Pacemaker implantation

What is a pacemaker? 

A pacemaker is used to regulate your heartbeat and can help if your heart beats too slowly. Leads coming from the pacemaker are placed in different parts of the heart. They cause the heart to beat when an electrical impulse is sent through them. 

Single chamber pacemakers have one lead, dual chamber pacemakers have two, and biventricular pacemakers (which can help patients with heart failure) have three leads. The type of pacemaker you have will depend on your heart condition. We will explain which one you have and why.

Why do I need a pacemaker?

The heart is a pump controlled by electrical signals. These signals can become unsettled for a number of reasons and this can lead to potentially dangerous heart conditions, such as:

• an abnormally slow (bradycardia) or abnormally fast heartbeat (tachycardia) due to damage to part of the heart called the sinoatrial (SA) node
• irregular heartbeat because the controlling electrical signals are not transmitted properly 
• cardiac arrest – when a problem with the electrical signals in the heart causes the heart to beat extremely fast or stop altogether.

How is a pacemaker fitted?

Before having your pacemaker fitted, you will need to come into hospital for an assessment. This might include tests, such as an echocardiogram, chest X-ray and / or blood tests. 

Your implantation will take place in the cardiac catheter lab. The most common method of fitting a pacemaker is transvenous implantation. The cardiologist will make a small cut just below your collarbone on the left-hand side and insert the wires of the pacemaker (pacing leads) into a vein. The leads are then guided along the vein, into your heart, using X-ray scans, and then become embedded in your heart tissue.

The other ends of the leads are connected to the pacemaker. The device is then fitted into a small pocket between the skin of your upper chest and your chest muscle that has been created by the cardiologist.

The fitting is carried out under local anaesthetic and you will usually need to stay in hospital overnight following the procedure.

What happens after my pacemaker has been fitted?

You will need to attend follow-up appointments at the pacing clinic. Your wound is expected to heal in around seven to ten days. It will either be covered in a skin adhesive (glue), which will peel off naturally between one and three weeks, or dissolvable stitches. It may be covered with a dressing that should be removed after three days.  

You should avoid putting strain on your wound for two to four weeks after your operation and not take part in any activity that involves lifting your elbow above shoulder level. Your wound will be checked at your first follow-up appointment, but you should contact the pacing clinic if you experience any increased:

• redness
• tenderness
• swelling
• discharge
• fever or chills.

Living with a pacemaker

After your procedure you will have received an ID card with your details on it. It is important that you show this to any doctor, dentist or other healthcare professional you see and tell them that you have a pacemaker. You should also show the card to security staff at airports before you go through the barrier. Walking through the metal detector archway will not affect your device but please do walk straight through it. 

You must not drive for at least one week after your pacemaker has been implanted. It is important that you also inform the DVLA and your motor insurance company that you now have a pacemaker.

Explain My Procedure: video animation to help guide you through your procedure 

Explain My Procedure uses video animation to help patients understand what their recommended cardiac procedure will involve, the associated risks and benefits, and possible alternatives. You can view this simple video animation on the Explain My Procedure platform to help you further understand what a pacemaker implantation will involve, the associated risks and benefits, and possible alternatives. To find out more about Explain My Procedure, click here.