Electrical System of Heart

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Electrical System of Heart

The heart’s electrical system regulates the rate and rhythm of the heartbeat. With each heartbeat, an electrical impulse travels from the top of the heart to the bottom, indicating the heart’s muscles contract and pump blood. A Heart Pacemaker (an electrical device) is required if the pumping of the heart is too fast or too slow (Irregular heartbeats are called arrhythmias). In either case, the body does not get enough blood. So the pacemaker regulates the electrical system that controls heart rhythm.

Electrical System of Heart


Electrophysiology Study (EPS): Once the doctor suspects that there is a heart rhythm problem, he advises the patient to undergo EPS which is a diagnostic study to determine the following:

  • Study of the electrical conduction system of the heart.
  • Detection of abnormal conduction that could be responsible for the heart rhythm disturbances that produce symptoms – shortness of breath , dizziness or light-headedness, palpitations , fatigue, chest pain or fainting spells.
  • Monitoring the effectiveness of medications in controlling abnormal heart rhythms.

During an EP study, small, thin wire electrodes are passed through a vein in the groin. These wire electrodes are then threaded into the heart, using a specific type of X-ray, called fluoroscopy. Once they reach the heart, electrical signals are measured. Then the electrical signals are sent through the catheter in order to stimulate the heart tissue to try to initiate the abnormal heart rhythm disturbances for evaluation.

Electrophysiology Study

Electrical System of Heart Diagnosis

Atrial Fibrillation

It is the most common type of arrhythmia. It occurs if fast, disorganized electrical signals lead the two upper chambers of the heart (atria) to contract very rapidly and irregularly.

Due to AF, the ventricles do not get completely filled with blood. Thus, they are not able to pump sufficient blood to the lungs and body. This can cause signs and symptoms, such as – shortness of breath, palpitations, chest pain, dizziness, fatigue and weakness. If not noticed on time, AF can lead to stroke and heart failure.

Following are the options for treatment of Atrial Fibrillation :

  • Prevention of blood clotting through medication;
  • Controlling the rate at which ventricles are beating;
  • Restoring and maintaining a normal heart rhythm either through medication or procedure.
  • Procedure options may include: Cardioversion, Radiofrequency Ablation (RFA) or Pacemaker Implantation.

Cardioversion is used to treat a fast or irregular heartbeat. During this procedure, low-energy shocks are given to the patient’s heart in order to trigger a normal rhythm.

Radiofrequency Ablation is another procedure performed in order to put the heart back into normal rhythm. RFA stops the electrical signals that come from places other than the SA node. During the procedure, thin wires are threaded into the heart through a vein in the arm or leg. One wire is used to find the diseased areas in the heart’s electrical system. Then heat is transferred through another wire. This heat destroys a small amount of tissue in those diseased areas and stops abnormal heart beats. The wires are taken out, once all the problem areas are fixed.

Atrial FibrillationAtrial FibrillationAtrial Fibrillation

Pacemakers are commonly used to treat two types of arrhythmias:

  • Tachycardia – a condition in which a heartbeat is too fast.
  • Bradycardia – a condition in which a heartbeat is too slow.

Types of Pacemakers

Pacemakers include one to three wires that are each placed in different chambers of the heart.

Single Chamber Pacemakers

In this procedure, only one lead is used, in either the right atrium or the right ventricle of the heart. A single lead is commonly used when the normal pacemaker of the heart is not working sufficiently. However, to use this technique of pacing, the rest of the heart’s normal conduction system should be functioning normally. The wires in a single chamber pacemaker generally carry pulses from the generator to the right ventricle (the lower right chamber of the heart). This often happens when the electrical flow gets slowed or blocked in the region of the AV node and the normal impulses from the atrium do not reach the ventricle. This results in too slow a heartbeat. The pacemaker system then keeps the heart beating at a steady rate.

Pacemaker Procedure

Pacemaker Procedure

Dual Chamber Pacemakers

These are pacemaker systems where a lead is used in the right atrium as well as the right ventricle. This type of pacing most closely resembles the heart’s normal conduction pattern by pacing consecutively from atria to ventricle, thus maximizing the heart’s pumping capacity. By having a lead in both the atria and ventricle the pulse generator is able to constantly regulate the heart’s electrical activity in both the chambers. These are the most commonly used pacemakers currently.

Biventricular Pacemakers (Also known as CRT, Cardiac Resynchronization Therapy, device)

The 3 wires in this procedure carry pulses from the generator to – right atrium, right ventricle and left ventricle (via the coronary sinus vein). The pulses then help in coordinating electrical signaling between the two ventricles. This procedure is used to treat the delay in heart ventricle contractions that occur in patients with advanced heart failure.

Biventricular Pacemakers

ICD (Implantable Cardioverter Defibrillator) Device

Irregular heartbeats (arrhythmias), a problem with the heart’s electrical system. ICDs use electrical pulses or shocks to treat life-threatening arrhythmias that take place in the ventricles.

When ventricular arrhythmias occur, the heart is unable to pump blood well. To keep away from death, the arrhythmia must be treated immediately with an electric shock to the heart. This treatment is known as defibrillation.

An ICD has wires with electrodes on its ends that connect to heart chambers. If the device detects any irregular rhythm in ventricles, it uses low-energy electrical pulses to re-establish a normal rhythm. If the low-energy pulses don’t restore normal heart rhythm, the ICD then switches to high-energy pulses for defibrillation. The device can also switch to high-energy pulses if ventricles start to vibrate rather than contract strongly. The high-energy pulses end only a fraction of a second. Since it has a pacemaker built into it, a defibrillator also has the ability of stimulating the heart like a pacemaker, to facilitate in stopping fast rhythms, at times, and to prevent the heart from getting too slow.

Types of Pacemaker Programming

Following are the two main types of programming for pacemakers:

  • Demand pacing
  • Rate-responsive pacing

A demand pacemaker monitors heart rhythm and only sends electrical pulses to heart if it is beating too slow or if it misses a beat.

A rate-responsive pacemaker speeds up or slows down heart rate depending on how active the patient is. To do this, the device monitors blood temperature , breathing,sinus node rate and other factors to determine a patient’s activity level.

Decision regarding which type of pacemaker amongst the above two is to be used, is taken by doctor on the basis of patient’s condition.

Ongoing care after procedure

Pacemaker needs to be checked regularly at an interval of about 3 months. Over a period of time, a pacemaker can stop working appropriately because of the following reasons:

  • Its wires get dislocated or broken
  • Its battery fails or gets weak
  • Patient’s heart disease progresses
  • Other devices have interrupted its electrical signaling

Battery Replacement

Depending upon how active the pacemaker is, its batteries last between 5 and 15 years (average 6 to 7 years). The treating doctor replaces the generator along with the battery before the battery starts to run down.

Replacing the generator and battery is a less-involved procedure than the original one to implant the pacemaker. The pacemaker wires also may need to be replaced in the long run. The doctor decides during follow up visits whether the pacemaker or its wires need to be replaced or not.

Why are more and more people choosing to have pacemaker surgery in India?

More and more people are choosing to have pacemaker surgery in India. There are many reasons for this, but the most important ones are the cost and the quality of care. Pacemaker implantation surgery in India is a fraction of the cost of having the surgery in developed countries. This is because the cost of living and doing business in India is much lower than in developed countries. As a result, surgeons and hospitals can offer their services at a fraction of the cost.

Apart from the cost factor, another reason why people are choosing to have their pacemaker surgery in India is because of the quality of care. Some of the best hospitals in India for pacemaker surgery are on par with those in developed countries, if not better. Even the best cardiac surgeons in India are highly trained and experienced. They have access to the latest medical research. As a result, patients who have pacemaker surgery in India can be confident that they will receive excellent care.

Finally, another reason people are opting for surgery in India is because of the shorter waiting periods. In developed countries, people often have to wait months or even years to get surgery, but in India they can usually get surgery within a few weeks.

So if you’re considering having pacemaker surgery, India is definitely worth considering.

There is no need to worry about language barriers as most hospitals in India offer English-speaking staff and doctors.

The cost of pacemaker surgery in India

In India, the cost of pacemaker surgery can vary depending on the hospital and the type of pacemaker. However, the average cost of pacemaker surgery in India is start from $2,000 USD. This includes the cost of the device itself, as well as the surgical procedure and post-operative care. The cost of a pacemaker in India is typically lower than in developed countries such as the United States or United Kingdom.

There are a number of factors that contribute to the lower cost of pacemaker surgery in India. First, there is a large number of qualified surgeons and hospitals available to perform the procedure. Second, the cost of medical devices and supplies is generally lower in India than in developed countries.

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