform together.
When a person has heart failure, often the right and left ventricles do not pump together. After the heart’s contraction, left ventricle won’t pump blood to the body. It gives uplift to the heart risks such as short breath, dry cough, swelling in the ankles or legs, weight gain, increased urination, fatigue, or rapid or irregular heartbeat.
What is the indication of the biventricular pacemaker?
In 50% of people, pacemaker cover the symptoms of heart failure, which after treatment have moderately heart failure symptoms. If you want to be eligible for the biventricular pacemaker, then heart failure candidates:
•    Achieving moderate or severe heart failure symptoms
•    heart failure symptoms.
•    Be taking medications to treat heart failure.
•    Have delayed electrical activation of the heart
What to do before pacemaker procedure?
Go to your doctor and ask to give you medicines which you are allowed to swallow down before bi-ventricular pacemaker. Your doctor may ask you to stop certain medications several days before your procedure. If you have diabetes, ask your doctor how you should adjust your diabetic medications.
Do not eat or drink anything after midnight the night before the procedure. Swallow only mini sips of water while in taking your medicine.
Wear loose clothes while assembling in the hospital for surgery. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.
What happens during the pacemaker procedure biventricular?Pacemakers can be implanted two ways:
- Inside the Heart (Endocardial, Tran venous approach): This is the most common technique used. Lead is inserted into a vein and then it is attached to your heart. Heart muscle is attached to the lead tip. The other end of the lead is attached to the pulse generator, which is placed under the skin in your upper chest. Surgery is performed under general anesthesia. This technique is done under local anesthesia (you will not be asleep).
- Outside the Heart (Epicardial approach): The lead tip is attached to the outside of the heart. The other end of the lead is attached to the pulse generator, which is placed under the skin in your abdomen. This technique is done under general anesthesia (you will be asleep) by a surgeon.
- Your doctor will decide which approach is best for you.
What is the procedure of pacemaker biventricular?
- Your procedure will take place in the electrophysiology (EP) lab. After admitting you, the nurse will give all the medicines and fluids on time. To prevent the infection, an antibiotic will be given to you through the IV. You will receive a medication through your IV to make you drowsy. Medicines provide to you will not make you fell asleep. The medication will not put you to sleep.
- You will be connected to several monitors by the nurse. This connection between you and monitor will help doctor and nurse to predict all the happenings going on during the procedure.
- After the leads are tested, the doctor will connect them to your pacemaker. Your doctor will determine the rate of your pacemaker and other settings. After implantation final pacemaker procedure is done with help of the specialized device called the programmer.
The pacemaker implant procedure lasts about 2 to 5 hours.
What happens after the pacemaker biventricular is implanted?
After the pacemaker implant, you will likely be admitted to the hospital overnight. The nurses will monitor your heart rate and rhythm. A small electrode patch has an attachment for telemetry monitor. The recording will be done of your heartbeat for about 12 hours. This is another way to check proper pacemaker function. Next morning after implantation, a chest X-ray
will be made for the checking of your lungs and the position of your pacemaker and leads.
For your final pacemaker check, you will sit in a reclining chair and the pacemaker will be attached to a computer monitor. The pacemaker is checked by a small machine known as the programmer. A small machine known as a programmer is used to check your pacemaker. This machine allows the nurse or doctor
to read your pacemaker settings and make changes during testing.
With these changes, the function of the pacemaker and leads can be evaluated. It will felt that your heart beat rate sometimes beat faster and slower. It is normal but you should tell the nurse in case if it gets worse. Results of the pacemaker check are discussed with your doctor who will then determine your pacemaker settings.
After your pacemaker check, an echocardiogram may be done. During an echo, the nurse will be there and your pacemaker will be changed to 3 times. The echo will be repeated with each change to evaluate heart function. The pacemaker will keep the settings that demonstrated your best heart function.
When will patients get discharged?
Usually, you will be able to go home the day after your pacemaker is implanted. Your doctor
will discuss the results of the procedure and answer any questions you may have. A doctor or nurse will go over specific instructions for your care at home. Please ask a responsible adult to drive you home, as the medications you received may cause drowsiness, making it unsafe for you to drive or operate heavy machinery.
When can you get back to the daily schedule?
You may move your arm normally and do not have to restrict its motion during normal daily activities if you have a pacemaker. Avoid extreme pulling or lifting motions (such as placing your arm over your head without bending at the elbow). Activities such as golf, tennis, and swimming should be avoided for 6 weeks from when the pacemaker was implanted. Microwave ovens, electric blankets, and heating pads may be used. Cellular phones should be used on the side opposite your pacemaker. Ask your doctor or nurse for more specific information regarding what types of equipment may interfere with your pacemaker.
How long will your pacemaker last?
Regular pacemakers usually last 4 to 8 years. Biventricular pacemakers
that are combined with an ICD and do not tend to last as long (about 4 to 6 years).
What are the precautions taken after the surgery?
Keep the area where the pacemaker was inserted clean and dry. After about five days, you may take a shower. Look at your wound daily to make sure it is healing. Call your doctor if you notice:
•    Increased drainage or bleeding from the insertion site.
•    Increased opening of the incision.
•    Redness around the incision site.
•    Warmth along the incision.
•    Increased body temperature (fever or chills).
Pacemaker chamber biventricular minimum cost for Rs. 75,000 to maximum Rs. 1,50,000.