Types of Pacemakers & ICDs
Cardiac implantable electronic devices (CIEDs) encompass a range of sophisticated medical devices designed to manage heart rhythm disorders. The three primary categories are pacemakers, which stimulate the heart to beat at a regular rate when its natural electrical system fails; implantable cardioverter-defibrillators (ICDs), which monitor for life-threatening fast heart rhythms and deliver electrical shocks to restore normal rhythm; and cardiac resynchronization therapy (CRT) devices, which coordinate the timing of the heart's chambers to improve pumping efficiency in patients with heart failure. Each category includes multiple device configurations tailored to specific clinical needs.
Traditional pacemakers consist of a pulse generator (the battery-powered computer that generates electrical impulses) implanted beneath the skin below the collarbone, connected to one, two, or three leads (insulated wires) that are threaded through veins into the heart chambers. Single-chamber pacemakers have one lead placed in either the right atrium or right ventricle. Dual-chamber pacemakers have two leads — one in the right atrium and one in the right ventricle — allowing more physiological pacing that preserves the natural timing between atrial and ventricular contractions. The latest generation of leadless pacemakers, such as the Medtronic Micra and Abbott Aveir, are miniaturized self-contained devices implanted directly inside the heart chamber via a catheter, eliminating the need for leads and the surgical pocket entirely.
Implantable cardioverter-defibrillators (ICDs) are more complex devices that combine pacemaker functionality with the ability to detect and terminate dangerous fast heart rhythms (ventricular tachycardia and ventricular fibrillation) through anti-tachycardia pacing or high-energy shock delivery. ICDs are indicated for patients who have survived sudden cardiac arrest, those with documented sustained ventricular tachycardia, and patients with significantly reduced heart function (ejection fraction 35% or below) who are at high risk for sudden cardiac death. CRT-D devices combine cardiac resynchronization therapy with defibrillator capability, providing comprehensive management for patients with advanced heart failure and conduction system disease.
- Single-Chamber Pacemaker: One lead in right ventricle or atrium; simplest device for basic bradycardia; battery life 8-12 years
- Dual-Chamber Pacemaker: Two leads (atrium + ventricle); preserves natural AV synchrony; most common pacemaker type; battery life 7-10 years
- CRT Pacemaker (CRT-P): Three leads including left ventricular lead; resynchronizes heart chambers in heart failure patients; battery life 5-8 years
- Single-Chamber ICD: Defibrillation capability with one ventricular lead; for patients at risk of sudden cardiac death; battery life 5-8 years
- Dual-Chamber ICD: Defibrillation plus dual-chamber pacing; improved rhythm discrimination reduces inappropriate shocks; battery life 5-7 years
- CRT-D (CRT Defibrillator): Resynchronization therapy combined with defibrillation; for heart failure patients at risk of sudden death; battery life 4-7 years
- Leadless Pacemaker: Self-contained miniature device implanted directly in heart chamber via catheter; no leads or surgical pocket; battery life 8-13 years
- Subcutaneous ICD (S-ICD): Defibrillator with no transvenous leads; electrode placed under skin along sternum; ideal for younger patients; battery life 5-7 years
When Is a Pacemaker or ICD Needed?
Pacemaker implantation is indicated when the heart's natural electrical conduction system fails to maintain an adequate heart rate, a condition broadly classified as bradycardia. The most common indications include sick sinus syndrome (where the heart's natural pacemaker, the sinus node, fires too slowly or pauses), complete heart block (where electrical signals fail to pass from the atria to the ventricles), and second-degree heart block Mobitz Type II (where intermittent failure of conduction occurs). Symptoms that prompt evaluation for pacemaker implantation include unexplained dizziness, fainting episodes (syncope), exercise intolerance, persistent fatigue, and shortness of breath caused by inappropriately slow heart rates.
ICD implantation is recommended for patients at significant risk of sudden cardiac death from ventricular arrhythmias. Primary prevention ICDs are implanted in patients who have never experienced a cardiac arrest but are at high risk based on their heart function — typically those with a left ventricular ejection fraction of 35% or below from ischemic or non-ischemic cardiomyopathy. Secondary prevention ICDs are implanted in patients who have already survived a cardiac arrest or documented sustained ventricular tachycardia. The decision to implant an ICD involves careful risk-benefit analysis by an electrophysiologist, considering the patient's overall health status, life expectancy, quality of life, and the specific mechanism and reversibility of their underlying heart condition.
Cost Comparison by Country
The cost of pacemaker and ICD implantation is driven primarily by the price of the device itself, which typically represents 50-70% of the total procedure cost. In the United States, a standard dual-chamber pacemaker costs $15,000 to $25,000 for the device alone, while a dual-chamber ICD costs $25,000 to $40,000, and a CRT-D device costs $30,000 to $50,000. When facility fees, physician charges, anesthesia, and hospital stay are added, total costs range from $30,000 to $60,000 for pacemaker implantation and $50,000 to $120,000 for ICD or CRT-D implantation. These costs have escalated dramatically over the past decade, making cardiac device implantation one of the fastest-growing segments of medical tourism.
Pacemaker & ICD Implantation Cost Comparison 2025
| Country | Pacemaker Cost | ICD/CRT-D Cost | Savings vs USA |
|---|---|---|---|
| USA | $30,000 - $60,000 | $50,000 - $120,000 | — |
| Turkey | $6,000 - $12,000 | $12,000 - $25,000 | Up to 80% |
| India | $4,000 - $8,000 | $8,000 - $18,000 | Up to 85% |
| Thailand | $8,000 - $15,000 | $15,000 - $28,000 | Up to 77% |
| South Korea | $12,000 - $20,000 | $20,000 - $35,000 | Up to 70% |
| Malaysia | $5,000 - $10,000 | $10,000 - $22,000 | Up to 82% |
| Colombia | $5,500 - $11,000 | $11,000 - $20,000 | Up to 83% |
| Mexico | $7,000 - $14,000 | $14,000 - $26,000 | Up to 78% |
Prices include device cost, implantation procedure, hospital stay (typically 1-2 days), and initial programming. The device itself represents 50-70% of the total cost. MRI-compatible devices may cost 10-15% more. All prices are approximate.
Turkey offers an excellent balance of cost savings and medical quality for cardiac device implantation. At hospitals like American Hospital Istanbul, pacemaker implantation packages range from $6,000 to $12,000 and ICD packages from $12,000 to $25,000, using the same FDA-approved devices from Medtronic, Abbott, Boston Scientific, and Biotronik that are implanted at US hospitals. The cost savings are primarily driven by lower facility overhead, physician compensation structures, and device procurement costs rather than any difference in device quality or brand. Turkish electrophysiologists at major cardiac centers are fellowship-trained, many at leading US and European institutions, and perform hundreds of device implantations annually.
India represents the most affordable option for cardiac device implantation, with pacemaker packages starting at $4,000 and ICD packages at $8,000. Major Indian cardiac centers including Medanta, Max Healthcare, and Fortis Heart Institute have extensive electrophysiology programs that implant thousands of devices annually. Malaysia and Colombia offer competitive mid-range pricing, while South Korea provides access to the latest leadless pacemaker and subcutaneous ICD technologies at prices well below Western averages. When comparing costs internationally, patients should ensure that quotes include the device cost, implantation procedure, hospital stay, device programming, and at least one follow-up interrogation before departure.
Procedure Steps & What to Expect
Pacemaker implantation is a relatively straightforward procedure typically performed under local anesthesia with conscious sedation, lasting 45 minutes to two hours depending on the number of leads and device complexity. The electrophysiologist makes a small incision (4-5 centimeters) below the left or right collarbone and creates a subcutaneous pocket for the pulse generator. Using fluoroscopic (X-ray) guidance, leads are advanced through the subclavian or cephalic vein into the appropriate heart chambers — the right atrium, right ventricle, or both. Each lead is tested for adequate sensing of the heart's natural electrical signals and appropriate pacing thresholds before being secured to the underlying tissue and connected to the pulse generator.
ICD implantation follows a similar process but requires additional testing to verify the device's ability to detect and terminate ventricular arrhythmias. After lead placement and generator implantation, a defibrillation threshold test (DFT) may be performed in which ventricular fibrillation is deliberately induced and the ICD is allowed to detect and shock the arrhythmia to confirm proper function. CRT device implantation is more complex, requiring placement of a third lead in a branch of the coronary sinus vein to pace the left ventricle. This step can be technically challenging and adds 30-60 minutes to the procedure. At experienced centers like Koç University Hospital, advanced imaging techniques including CT venography and 3D mapping systems are used to optimize lead placement and maximize the hemodynamic benefit of cardiac resynchronization.
Post-procedure, patients are typically monitored overnight and discharged the following day after a chest X-ray confirms proper lead positioning and a device interrogation verifies appropriate function and programming. Activity restrictions for the first four to six weeks include avoiding raising the arm on the implant side above shoulder level, not lifting more than five to ten pounds with the affected arm, and avoiding repetitive arm movements that could dislodge the leads before they become firmly embedded in the cardiac tissue. After this healing period, most patients can resume all normal activities without restriction, and the device functions continuously and automatically without requiring any conscious effort from the patient.
Modern cardiac devices are remarkably reliable and sophisticated, continuously monitoring every heartbeat and delivering precisely timed therapy when needed. The implantation procedure itself has become so refined that most patients go home the next day and return to normal activities within weeks. The real key is proper device selection and programming tailored to each patient's specific rhythm disorder.
Dr. Sarah Winters, Clinical Cardiac Electrophysiology
Battery Life & Device Longevity
Device battery longevity is an important consideration, particularly for patients considering implantation abroad, as generator replacement (battery change) will be required at some point in the future. Modern pacemaker batteries typically last 7-13 years depending on the device type, programming parameters, and the percentage of time the device is actively pacing the heart. A patient whose heart requires pacing only occasionally will experience longer battery life than a patient who is pacemaker-dependent (requiring pacing 100% of the time). Leadless pacemakers like the Medtronic Micra have projected battery lives of 8-13 years based on clinical trial data, with the advantage that a new device can be implanted alongside the depleted one without removal.
ICD batteries deplete faster than pacemaker batteries due to the higher energy requirements of defibrillation therapy and the more complex monitoring algorithms. Standard ICD battery life ranges from 5-8 years, while CRT-D devices, which provide continuous biventricular pacing plus defibrillation capability, typically last 4-7 years. Battery longevity is monitored through regular device interrogations — either in-person at a clinic or remotely through home monitoring transmitters that send device data to the clinical team daily. When the battery reaches its elective replacement indicator (ERI), the generator must be replaced within approximately three months. Generator replacement is a simpler procedure than the initial implantation because the existing leads are typically reconnected to the new generator without requiring lead replacement.
Follow-Up Care After Implantation
Post-implantation follow-up care is essential for ensuring optimal device function, battery monitoring, and clinical management of the underlying rhythm disorder. The standard follow-up schedule includes a wound check and device interrogation one to two weeks after implantation, a comprehensive evaluation at six to eight weeks, and then routine interrogations every six to twelve months for the life of the device. Patients who receive their device abroad can typically have their one-to-two-week wound check and initial programming verification performed before departing the destination country, with subsequent follow-up transferred to an electrophysiologist near their home.
Remote monitoring technology has revolutionized the follow-up care of cardiac implantable devices and is particularly valuable for patients who receive devices abroad. All major device manufacturers — Medtronic (CareLink), Abbott (Merlin.net), Boston Scientific (LATITUDE), and Biotronik (Home Monitoring) — offer remote monitoring systems consisting of a bedside transmitter that wirelessly communicates with the implanted device and securely transmits data to the clinical team. Remote monitoring enables daily automatic device checks, early detection of lead or device malfunctions, automatic arrhythmia alerts, and battery status tracking without requiring office visits. At hospitals like Liv Hospital Istanbul, international patients are set up with remote monitoring before discharge, allowing the implanting team to continue monitoring device function even after the patient returns home.
An important practical consideration for patients receiving cardiac devices abroad is ensuring device compatibility with the follow-up infrastructure in their home country. The four major device manufacturers operate globally, and their devices can be interrogated using the manufacturer's programmers at any cardiology practice worldwide. Before traveling for device implantation, patients should confirm that an electrophysiologist near their home has the appropriate programmer for the device manufacturer being used and is willing to assume long-term follow-up care. Providing the home electrophysiologist with complete implantation records including the device model and serial number, lead specifications, implantation parameters, and programming settings is essential for seamless continuity of care.
- 1-2 weeks post-implant: Wound check, chest X-ray, initial device interrogation and programming optimization (done before leaving destination country)
- 6-8 weeks: Comprehensive device evaluation, lead maturation assessment, final programming adjustments, lifting restrictions lifted
- Every 6-12 months: Routine in-person device interrogation, battery status check, arrhythmia log review, medication adjustment if needed
- Continuously: Remote monitoring transmissions (daily or weekly depending on device and manufacturer), automatic alert notifications
- At ERI (battery low): Generator replacement procedure scheduled within 3 months, can be performed locally or abroad
- Ongoing: Carry device identification card at all times, inform medical staff of device before any procedure, avoid strong electromagnetic fields
Need a pacemaker or ICD at a fraction of US costs? Connect with our cardiac device advisors for hospital recommendations, cost estimates, and assistance coordinating your care.
Get Free Pacemaker/ICD QuotePatients with cardiac implantable devices must observe certain precautions throughout their lives. While modern devices are well-shielded against electromagnetic interference, patients should avoid prolonged close proximity to strong magnetic fields, high-voltage electrical equipment, and certain industrial or medical devices that could interfere with device function. Airport security metal detectors will detect the device, and patients should carry their device identification card and request a hand search rather than passing through the scanner. MRI scanning is now safe with most modern MRI-conditional devices when performed under appropriate supervision, but patients should always inform their radiologist about their implanted device before any imaging procedure. Contact sports and activities with a high risk of chest trauma should generally be avoided to protect the device and leads from mechanical damage.
Compare pacemaker and ICD implantation costs across Turkey, India, Thailand, and more. Our team provides detailed cost breakdowns including device options from all major manufacturers.
Compare Device CostsFrequently Asked Questions
Frequently Asked Questions
Are the same pacemaker brands available abroad as in the US?
Yes, the same FDA-approved devices from Medtronic, Abbott (formerly St. Jude Medical), Boston Scientific, and Biotronik are available at major cardiac centers abroad. These manufacturers operate globally and supply their devices to accredited hospitals worldwide. Your international electrophysiologist will select the optimal device based on your clinical needs, and you will receive the same model that would be implanted at a US hospital. Device warranties are honored internationally by all major manufacturers.
How long does pacemaker implantation take?
Standard dual-chamber pacemaker implantation takes 45 minutes to 1.5 hours. ICD implantation takes 1-2 hours, and CRT device implantation (with the additional left ventricular lead) takes 1.5-3 hours. The procedure is performed under local anesthesia with conscious sedation in most cases. Patients are awake but comfortable throughout the procedure. Leadless pacemaker implantation via catheter takes approximately 30-45 minutes and is performed through a vein in the leg rather than the chest.
Can I fly with a pacemaker or ICD?
Yes, air travel is completely safe with a pacemaker or ICD. The cabin pressure, altitude, and electronic systems in commercial aircraft do not affect device function. You can fly as soon as 3-5 days after implantation if your recovery is uncomplicated, though most physicians recommend waiting at least one week. Always carry your device identification card and inform airport security about your implanted device. Request a hand search or pat-down rather than walking through metal detectors, though brief exposure to security scanners is generally considered safe.
How much does a pacemaker cost abroad compared to the US?
In the US, total pacemaker implantation costs range from $30,000-$60,000. Abroad, costs are significantly lower: Turkey ($6,000-$12,000), India ($4,000-$8,000), Thailand ($8,000-$15,000), Malaysia ($5,000-$10,000). ICD costs range from $50,000-$120,000 in the US compared to $12,000-$25,000 in Turkey and $8,000-$18,000 in India. These savings represent 60-85% reductions while using the same FDA-approved devices.
How often does a pacemaker battery need to be replaced?
Modern pacemaker batteries typically last 7-13 years depending on the device type and how frequently the device paces the heart. ICD batteries last 5-8 years, and CRT-D batteries 4-7 years. Battery replacement is a simpler procedure than the initial implantation — only the generator is replaced while the existing leads are reused if they are functioning properly. The procedure takes about 30-45 minutes and is typically done as a same-day or overnight procedure.
Will my pacemaker set off airport metal detectors?
Yes, the metal casing of the pacemaker or ICD will trigger metal detectors. Always carry your device identification card provided at implantation, inform security personnel about your device before screening, and request a hand search. Modern devices are designed to withstand brief exposure to standard airport security equipment including walk-through metal detectors and handheld wands, but prolonged exposure should be avoided. Full-body scanners used at many airports are considered safe for patients with cardiac devices.
Can I get an MRI with a pacemaker or ICD?
Most modern pacemakers and ICDs manufactured after 2010-2012 are designated as MRI-conditional, meaning they can safely undergo MRI scanning under specific conditions including using 1.5 Tesla scanners, specific absorption rate limits, and device reprogramming to MRI-safe mode before scanning. Before your implantation abroad, discuss MRI compatibility with your electrophysiologist and specifically request an MRI-conditional device if you anticipate needing MRI scans in the future. The small additional cost of MRI-conditional devices (10-15%) is well worth the diagnostic flexibility they provide.
Who will manage my pacemaker follow-up when I return home?
Any electrophysiologist or cardiologist trained in device management can follow your pacemaker or ICD, regardless of where it was implanted. Before traveling for device implantation, identify a local electrophysiologist who has the appropriate manufacturer programmer (Medtronic, Abbott, Boston Scientific, or Biotronik) and confirm they will accept your follow-up care. Provide them with complete implantation records. Remote monitoring, available from all major manufacturers, enables your implanting center abroad to continue monitoring alongside your local physician.