Pacemaker implantation

Pacemaker implantation is a procedure to fit a small electrical device — called a pacemaker — into your chest to help regulate your heart rhythm. Having a pacemaker fitted can significantly improve your quality of life if you have heart rhythm problems. For some people, it can even be lifesaving.

What is a pacemaker?

A pacemaker is a small, battery-powered device. It detects how your heart is beating and corrects any problems with its rhythm so it beats regularly. It’s a small metal box, the size of a matchbox or smaller, and weighs 20–50 grams. The box is attached to one or more wires that connect to your heart.

A pacemaker contains:

• An impulse generator — this is the main body of the pacemaker, containing a battery and a tiny computer circuit
• 1 or more wires known as pacing leads

A pacemaker is sometimes called a cardiac pacing device.

How does a pacemaker work?

A pacemaker senses problems with your heart’s rhythm and sends electrical signals when needed. These signals travel through the leads to your heart and make it contract.

Most modern pacemakers work on demand. They only send a signal if your heart is beating too slowly or has missed a beat. If your heart is beating normally, the pacemaker stays inactive.

Most pacemakers also respond to your activity level. Special sensors can detect movement or breathing rate. For example, if you’re active, the pacemaker can increase your heart rate to match your body’s needs.

What are the different types of pacemakers?

The main types of pacemakers include:

Single-chamber pacemaker

This has 1 lead and sends signals to 1 chamber of your heart, usually the right atrium (upper chamber) or right ventricle (lower chamber).

Dual-chamber pacemaker

This has 2 leads, connected to both the right atrium and the right ventricle.

Bi-ventricular pacemaker

This type — also known as cardiac resynchronisation therapy (CRT) — uses 3 leads to monitor and coordinate both the right and left ventricles.

Your consultant will recommend the type of pacemaker based on your specific heart condition.

Reasons for having a pacemaker implantation

The heart has its own electrical system, which controls how it beats. Electrical pulses are generated by a group of cells called the sinoatrial node (SA). These signals tell the heart how to beat. When there are problems with this natural electrical system, a pacemaker may be recommended.

Pacemakers are used to treat conditions where the heart doesn’t beat normally (arrhythmias), for example:

• Bradycardia — a heartbeat that’s too slow
• Tachycardia — a heartbeat that’s too fast
• Heart block — when the electrical signals controlling your heartbeat are disrupted
• Cardiac arrest — when problems with electrical signals cause the heart to stop beating

Is pacemaker implantation right for you?

A pacemaker is usually recommended if you have a condition that affects your heart rhythm. It can help ease symptoms such as dizziness, shortness of breath and chest discomfort — and for some, it can be lifesaving. Most people with pacemakers can enjoy a full, active life.

After surgery, you may need to make a few adjustments to your lifestyle. You’ll also need regular check-ups, usually every 3 to 12 months for the rest of your life.

Pacemakers have a limited lifespan and need to be replaced when the battery runs low. Most batteries last 6–10 years and replacement is usually a straightforward procedure.

Pacemaker implantation is one of the most common heart procedures. The most common method is called transvenous implantation.

You’ll be given a local anaesthetic, so you’ll be awake during the operation but should not feel any pain.

The procedure usually involves:

• A small cut of 5–6cm just below your collarbone, usually on the left side of your chest
• Inserting one or more pacemaker wires (pacing leads) into a vein and guiding them to your heart using x-ray scans
• Connecting the other end of the leads to the pacemaker, which is placed in a small space between your skin and chest muscle
• Closing the cut with medical glue or stitches

Once the leads are in place, your cardiologist will test them to make sure they work properly. Small amounts of energy are sent through the leads to your heart to make it contract. You may feel your heart beating faster during this test — let your care team know what you’re feeling. Your cardiologist will then adjust your pacemaker settings to match your needs.

How to prepare for your pacemaker implantation surgery

Before having a pacemaker fitted, you’ll need a pre-operative assessment. This helps your consultant check you’re well enough for the procedure and gives your care team the information they need to plan your treatment.

During the assessment, your consultant will talk to you about:

• Your general health
• Your heart health
• Any other medical problems
• Previous operations
• Any issues you or your family had with anaesthetics
• Any medication you take — make sure you mention all medicines, including herbal remedies and over-the-counter products

Feel free to ask any questions to make sure you understand what the procedure involves, including any risks and how to look after yourself afterwards.

You may also need some tests, such as blood tests and an electrocardiogram (ECG).

It’s a good idea to be as healthy as possible before your surgery, as this can support your recovery and reduce the risk of complications. Eating a healthy, balanced diet, exercising regularly and stopping smoking are all positive steps.

Your care team will let you know when to fast, ie when to stop eating and drinking before the procedure — this is usually a few hours before. Your admission letter will also include full instructions.

Who will be involved?

Your operation will be carried out by a consultant cardiologist (heart specialist) or an electrophysiologist — a cardiologist who specialises in heart rhythm problems. A consultant anaesthetist will give you the anaesthetic and monitor you throughout the procedure. All Spire Healthcare consultants are highly experienced and registered with the General Medical Council (GMC).

You’ll also be cared for by a dedicated team of nurses and recovery staff before, during and after your operation.

How long does the procedure take?

The operation usually takes around 1 hour but may take longer if you’re having other heart surgery at the same time.

Anaesthetic choices

Pacemaker implantation surgery is usually done under local anaesthetic. You may also be given sedation to help you stay calm and relaxed — this can make you feel sleepy during the procedure.

Pain during surgery and straight after surgery

You’ll be awake during the procedure, but you should not feel any pain in the area being operated on, as you’ll be given a local anaesthetic. Some pain or discomfort is normal afterwards, but you’ll be given pain relief to help manage this.

What happens straight after surgery

You’ll be taken to a recovery area, where your care team will monitor you as the anaesthetic wears off. 

Your hospital stay

Most people can go home on the day of surgery or the following day. You’ll need to arrange for someone to take you home, as you won’t be able to drive yourself.

Recovery time

You should be able to return to most of your activities after about 4 weeks.

Short-term side effects

You may have some pain or discomfort after surgery, along with bruising around the area where the pacemaker was fitted. This should settle in a few days.

After the operation

In addition to some pain, discomfort and bruising after the procedure, you might also feel very tired for a couple of days.

You may be aware of your pacemaker at first or feel uncomfortable lying in certain positions, but most people adjust with time.

Pain relief

You may have some pain or discomfort for the first 48 hours, but you’ll be given medication to help manage it and instructions on how often to take it.

Wound care

Avoid getting your wound wet until your stitches have been removed. Once they’re out, try not to wear anything that rubs against the area. If you wear a bra, you may need one with wider straps for comfort.

Many stitches are dissolvable and will disappear on their own. If not, they’re usually removed after 7–10 days. Your care team will let you know which type you have before you leave hospital.

Avoid exposing your wound to sunlight for the first year, as this can darken your scar.

How long do pacemaker batteries last?

Most pacemaker batteries last 6–10 years. When the battery runs low, the pacemaker unit is usually replaced with a new one. Your consultant will advise on when your pacemaker needs replacing and what signs to look out for.

Check-ups after surgery

You’ll usually have a follow-up appointment 4–6 weeks after surgery to check how your pacemaker is working. After that, you’ll need regular check-ups for the rest of your life. This is usually every 3–12 months, depending on your device and condition.

If you feel your pacemaker isn’t working as well as it could, let your care team know. They can adjust the settings if needed.

How your loved ones can help

When you’re ready to go home, you’ll need someone to drive you, as you won’t be able to drive yourself straight away. It’s a good idea to arrange some help at home. Support from friends or family with things like shopping, cooking or housework can make your recovery easier.

Using electrical equipment

Most household devices, like microwaves or hairdryers, won’t interfere with your pacemaker, as long as you keep them at least 15cm (6 inches) from your pacemaker.

However, some appliances, like induction hobs, can interfere with your pacemaker. Your care team will be able to advise you and answer any questions you have about using electrical equipment.

Smoking

If you smoke, it’s important to stop before surgery and avoid it afterwards. This will support your recovery and reduce the risk of complications.

Driving

You can usually drive again after 1 week, as long as you don’t have any symptoms that could affect your ability to drive, such as dizziness or fainting. If you drive a large or passenger-carrying vehicle, you’ll need to wait for at least 6 weeks. Your consultant will be able to advise you.

You must also tell the Driver and Vehicle Licensing Agency (DVLA) and your insurance provider that you have a pacemaker.

Time off work

This varies depending on your job, but most people need about a week off work. Your consultant will be able to advise you.

If you drive a bus or a lorry for work, you’ll need to wait at least 6 weeks before driving these types of vehicles.

Sexual activity

If you feel well after your pacemaker is fitted, you can enjoy a normal sex life. You’ll need to avoid positions that put pressure on your chest or arm during the first 4 weeks after surgery.

What you should/shouldn’t do after surgery

For the first 4–6 weeks, you should avoid:

• Heavy lifting
• Reaching or raising your arm above shoulder height on the side your pacemaker was fitted
• Strenuous activity

Things you can do to help with recovery

To help support your recovery:

• Attend your follow-up appointments
• Eat a healthy, balanced diet
• Protect your scar from the sun for the first year
• Rest — avoid strenuous activity for at least 4 weeks
• Stop smoking if you smoke

It’s also important to follow any advice from your consultant and care team.

When can you resume normal activities?

Most people can return to everyday activities within a few days. However, for the first 4–6 weeks, avoid:

• Reaching up with the arm on the side your pacemaker was fitted — for example, when hanging out washing
• Strenuous activity

You should be able to return to most activities and sports after that. If you play contact sports, such as football or rugby, make sure you avoid collisions — you may want to wear a protective pad. Very energetic sports, like squash, are best avoided. Speak to your doctor if you’re unsure about what activities are safe for you.

As with any surgery, pacemaker implantation has benefits as well as risks. Possible complications include:

• Blood clots — may develop in a vein in the arm on the side where your pacemaker was fitted, causing swelling
• Pacemaker infection — symptoms include a high temperature, pain, swelling or redness in the implant area
• Pacemaker malfunction — in rare cases, the pacemaker may not work properly and may need to be replaced
• Twiddler’s syndrome — when the pacemaker is moved or dislodged from its position

Contact your care team straight away if you notice any of these symptoms or if anything feels unusual.