Pacemaker implantation

Pacemaker implantation is a surgical procedure where a small electrical device called a pacemaker is implanted in your chest.

The pacemaker sends regular electrical pulses that help keep your heart beating regularly.

Having a pacemaker fitted can greatly improve your quality of life if you have problems with your heart rhythm, and the device can be lifesaving for some people.

Pacemaker implantation is one of the most common types of heart surgery carried out in the UK. During 2012-13 in England, more than 40,000 people had a pacemaker fitted.

How does a pacemaker work?

The pacemaker is a small metal box weighing 20-50g. It is attached to one or more wires, known as pacing leads, which run to your heart.

The pacemaker contains:

• a battery, which usually lasts six to 10 years depending on how advanced the device is (more advanced pacemakers tend to use more energy so have a shorter battery life)
• a pulse generator
• a tiny computer circuit that converts energy from the battery into electrical impulses, which flow down the wires and stimulate your heart to contract

The rate at which these electrical impulses are sent out is called the discharge rate.

Almost all modern pacemakers work on demand. This means that they can be programmed to adjust the discharge rate in response to your body's needs. If the pacemaker senses that your heart has missed a beat or is beating too slowly, it sends signals at a steady rate. If it senses that your heart is beating normally by itself, it does not send out any signals.

Most pacemakers have a special sensor that recognises body movement or your breathing rate. This allows them to speed up the discharge rate when you are active. Doctors describe this as rate responsive.

Why do I need a pacemaker?

The heart is essentially a pump, made of muscle, which is controlled by electrical signals.

These signals can become disrupted for several reasons, which can lead to a number of potentially dangerous heart conditions, such as:

• an abnormally slow heartbeat (bradycardia) or an abnormally fast heartbeat (supraventricular tachycardia) – caused by damage to part of the heart called the sinoatrial node
• heart block – where your heart beats irregularly because the electrical signals that control your heartbeat are not transmitted properly 
• cardiac arrest – when a problem with the electrical signals in the heart causes the heart to stop beating altogether

An implantable cardioverter defibrillator (ICD) is a device similar to a pacemaker. This sends a larger electrical shock to the heart that essentially reboots the heart to get it pumping again. Some devices contain both a pacemaker and an ICD.

ICDs are often used as a preventative treatment for people thought to be at risk of cardiac arrest at some point in the future. If the ICD senses that the heart is beating at a potentially dangerous abnormal rate, it will deliver an electrical shock to the heart. This can often help return the heart to a normal rhythm.

Read more about why you might need a pacemaker.

What happens during a pacemaker implantation?

Having a pacemaker implanted is a relatively straightforward process. It is usually carried out under local anaesthetic, which means you will be awake during the procedure.

Most commonly, the generator is placed under the skin near the collarbone, on the left side of the chest. The generator is attached to a wire that is guided through a blood vessel to the heart.

The procedure usually takes about an hour and most people are well enough to leave hospital the day after surgery.

Read more about how a pacemaker is fitted.

After pacemaker surgery

You should be able to get back to normal physical activities very soon after surgery. As a precaution, it is normally recommended that you avoid strenuous activities for around four to six weeks after having your pacemaker fitted. After this, you should be able to do most activities and sports.

You will be able to feel the pacemaker, but you will soon get used to it. At first, it may seem a bit heavy and may feel uncomfortable when you lie in certain positions.

You will need to attend regular check-ups to make sure your pacemaker is working properly. Most pacemakers store information about your natural heart rhythms. When you have follow-up appointments, doctors can retrieve this information and use it to check how well the pacemaker and your heart are working.

Most ordinary household electrical equipment is safe to use and will not interfere with your pacemaker. This includes microwaves, as long as they are in good working order.

Read more about recovering from pacemaker surgery. 

Safety

Having a pacemaker implanted is usually a very safe procedure with a low risk of complications. The biggest concern is that the pacemaker loses the ability to control the heartbeat, either because it malfunctions or the wire moves out of the correct position.

Sometimes it is possible to "reprogramme" the pacemaker to fix a malfunction by using wireless signals. However, further surgery may be required if the pacemaker moves out of position.

Read more about the risks of having a pacemaker.