Does your heart skip a beat?

Does your heart skip a beat?
Aruna Chandaraju

For most of us, the heart beats maintains a steady rhythm thanks to an inbuilt electrical conduction system or natural pacemaker…

For most of us, the heart beats maintains a steady rhythm thanks to an inbuilt electrical conduction system or natural pacemaker. An irregularity in this natural rhythm is called arrhythmia. Stress or anxiety can cause alteration, so, the heart might skip a beat once in a while resulting in a mild palpitation or flutter, but it largely maintains a consistent rhythm through our life.

However, millions have a serious defect in this electrical conduction system, resulting in recurrent arrhythmias. Their heart beats too slow (bradycardia) or too fast (tachycardia), or so irregularly that it sometimes stops beating altogether resulting in Sudden Cardiac Death (SDC). Fortunately, there is a way to save the person by anticipating this. A pager-sized device called Implanatable Cardioverter Defibrillator (ICD) when implanted under the skin monitors heart rate, and performs two functions: 1) cardioversion where the too-fast or too-slow rhythm is corrected and made normal; 2) defibrillation where the heart which has stopped beating is given a shock to revive it, get it out of the cardiac arrest and back to beating normally. Dr Upinder Kaul, Director, Cardiology, Fortis Group of Hospitals, New Delhi, explains:

“Any patient who, four weeks after a heart attack, has a left ventricular ejection fraction of less than 40 percent is a possible candidate for SCD. There are other categories with poor heart function with documented ventricular tachycardia, syncope, and many other indications in primary electrical disorders of the heart.”

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There are lakhs of Indians with this problem. Yet, while thousands of implants are needed every year, only a few hundred are able to access the treatment. As Dr Kaul reveals: “Approximately 350 ICD implants are done every year in India. The number of people needing it is very large––about 50,000 per year at a conservative estimate.”

What accounts for this large gap? A major factor is the cost. As Dr P K Dash, Head, Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, points out, these little lifesavers cost between Rs four lakh to eight lakh each depending on the brand. Besides, there’s the cost of implant and hospital stay which adds up to another lakh or two depending on the hospital. In a country like ours where millions live below the poverty line and where percapita income is low compared to developed countries in Europe or USA, the treatment becomes largely unaffordable, except to a few of those who need it. Also, the reach of medical insurance is not as widespread in India as in developed countries, adds Dr K S Rastogi, Mumbai-based cardiologist.

Complicating this cost factor in India, is the fact that many of the candidates for ICDs are senior citizens who are dependent on others for medical care.

Sometimes, there is a humanitarian initiative that makes this affordable. For eg, last month, eight dual-chamber ICDs were implanted within five days––an Indian medical record––and totally free of cost, at the charitable Sri Sathya Sai Institute in poor, by visiting US-based cardiac specialists.

However, this is a rare phenomenon. So, what’s the solution? Dr Kaul opines: “Continuing medical education programmes for physicians As well the production of low-cost shock devices.”

Reference