By the time he turned 42, Diwakar Sharma knew he was in trouble. He had hypertension and was severely diabetic. And, he had developed diabetic cardiomyopathy - a disorder which affected the ability of his heart muscles to pump blood effectively. Sharma was put on heavy medication to control his BP and diabetes. In five years, things went from bad to worse. By the time he was 47, he could barely walk and was constantly fatigued. All he wanted to do was to either sit or lie down. By now, his heart was pumping only 25 per cent of the blood it should with each beat. "I was struggling to survive," he says.
It was around this time that Sharma, who lives in Delhi, learnt about pacemakers that did more than just correct the slow beating of the heart. These were state-of-art pacemakers that understood the heart, and could feel its rhythm and correct it. If they sensed trouble, they could even give the heart a mild electric jolt to put it back in balance - much like the shock we see being administered in the movies to bring the heart back from the brink.
"We've had pacemakers for hearts that beat in an irregular manner for about 50 years now," says Aparna Jaswal, senior cardiologist and electrophysiologist at Fortis Escorts Heart Institute in Delhi. Traditional pacemakers got the heart to beat at a particular pace, whether a person was walking, sleeping or exercising. They were not programmed to understand when the body needed the heart to beat faster (such as when climbing stairs) or when it needed it to slow down (like, when resting).
Today's pacemakers are mature, smaller, thinner and, more importantly, compatible with diagnostic tests such as MRI scans. The older metallic pacemakers were a hazard inside magnetic scanning chambers, and all patients implanted with the device would be warned of the risks to both body and device. Now the internal circuit, external body and leads of a pacemaker are all made of non-ferromagnetic material that are unaffected by magnetic rays. That, say cardiologists, is critical. Of the 30,000-odd Indians who get pacemakers implanted every year, about 75 per cent may need to, at some stage, go for an MRI test.
Pacemakers have become smarter too. Take, for example, Sharma's case. Instead of going for the traditional pacemaker, which would only prod the heart to beat with metronomic regularity, the factory-owner opted for the cardiac resynchronisation therapy (CRT) heart device along with defibrillation therapy device, or CRT-D. The smartest of the lot, this multifunction device has the ability to detect and treat dangerously fast heart rhythms, or speed up a heart that is beating too slowly, or give a mild electric shock if the heart is about to let you down. It is equipped to control heart rate as well as prevent heart failure and, therefore, prevent sudden cardiac death.
Like Sharma, 67-year-old Manjula Malik (name changed) also got a second chance at life after she got a biventricular pacemaker implanted five years ago. Malik suddenly collapsed while she was alone at home. She was rushed to the nearby hospital where doctors detected the poor condition of her heart. The prognosis was bleak. But after getting a pacemaker, she can perform routine activities and live a healthier life. Unlike the traditional pacemaker that has a single wire providing electrical impulse to a single chamber of the heart, Malik got a newer model that performed much better with its two leads going from the battery unit to both the ventricles of her heart.
For a procedure that allows virtually a second lease of life, pacemaker implantation isn't complex. "The procedure is performed under local anaesthesia and lasts about an hour," says Jaswal. It does not require open heart surgery. A small incision, about two-inch-long, is made in the upper chest. Leads -single, double or three, according to the device opted for - are pushed into the heart and the pacer lodged under the chest muscle. After three to four days of hospitalisation, the person can go home. A check-up is recommended every four to six months. The battery is regularly monitored and needs replacement every seven to eight years. Researchers at the University of Michigan are, meanwhile, working to develop a new kind of pacemaker that can be powers using kinetic energy generated by the vibrations in the chest as the heart pumps blood.
With hypertension, leading to coronary diseases, affecting more than 100 million Indians, these pacemakers are gaining ground. At the Fortis hospital in Delhi alone 20-30 such pacemakers are implanted every month. While it is safe, like in every medical procedure, there is a slight risk of infection. In this case, it is one to two per cent worldwide. That's a small risk certainly for a return to a near-normal life.
It was around this time that Sharma, who lives in Delhi, learnt about pacemakers that did more than just correct the slow beating of the heart. These were state-of-art pacemakers that understood the heart, and could feel its rhythm and correct it. If they sensed trouble, they could even give the heart a mild electric jolt to put it back in balance - much like the shock we see being administered in the movies to bring the heart back from the brink.
"We've had pacemakers for hearts that beat in an irregular manner for about 50 years now," says Aparna Jaswal, senior cardiologist and electrophysiologist at Fortis Escorts Heart Institute in Delhi. Traditional pacemakers got the heart to beat at a particular pace, whether a person was walking, sleeping or exercising. They were not programmed to understand when the body needed the heart to beat faster (such as when climbing stairs) or when it needed it to slow down (like, when resting).
| LISTEN TO THE BEAT |
| Biventricular pacemaker The electronic, battery-powered device, which is surgically implanted under the skin, helps the heart beat in a more normal way in people with heart failure. Heart failure refers to poor ejection fraction, or EF, which is a measure of how much blood is being pumped out of the heart's left ventricle. In simple terms, heart failure, or poor EF, means that the pumping power of the heart is weak. A normal heart pumps 50-70 per cent of full capacity, while people with heart failure show an EF of less than 35 per cent. It has leads from the battery to both ventricles of the heart. By helping balance the pumping power of the heart, a biventricular pacemaker improves both the quality and quantity of life. Cost: Rs 4.5 lakh |
| Implantable cardioverter-defibrillator (ICD) A small battery-powered device, ICD can be described as an emergency room that's constantly travelling with you or an intelligent doctor sitting in your chest. It's an impulse generator that is implanted in patients who are at the risk of sudden cardiac death. The device can detect cardiac arrhythmia in which there is abnormal electrical activity in the heart that can, in some cases, cause a cardiac arrest. What the ICD does is detect the condition and correct it with a jolt of electricity. An intelligent device, it constantly monitors the rate and rhythm of the heart. The process of implantation is similar to that of a pacemaker. ICD improves the quantity of life and helps a person live longer. Cost: Rs 4.5 lakh |
| Biventricular implantable cardioverter-defibrillator For some patients with heart failure, the cardiac resynchronisation therapy works best. This is a combination of biventricular pacemaker and an implantable cardiac defibrillator. The device helps correct abnormal heart rhythm, resynchronises the heartbeat and prevents the risk of sudden death through automatic defibrillation. CRT-D reduces the risk of sudden death and helps improve the quality of life. Cost: Rs 7.5 lakh |
Today's pacemakers are mature, smaller, thinner and, more importantly, compatible with diagnostic tests such as MRI scans. The older metallic pacemakers were a hazard inside magnetic scanning chambers, and all patients implanted with the device would be warned of the risks to both body and device. Now the internal circuit, external body and leads of a pacemaker are all made of non-ferromagnetic material that are unaffected by magnetic rays. That, say cardiologists, is critical. Of the 30,000-odd Indians who get pacemakers implanted every year, about 75 per cent may need to, at some stage, go for an MRI test.
Pacemakers have become smarter too. Take, for example, Sharma's case. Instead of going for the traditional pacemaker, which would only prod the heart to beat with metronomic regularity, the factory-owner opted for the cardiac resynchronisation therapy (CRT) heart device along with defibrillation therapy device, or CRT-D. The smartest of the lot, this multifunction device has the ability to detect and treat dangerously fast heart rhythms, or speed up a heart that is beating too slowly, or give a mild electric shock if the heart is about to let you down. It is equipped to control heart rate as well as prevent heart failure and, therefore, prevent sudden cardiac death.
* * * * *
Two-and-a-half years after he got this device, which he calls a "mini heart", Sharma says he's able to live a "normal life". "There was a time when I couldn't walk or drive and would have to call a cab to take me home from office. An outstation trip would leave me exhausted for a week." This severely affected his work which involved a great deal of travelling. With two children - one is in Class XII now and the other's in Class X - he also had a family to take care of. Today, Sharma says he "travels a lot, even overseas". He goes for a walk to India Gate every evening. Tests show his heart is pumping more blood now - 40 per cent, not optimum yet but it's getting there. There are still a few things he avoids though, "like walking up the stairs two or three storeys". Or doing stretching exercises lest the wires attached to his heart break.| DOS AND DON'TS |
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Like Sharma, 67-year-old Manjula Malik (name changed) also got a second chance at life after she got a biventricular pacemaker implanted five years ago. Malik suddenly collapsed while she was alone at home. She was rushed to the nearby hospital where doctors detected the poor condition of her heart. The prognosis was bleak. But after getting a pacemaker, she can perform routine activities and live a healthier life. Unlike the traditional pacemaker that has a single wire providing electrical impulse to a single chamber of the heart, Malik got a newer model that performed much better with its two leads going from the battery unit to both the ventricles of her heart.
For a procedure that allows virtually a second lease of life, pacemaker implantation isn't complex. "The procedure is performed under local anaesthesia and lasts about an hour," says Jaswal. It does not require open heart surgery. A small incision, about two-inch-long, is made in the upper chest. Leads -single, double or three, according to the device opted for - are pushed into the heart and the pacer lodged under the chest muscle. After three to four days of hospitalisation, the person can go home. A check-up is recommended every four to six months. The battery is regularly monitored and needs replacement every seven to eight years. Researchers at the University of Michigan are, meanwhile, working to develop a new kind of pacemaker that can be powers using kinetic energy generated by the vibrations in the chest as the heart pumps blood.
With hypertension, leading to coronary diseases, affecting more than 100 million Indians, these pacemakers are gaining ground. At the Fortis hospital in Delhi alone 20-30 such pacemakers are implanted every month. While it is safe, like in every medical procedure, there is a slight risk of infection. In this case, it is one to two per cent worldwide. That's a small risk certainly for a return to a near-normal life.