Pacemaker Implantation
in Hyderabad

Modern pacemakers are intelligent devices

Contemporary pacemakers do far more than simply pace the heart at a fixed rate. They adapt the pacing rate to the patient's activity level (rate-responsive pacing), communicate wirelessly with monitoring equipment at home, store detailed rhythm logs for review at each clinic visit, and in many models, are compatible with MRI scanning.

Why would I need a pacemaker?

A pacemaker is recommended when the heart's natural electrical system produces a rhythm that is too slow, pauses too long, or is poorly coordinated — and when this is causing symptoms or poses a significant risk. The most common indications are:

Sick sinus syndrome (SSS)The sinus node — the heart's natural pacemaker — fires too slowly, too irregularly, or alternates between slow and fast rhythms. Symptoms include fatigue, lightheadedness, shortness of breath, and fainting. SSS is one of the most common reasons for pacemaker implantation, particularly in older patients.

Atrioventricular (AV) block — heart block

The electrical signal between the upper chambers (atria) and lower chambers (ventricles) is delayed or completely interrupted. There are three degrees:

Bundle branch block with symptoms

The electrical conducting pathways (bundle branches) within the ventricles are blocked. Left bundle branch block (LBBB) or right bundle branch block (RBBB) combined with symptoms or other conduction abnormalities may require pacing.

After cardiac procedures

TAVR, open-heart valve surgery, or heart transplantation can disrupt the conduction system, sometimes requiring a permanent pacemaker. Approximately 10 to 20% of TAVR patients require permanent pacing after valve implantation.

Neurocardiogenic (vasovagal) syncope — selected cases

Recurrent unexplained fainting caused by sudden drops in heart rate — in patients who have not responded to other treatments and who have a predominantly cardioinhibitory pattern on tilt table testing — may benefit from a pacemaker.

Types of pacemakers

The type of pacemaker implanted is determined by the underlying electrical problem, the number of heart chambers that need pacing, and individual patient factors including age, lifestyle, and whether MRI compatibility is required.

Temporary pacemakers — when are they used?

A temporary pacemaker is a non-implanted device used to pace the heart in emergency or short-term situations while a decision about permanent pacing is made, or while a reversible cause of bradycardia is treated.

How is a pacemaker implanted? Step by step

Before the procedure

• Admission the evening before or on the morning of the procedure.
• Blood tests, ECG, chest X-ray, and echocardiogram reviewed.
• Antibiotic cover given intravenously before the incision to prevent device infection.
• The left upper chest is shaved, cleaned, and prepared. The right side is used in specific anatomical situations.
• An IV line is placed in the arm. Monitoring electrodes are attached.
• You fast for 4 to 6 hours before the procedure.

During the procedure

1. You lie on the procedure table. Local anaesthesia is injected beneath the left collarbone — this causes a brief sting, after which the area is completely numb. Conscious sedation keeps you comfortable and relaxed throughout. You remain awake and can communicate with Dr. Bhishma Chowdary and the team at any time.
2. A small incision of approximately 3 to 4 cm is made just below the collarbone.
3. The subclavian or cephalic vein — a vein running just beneath the collarbone — is accessed. This provides the pathway for the pacing lead(s) to reach the heart.
4. One or two leads (depending on the device type) are advanced through the vein into the heart under live X-ray guidance. The lead tip is positioned carefully in the right ventricle (and right atrium for dual-chamber devices) and fixed in place — either by a small screw mechanism at the tip (active fixation) or by soft tines that grip the heart wall (passive fixation).
5. Pacing and sensing thresholds are measured to confirm excellent lead position and function — this ensures the device delivers effective pacing with the lowest possible energy consumption.
6. A small subcutaneous pocket is created just beneath the skin and fat layer of the upper chest. The pacemaker generator is connected to the leads and placed into this pocket.
7. The incision is closed with sutures. A sterile dressing is applied.
8. A chest X-ray is taken immediately to confirm lead positions and rule out any procedural complications.
9. The pacemaker is programmed to your specific heart rate requirements before you leave the cath lab.

After the procedure

• You are monitored on the cardiac ward overnight — ECG monitoring confirms stable pacing and sensing.
• A 12-lead ECG and repeat chest X-ray are done the following morning.
• The device nurse programmes and checks the pacemaker before discharge.
• You receive a pacemaker identity card — carry this at all times. It contains your device model, implanting cardiologist's details, and hospital contact information. Essential for any future medical procedures, airport security, and emergency situations.
• Most patients are discharged on day 1 or day 2 after the procedure.

Recovery after pacemaker implantation

First week

• Keep the wound site clean and dry. A waterproof dressing is provided for showering. Avoid submerging the wound in water (no baths, swimming) until fully healed — approximately 2 weeks.
• Do not raise the arm on the implant side above shoulder level for 4 to 6 weeks. This is the most important restriction — early arm elevation can displace the pacing leads before they have fixed securely.
• Light walking is encouraged from the first day. It is good for recovery.
• Avoid driving for at least 1 week. Confirm timing with Dr. Bhishma Chowdary.
• Desk work and light activities can resume within 5 to 7 days.

First month

• Attend the 6-week device check appointment — the first formal pacemaker interrogation after implantation. Lead thresholds, battery status, and stored rhythm data are reviewed.
• Avoid contact sports, heavy lifting (nothing over 5 kg on the implant side), and activities involving repetitive or forceful arm movements above the head for 4 to 6 weeks.
• Report immediately if you notice: redness, swelling, or discharge from the wound; fever; persistent hiccups (can indicate lead displacement); pulsing sensation in the neck; dizziness or recurrence of pre-pacemaker symptoms.

Long term

• Device checks every 6 to 12 months — either in clinic or via remote monitoring.
• Remote monitoring: Many modern pacemakers transmit data nightly to a secure server. Dr. Bhishma Chowdary's team can review rhythm logs, battery status, and alerts without the patient needing to attend clinic — particularly valuable for elderly patients and those travelling from outside Hyderabad.
• Battery replacement: When the battery nears depletion (detected months in advance at a routine check), a generator replacement procedure is performed. This involves reopening the original pocket, disconnecting the old generator, connecting a new one to the existing leads, and closing. The leads are usually not touched. It is significantly simpler than the original implantation.

Living with a pacemaker — what you need to know

Everyday activities that are safe

• All standard household appliances — microwave ovens, televisions, computers, mobile phones (keep phone 15 cm from device when in use), electric blankets.
• Air travel — inform security personnel and show your pacemaker identity card. Walk-through metal detectors may trigger an alarm. Request a hand wand scan instead of a prolonged magnetic wand directly over the device.
• Driving — usually permitted from 1 week after implantation for routine bradycardia indications. Note: if a pacemaker was implanted after a syncopal (blackout) episode, DVLA/RTO driving restrictions may apply for a period. Dr. Bhishma Chowdary will advise specifically.
• Sexual activity — can resume within 2 to 4 weeks once the wound has healed.
• Exercise — moderate regular exercise is encouraged. Swimming after wound healing is permitted. Contact sports and activities with a high risk of blunt chest impact should be discussed first.

Situations requiring caution or prior notification

• MRI scanning — if you have an MRI-conditional pacemaker, MRI is possible under specific conditions. The scanning team must be informed in advance so the device is switched to MRI Safe mode before the scan and reprogrammed afterwards. Always carry your device identity card to any MRI appointment.
• Dental procedures — most routine dental work is safe. Electrosurgery (diathermy) during dental or surgical procedures can interfere with pacemakers. Always inform your dentist and any surgeon about your pacemaker before procedures.
• Physiotherapy equipment — avoid therapeutic ultrasound, TENS machines, and electrocautery directly over the pacemaker pocket.
• Industrial equipment — strong magnetic fields from industrial welding equipment, arc welders, and large electrical generators can interfere with pacemaker function. Maintain a safe distance as advised on your device card.
• Radiotherapy — radiation therapy near the pacemaker site can damage the device. Always inform your oncologist of your pacemaker if radiotherapy is being planned.

Frequently asked questions

Will I feel the pacemaker pacing?
Most patients do not feel the electrical impulses from a pacemaker at all — the signals are tiny and sub-threshold for sensation. Some patients occasionally notice a slight flutter or awareness of the heartbeat, particularly when pacing switches on suddenly after a pause. This is usually described as mild and not distressing. If you experience regular uncomfortable palpitations after pacemaker implantation, inform Dr. Bhishma Chowdary — the device settings can be adjusted.

Can I have an MRI scan with a pacemaker?
This depends on your specific device. Modern MRI-conditional pacemakers — which are now implanted as standard at AIG Hospitals — can safely undergo MRI scanning when specific protocols are followed: the device must be programmed to MRI Safe mode before the scan, the MRI must be performed within specified field strength limits, and the device must be reprogrammed back to normal settings afterwards. Older pacemaker models that are not MRI-conditional require a risk-benefit discussion before any MRI. Always carry your pacemaker identity card and inform the radiology team before any MRI appointment.

How will I know if my pacemaker is working?
There are three ways this is monitored. First, the resolution of your original symptoms — dizziness, fainting, and fatigue should improve significantly after implantation if they were due to the slow rhythm. Second, regular device checks in clinic — a programmer communicates wirelessly with the pacemaker to read stored data, check battery level, and verify pacing and sensing thresholds. Third, remote monitoring — if your device supports it, nightly data transmissions allow Dr. Bhishma Chowdary's team to review device performance without a clinic visit and respond proactively to any alerts.

What happens when the pacemaker battery runs out?
Pacemaker batteries do not run out suddenly. The device tracks its own battery status and signals when it is approaching end of service — typically 3 to 6 months before full depletion. This is detected at a routine device check well in advance. A generator replacement procedure (battery change) is then planned — this is a simpler procedure than the original implantation. The existing leads are reconnected to a new generator through the same pocket. Most patients go home the same day or the following morning.

Can I use my mobile phone with a pacemaker?
Yes, mobile phones are safe with modern pacemakers. The recommended precaution is to keep the phone at least 15 cm away from the pacemaker generator — so do not carry the phone in a breast pocket on the implant side, and hold the phone to the opposite ear when making calls. Bluetooth earpieces, wireless headphones, and standard headphones are all safe.

I have been told I need a pacemaker but I am worried about the procedure. What should I know?
This is a very common and understandable concern. The procedure is performed under local anaesthesia — you will not feel the incision or the lead placement. Conscious sedation keeps you relaxed throughout. The procedure takes 1 to 2 hours and most patients are surprised by how comfortable it is compared to expectations. Dr. Bhishma Chowdary and the team explain each step as it happens. The vast majority of patients feel significantly better within days of implantation as their heart rhythm stabilises and symptoms resolve.

Will the pacemaker be visible under the skin?
In most patients, a small contour or bulge is visible and palpable just below the collarbone — particularly in slim individuals. The device sits beneath the skin and fat layer above the chest muscle. Over time, surrounding tissue adapts and it becomes less noticeable. Clothing covers it entirely. The incision scar is approximately 3 to 4 cm and fades to a thin line over months.

What is the difference between a pacemaker and a defibrillator (ICD)?
A pacemaker treats slow heart rhythms (bradycardia) by pacing the heart when it beats too slowly. An implantable cardioverter-defibrillator (ICD) treats dangerously fast heart rhythms (tachycardia or ventricular fibrillation) by delivering a shock to reset the heart. Some patients need both functions — these receive a combined CRT-D or dual-function device. The decision about which device is appropriate depends entirely on your specific heart rhythm diagnosis.

Do I need to change my diet or take new medications after pacemaker implantation?
The pacemaker itself does not require specific dietary changes. However, you will continue any existing heart medications as prescribed. If new medications are started for the underlying heart condition (such as blood thinners if atrial fibrillation is also present), these will be discussed at discharge. A heart-healthy diet and avoidance of smoking remain important for your overall cardiac health regardless of the pacemaker.

Why choose Dr. Bhishma Chowdary for pacemaker implantation in Hyderabad?

• DM Cardiology from Amrita Institute of Medical Sciences, Kochi — comprehensive electrophysiology and device training.
• Experience in the full range of cardiac device implantations: single-chamber, dual-chamber, rate-responsive, CRT-P, and leadless pacemakers.
• MRI-conditional pacemakers implanted as standard — eliminating future MRI restrictions for patients.
• Remote monitoring programme — patients can be reviewed without clinic visits, particularly valuable for elderly patients and those from outside Hyderabad.
• Integrated post-TAVR pacing programme — seamless management of conduction complications after structural heart procedures.
• Complete cardiac care under one roof at AIG Hospitals — echocardiography, cardiac CT, device laboratory, and cardiac surgery all on-site.
• Transparent pre-procedure counselling — full explanation of device type, programming rationale, lifestyle implications, and long-term follow-up plan before any procedure.
• Fluent consultations in English, Hindi, and Telugu.

Book a pacemaker consultation in Hyderabad

If you have been told you have a slow heart rate, heart block, sick sinus syndrome, unexplained fainting, or have been advised you may need a pacemaker — contact Dr. Bhishma Chowdary at AIG Hospitals, Gachibowli, Hyderabad for a specialist assessment.

Call: +91-9000352998

Email: bhishmachowdary@gmail.com

Location: AIG Hospitals, Gachibowli, Hyderabad — 500032

Clinic hours: Monday to Saturday, 10:00 AM to 4:00 PM

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