A pacemaker is a small device with two parts — a generator and wires (leads, or electrodes) — that’s placed under the skin in your chest to help control your heartbeat.
There are 2 forms of pacemaker, one is temporary, the other permanent. The first type can be in your heart for a few days, the second type for many years. In each case, there is a battery and one or two long wires/leads.
Apart from the two main types of pacemaker there are many types of permanent pacemaker. Some are made to make your heart beat at different rates depending on what you are doing. These “smart” ones can speed up the heart when, for example, you run for a bus but will slow it down again when you are at rest. This is more like what your heart normally does.
Other pacemakers can help the right and left side of your heart to beat in time together actually synchronising the two sides as in CRT (Cardiac Resynchronisation Therapy) which involves the placement of a third wire/lead.
A pacemaker is used to help your heart beat faster when it needs to. Normal ageing may have upset the electrical activity of your heart causing it to beat too slowly. Or damage to your heart muscle from a heart attack can disrupt the pace of your heart beat. Sometimes medication can slow your heart rate.
If your heart has been beating too slowly at times you might have noticed dizziness or a blackout. A pacemaker, when in place, can tell when your heart is slowing down and so “kick in” to speed up your heart rate and protect you from a blackout.
Sensors in the pacemaker may recognise when movement or breathing rate increases (like during exercise or physical activity) and respond by increasing your heart rate to meet the demand for blood and oxygen. Some pacemakers can help to treat heart failure.
Most people have no problems having a pacemaker implanted. There is always a small risk of getting an infection where the pacemaker was implanted. There may be some bleeding or swelling at the pacemaker site, particularly if you are taking blood thinners but some pressure applied to the wound site will usually stop this.
Bruising is common and may spread around your chest and arm. More severe complications are rare but can include collapsed lung, damage to blood vessels or nerves in the chest around the pacemaker.
Before your doctor decides if you need a pacemaker, you’ll have several tests to find out the cause of your slow heartbeat. These could include: ECG, echo, Holter monitor, and exercise stress test. A pacemaker is then usually implanted on your left side, as this is closer to the heart and allows for the wires to be inserted easily into the heart. The procedure usually takes about an hour and is often done using local anaesthetic so you will be awake but should not feel anything.
The pacemaker box contains the battery and one, two or three long wires to complete the pacing unit. The wires can be fed into your heart through a vein below the collarbone on either side. This is done using a local anaesthetic through a small cut about 2 or 3 inches long. The pacemaker box can then be fitted on to the wire(s) and a pouch made under the skin. The pacemaker will then be programmed to the settings needed to treat your condition.
The wound will heal up over a few days. You may need to take antibiotics to prevent infection, but it’s still important to look out for signs of infection. If you notice any increased swelling, redness, pain or oozing from the wound you should contact your doctor.
For the first while after you get home you will need to be careful not to lift your arm too high or put a lot of pressure on your arm. This allows the pacemaker and the leads to “bed in” or settle in to place.
The wound will be covered with a dressing for a few days. Your doctor or nurse will advise you on how to look after the wound and whether there are any stitches to be removed.
It’s normal to feel tired for a few days afterwards, but most people find that they are able to get back to their normal lifestyle fairly quickly.
From time to time the battery will need to be checked – about every 6 months to 1 year. In this way, it is possible to check how much energy is left in the battery. A new one can be put in when you need it. Usually it takes about 8 years before the power is used up, sometimes much longer (5 – 15 years).
You may need to take some precautions in your daily life after your pacemaker is installed but you should be able to return to your normal activities very quickly. Most household equipment and devices are unlikely to cause any interference with your pacemaker.
Magnets and airports
You do need to be careful around some equipment with magnets in it. If you are going through an airport on your travels, be sure to mention you have a pacemaker to the security staff so they don’t hold the metal detector over your pacemaker.
Heart & Stroke Conditions A-Z – see our range of guides.
Step by Step through Heart Attack – our patient information booklet
Step by Step through Stroke – our patient information booklet
Step by Step through Heart Medicines – our patient information booklet
Step by Step through Inherited Heart Disease – our patient information booklet
Step by Step through Heart Failure – our patient information booklet
Angina – our guide from symptoms to treatment
AF and You – our information booklet for people living with Atrial Fibrillation