Pacemaker Implantation
Pacemaker implantation is a procedure to put a small battery-operated device called a pacemaker into your chest. The pacemaker sends regular electrical impulses, which help keep your heart beating regularly.
Having a pacemaker fitted is one of the most common types of heart procedures.
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, that run to your heart.
The pacemaker contains:
- a battery, which usually lasts from 8 to 10 years depending on how advanced the device is (pacemakers that are more advanced tend to use more energy so have a shorter battery life)
- an impulse 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 pulses 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:
- damage to part of the electrical circuit called the sinus node – which can cause an abnormally slow heartbeat (bradycardia), an abnormally fast heartbeat (supraventricular tachycardia), or sometimes a combination of both
- heart block – when your heart beats irregularly because the electrical signals that control your heartbeat are not transmitted properly
- cardiac arrest – when the heart stops pumping blood around your body
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 into the muscle near the collarbone. The generator is attached to a wire that is guided through a blood vessel to the heart.
The procedure takes around 30–60 minutes, and most people are well enough to leave hospital the day after the procedure.
After a pacemaker implant
You should be able to get back to normal physical activities very soon afterwards. As a precaution, it is normally recommended that you avoid strenuous activities for around 3 to 4 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're in good working order.
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 're-programme' the pacemaker to fix a malfunction by using wireless signals. However, further procedures may be required if the pacemaker moves out of position.