Dr Matthew Webber
Heart Failure, Cardiac Devices and Advanced CMR Specialist
Pacemakers
What is a Pacemaker?
A permanent pacemaker is a small electronic device that helps control the heart’s rhythm when the heart beats too slowly. It continuously monitors the heart’s electrical activity and delivers tiny electrical impulses if the heart rate falls below a pre-programmed level.
A pacemaker has two main parts:
• Generator – a small titanium case containing the battery and computer circuitry
• Leads (wires) – thin flexible insulated wires that connect the pacemaker to the heart/ These leads detect the heart’s rhythm and deliver pacing signals when needed
Why might I need a pacemaker?
Pacemakers are used to treat conditions where the heart beats too slowly or irregularly. By preventing the heart rate from dropping too low, pacemakers can improve symptoms such as dizziness, blackouts or fainting, fatigue and breathlessness.
What to expect?
Before
Pacemaker implantation is a routine procedure performed under local anaesthetic, sometimes with light sedation to help you relax.
The procedure usually takes around one hour and is commonly performed as a day-case procedure, meaning you can usually go home the same day.
During
During the procedure, a small incision is made just below the collarbone. One or two leads are then guided through a vein into the heart using X-ray imaging and connected to the pacemaker generator.
The generator is placed into a small pocket under the skin beneath the collarbone, and the incision is closed with absorbable sutures.
After
Some bruising and mild discomfort around the pacemaker site is common and usually settles within a few weeks but it can sometimes take a little longer. Most people return home the same day or the following morning.
You will be advised to:
• Avoid heavy lifting with the affected arm for a few weeks
• Avoid raising the arm fully above shoulder height initially
• Keep the wound clean and dry while it heals
A follow-up appointment will be arranged to check the wound and ensure the pacemaker is working correctly.
What are the risks?
Pacemaker implantation is a very safe and well-established procedure, but as with any medical procedure there are potential risks. Overall, complications occur in approximately 1 in 20 procedures.
Possible complications include:
Bleeding or haematoma (blood collection)
This may occur under the skin around the pacemaker pocket. Most resolve without treatment, but occasionally a further procedure is required to drain the collection.
Air around the lung (pneumothorax)
Rarely (around 1%), air can leak around the lung during lead insertion. This is usually detected immediately and may require a temporary drain.
Fluid around the heart (<1%)
Very occasionally bleeding into the sac around the heart can occur and may require drainage, blood transfusion or extremely rarely urgent surgery.
Lead movement
In a small number of cases the lead may move during the first few weeks after implantation, meaning it does not work properly and may need repositioning.
Infection
The risk of infection is slightly under 1 in 100. If infection occurs it usually requires removal of the pacemaker system to fully treat the infection.
Living with a pacemaker
Pacemakers are extremely reliable devices.
After implantation your pacemaker will be monitored through a combination of:
• Remote monitoring from home
• Periodic pacemaker clinic visits
Pacemaker batteries typically last around 8–12 years depending on usage. When the battery runs low, a straightforward procedure is performed to replace the generator while usually leaving the leads in place.
Occasionally device components may require replacement if problems are identified through international device safety monitoring systems.