What Is a Pacemaker,
and How Is an ICD Different?
A pacemaker is a small battery-powered device, placed under the skin below the collarbone, that sends tiny electrical pulses to the heart when it beats too slowly. An ICD (implantable cardioverter-defibrillator) looks similar but also detects life-threatening fast heart rhythms and stops them with rapid pacing or an electric shock. Every ICD can also work as a pacemaker.
Your heartbeat is controlled by an electrical system. When that system slows down or is blocked — for example in heart block or sick sinus syndrome — the heart may beat too slowly to pump enough blood, causing dizziness, fainting or tiredness. A pacemaker fills in the missing beats.
Some people are at risk of the opposite problem: very fast, chaotic rhythms from the lower chambers (ventricular tachycardia or fibrillation) that can stop the heart pumping within seconds. An ICD monitors every heartbeat and treats these rhythms automatically, which is why it is called a life-saving device for sudden cardiac arrest.
At KG Heart Center, devices are implanted by the cardiology and electrophysiology team, who also programme and follow up every device after implantation.
- Local anaesthesia
- Small cut below collarbone
- Usually about 1–2 hours
- Day case or overnight
- Leadless option available
- Remote monitoring
When Is a Pacemaker
or ICD Needed?
Decisions follow international guidelines (ESC 2021 on cardiac pacing and CRT; ESC 2022 on ventricular arrhythmias). If your rhythm problem can be cured by catheter ablation instead of a device, your electrophysiologist will discuss that too.
Types of Pacemakers
& Cardiac Devices at KGH
Single & Dual-Chamber Pacemaker
One lead (single-chamber) or two leads (dual-chamber, in the upper and lower chambers) connected to a small generator under the skin. Dual-chamber pacing keeps the natural timing between the chambers.
StandardLeadless Pacemaker
A capsule-sized pacemaker placed directly inside the heart through a vein in the groin. There are no leads and no chest pocket, which lowers the risk of lead and pocket problems.
No leadsConduction System Pacing
HIS bundle pacing and left bundle branch area pacing stimulate the heart’s own wiring, so the heart contracts in a more natural pattern than with conventional right ventricular pacing.
PhysiologicalCRT — Cardiac Resynchronisation
A three-lead device (CRT-P, or CRT-D with a defibrillator) that coordinates both lower chambers in heart failure. CRT improves symptoms in about 60–70% of suitable heart-failure patients.
Heart failureICD — Implantable Defibrillator
Continuously monitors the heart and treats ventricular tachycardia or fibrillation with painless rapid pacing or a shock, preventing sudden cardiac death. Also works as a pacemaker.
Life-savingBattery Replacement & Upgrades
When a battery runs low, the generator is replaced in a short procedure, usually reusing the existing leads. Devices can also be upgraded, for example from a pacemaker to CRT.
Follow-upTests Before a
Pacemaker or ICD
The goal of testing is to link your symptoms to a definite rhythm problem and to check how well your heart pumps — because that decides whether you need a pacemaker, an ICD, CRT or a different treatment.
Some patients need an electrophysiology study (EPS), in which thin catheters map the heart’s electrical system from the inside. It is performed in KG Hospital’s cath lab, and if a treatable short-circuit is found, ablation can sometimes be done in the same sitting.
Pacemaker Implantation —
Step by Step
Preparation
You may be asked to fast for a few hours and to adjust blood thinners. An antibiotic is given to prevent infection. The procedure is done in the cath lab.
Local anaesthesia
The area below the collarbone is numbed; you stay awake, with light sedation if needed. A small cut of about 5 cm is made.
Placing the leads
Under X-ray guidance, one to three thin leads are passed through a vein into the heart and tested to make sure they sense and pace correctly. For a leadless pacemaker, the device is placed through a vein in the groin instead.
Connecting the device
The leads are connected to the generator, which sits in a small pocket under the skin. The wound is closed, usually with dissolvable stitches.
Checks and discharge
The device is programmed and checked, along with an X-ray. Most patients go home the same day or the next day with a device ID card and a follow-up date.
Pacemaker vs ICD vs CRT
at a Glance
| Factor | Pacemaker | ICD | CRT |
|---|---|---|---|
| Main purpose | Treats a slow heartbeat | Stops dangerous fast rhythms | Makes both ventricles beat together |
| Typical patient | Heart block, sick sinus | Cardiac arrest survivor, weak heart | Heart failure with wide QRS |
| Delivers a shock? | No | Yes, when needed | Only CRT-D |
| Leads | 0 (leadless) to 2 | 1–2 | 3 |
| Hospital stay | Day case or 1 night | Usually 1 night | 1–2 nights |
Typical figures; your stay depends on your device and overall health. Many CRT and ICD patients are followed in KG Hospital’s Advanced Heart Failure Clinic.
Recovery & Living
With a Device
Most people return to normal daily activities within a few days. For devices with leads, avoid lifting the arm on the implant side above shoulder height and avoid heavy lifting for about four to six weeks, so the leads can settle. Keep the wound clean and dry until it is checked.
Battery life: pacemaker batteries usually last many years — often 7–12 — and ICD batteries somewhat less, depending on how often the device works. Battery level is checked at every follow-up, and replacement is a short, planned procedure.
Everyday life: mobile phones and household appliances are safe; keep phones about 15 cm from the device and use the ear on the other side. Show your device card at airport security. Many modern devices are MRI-conditional — always tell the MRI team you have a device. Ask your cardiologist about driving, especially after an ICD.
What are the risks?
Device implantation is a common, low-risk procedure. Possible complications include bruising or a blood collection at the wound, infection, a lead moving out of position, and, rarely, a collapsed lung or injury to the heart wall. ICDs can occasionally deliver an unnecessary shock, which is usually fixed by reprogramming. Your specialist explains your personal risk beforehand.
Pacemaker & ICD Cost
in Coimbatore
The cost mainly depends on the type of device — single-chamber, dual-chamber, leadless, ICD or CRT — and its features, such as MRI compatibility and remote monitoring. Other factors are the hospital stay and any tests such as an EP study. KG Hospital gives a written estimate once the right device is decided.
KG Hospital is empanelled with 50+ insurers and TPAs and with CMCHIS, PM-JAY, ESI, CGHS and ECHS. Device cover depends on your policy or scheme, so the insurance desk checks eligibility and sends pre-authorisation, usually within 1–4 hours. Call 0422-4042121, Extn 205. Insurance & cashless details →
Coming from another city or country? Our International Patient Care team shares a free estimate within 48 hours of receiving your reports.
Electrophysiology & Device
Specialists at KG Heart Center
KG Heart Center is part of KG Hospital, founded in 1974 by Padma Shri awardee Dr G. Bakthavathsalam, and accredited by NABH.
About this page. Written by the KG Heart Center cardiology and electrophysiology team, KG Hospital, Coimbatore. Clinical information is consistent with the international guidelines listed below. Last updated: .
References
- 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy — European Society of Cardiology.
- 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death — European Society of Cardiology.