New Generation Pacemakers

By Dr. Naveen Bhamri in Cardiac Sciences

May 06 , 2016 | 4 min read

Sudden death is one of the most common causes of death in India & worldwide and it can be prevented by implanting a pacemaker (ICD). Studies have shown that 60 per cent of all Sudden Cardiac Arrest occur due to arrhythmia." Each year 1-2 million individuals worldwide die due to a lack of access to pacemakers. In India, about 1, 00,000 patients suffer from bradycardia (slow heart rate) every year. However, only 20,000 patients resort to pacemakers in India annually.

According to Naveen Bhamri, HOD & Associate Director, Cardiology, Max Super Speciality Hospital Shalimar Bagh-Basically, a pacemaker is a small device which is placed under the skin of a patient's chest or abdomen to help control abnormal heart rhythms. Initially they were developed only as a backup to patients with slower heart rate, by giving electrical pulses to prompt the heart to beat at a normal rate.

Today, pacemaker therapy is synonymous for managing all arrhythmias (abnormal slow or fast heart rate) or heart rhythm-related disease. "Newer technologies in past few years have emerged as device therapy of arrhythmias (ICDs), Device therapy for heart failure (cardiac resynchronisation therapy, CRT), and device therapy in combination for arrhythmias and heart failure (combo-device). These implantable medical devices which are prescribed for controlling fast abnormal heart rhythms, which are harbinger to death if not controlled within minutes, and also to improve cardiac function in patients of heart failure (hearts inability to pump blood),”

This, in turn, has led to better patient outcomes, lesser side effects and hospitalizations and improved longevity including quality of life. The technology has also helped in lowering cost of managing the disease.

Broadly, there are two types of pacemakers available—external and internal. The external pacemakers are utilized to stabilize the patient till the internal pacemaker is actually implanted. Not only internal pacemakers have become better with time, external pacemakers have also witnessed a considerable change. Pacemakers which come with defibrillators are much in demand.

Size and Battery

Pacemakers have improved in quality and size. "Pacemakers have improved quite a bit since the early days, most visibly in size, but also in battery life and functionality," says Dr Bhamri. Due to development of integrated circuits and miniaturisation of components, modern pacemakers are getting progressively smaller despite more complex operations. Similarly, battery technology has kept pace, resulting in safer and longer lasting devices."

Not only the pacemakers are becoming smaller and more energy efficient but, also, digital signal processing allows better longevity and more data storage, thus increasing diagnostics.

Initially, pacemakers paced the heart at a fixed rate irrespective of the patient's demand and intrinsic rhythm. The competition between the pacemaker and the patient's intrinsic heart rhythm was often symptomatic (palpitations) and caused other problems. They slowly evolved over a period of time to offer sensing ability and different types of programming abilities. "The current generation of pacemakers tries to encourage the intrinsic activity and pace only when it's absolutely necessary. When pacemakers act on stand-by, encouraging the internal rhythm, the quality of life for the patients is better and the longevity of the pacemaker better."

In a step to mimic the natural functioning of the heart, there are Rate Responsive Pacemakers (RRPs), which adjust the rate at which the heart is paced based on the activity of the patient. RRPs were developed which have an activity sensor and can change the pacing rate automatically depending on level of patient's activity.

Programmable Pacemaker

The function of programmability has also changed over time. Initially, pacemakers were not programmable at all. The functioning parameters were pre-set by the manufacturer. "Later, programmable pacemakers were developed which can be programmed from outside the body using telemetry," says Dr Bhamri.

Today, pacemakers are not limited to single chamber. Pacemakers have evolved from stimulating a single chamber of the heart to dual chamber pacing and even three chambers. "This evolution has immensely helped the patients and has improved both quality of life as well as life expectancy of the patients at a great deal. The size and the new technologies have enabled the cardiologists to implant pacemakers more effortlessly. "Previously, pacemakers were implanted by surgeons only, but, today, they are implanted by cardiologists, said Dr Bhamri.

Globally, the demand of internal pacemakers is now on a rise. This can be attributed to increase in cardiac diseases, better paying capacity as well as lifestyle. What's a cause of worry for Cardiologists is that in India, about 1,00,000 patients suffer from bradycardia (slow heart rate) every year. However, only 20,000 patients resort to pacemakers in India annually. The reason for this is the lack of awareness of patients as well as doctors.

These devices are safer than ever before. "Although, pacemaker technology has extended the lives of millions of patients but upto few years back these patients are prohibited from receiving the MRI scans, a widely practiced diagnostic method for many common diseases and conditions, because their devices could interact with MRI machines, potentially affecting the device or patient safety,". But now MRI compatible pacemakers are available in Few leading Hospitals in NCR including Max Hospital Shalimar Bagh, best heart hospital in Delhi which abolishes the risk of interaction of pacemakers with MRI, since these New generation pacemakers have No ferro magnetic elements.

In western countries, for every million people, 600 to 700 pacemakers are implanted, but in India, for every million people, we implant only eight to nine pacemakers. There are many factors that have resulted into lower number of implants per million. The major reasons are low awareness levels, affordability, lack of Advance Cardiac centres, indifference to quality of life, thin cover of Insurance system in India.


Wireless pacemakers are expected to hit the Indian market in a big way. In future, we expect pacemakers with longer battery life. We are also expecting Battery Free Pacemakers powered by your Own Heart. As of now, the first step is to generate enough awareness about this technological marvel, so that many precious lives can be saved.