Pacemaker implantation

A pacemaker is used to help treat irregular or slow heart rhythms (bradycardia).

Implanted under the skin of the chest a pacemaker is a small medical device that helps manage irregular or slow heart rhythms (bradycardia). One or more leads are attached to the pacemaker that can deliver electrical impulses from the pacemaker to the heart.

A pacemaker works by sensing an individual's own heart rate and when it determines that this rate is too slow, stimulates the heart to beat. This will keep the heart rate at or above the programmed rate of the pacemaker device. The aim of pacemaker therapy is to reduce or eliminate symptoms caused by bradycardia and pauses.

Other heart rhythm disorders may require more specialized implantable cardiac devices like biventricular pacemakers (CRT or cardiac re-synchronisation pacemakers) or ICDs (internal cardioverter defibrillators). It is a very similar procedure to having a standard pacemaker implanted.

What is a pacemaker?

A pacemaker system is made up of two components.

The pulse generator: the generator is a small metal case that houses the battery and electrical circuitry of the pacemaker.  The generator continuously monitors your heart rhythm and rate and delivers electrical pulses to pace your heart when it senses a slow rhythm. 

The leads: a pacemaker lead is an insulated wire that connects the pulse generator to the inside of your heart.  The leads act as a two-way pathway for electrical information.  Electrical signals from your heart can be carried to the pulse generator (sensing) and energy from the pulse generator can be delivered to your heart to make it beat (pacing). 

Are there different types of pacemaker?

There are three types of permanent pacemaker available: Your cardiologist will advise which kind of pacemaker is appropriate for you.

Single chamber: a single chamber pacemaker has one lead attached to it. This lead is placed in either the right atrium (RA) or right ventricle (RV) depending on the type of abnormal heart rhythm.

Dual chamber: a dual chamber pacemaker uses two leads. One is placed in the right atrium and one in the right ventricle.  The leads work together to ensure the atrium and ventricles contract in a coordinated way.

Biventricular: a biventricular pacemaker uses three leads which pace the right atrium, right ventricle and the left ventricle.  This ensures that, not only are the atrium and ventricles contracting in a coordinated way with respect to each other, but that the left and right ventricles are synchronised too.

Will anything interfere with a pacemaker?

Most modern pacemakers are shielded and have built-in features to guard against outside interference. It is safe to use appliances such as kettles, toasters, electric blankets, radios, remote controls, electric shavers and microwave ovens.

If there is interference this is usually temporary and will not permanently damage the pacemaker.  If you feel unwell, move away from the source of the interference. Please carry your pacemaker identification card with you. Some things should be avoided, or precautions taken:

  • Mobile phones – it safe to use but keep the phone 15cm away from the pacemaker site.  
  • Shop or airport security systems – you may pass through security systems or metal detectors but do not linger. Should the metal detector be set off, be ready to present the pacemaker identification card.
  • Medical equipment – ensure doctors, dentists and other medical professionals know you have a pacemaker.  Certain procedures such as MRI, radiation treatment, diathermy and shock wave lithotripsy can interfere with the pacemaker.
  • Power generating equipment – welding equipment or high voltage transformers can interfere with the pacemaker.  Ensure you are standing at least 60cm away from this equipment.

What will I experience during the procedure?

The chest is painted with an anti-septic solution to clean the skin where the pacemaker will be implanted and local anaesthetic used to completely numb the incision site for the pacemaker. The pacemaker lead/s are guided into the heart using X-ray, via a vein just under the collar bone.

Once the pacemaker is connected to the lead/s, testing is performed using a pacemaker programmer to check the lead/s are in the correct place and are working efficiently. The incision site is closed using internal sutures and a special skin glue. The procedure can take anywhere from 30 minutes to one hour depending on the type of pacemaker implanted. Generally, the more leads, the longer the procedure.

Do pacemaker batteries need replacing?

Pacemakers have a battery life of about seven to fifteen years. The battery life is carefully checked at each pacemaker follow up and a pacemaker replacement procedure will be scheduled several months before the battery is fully depleted.  

During a replacement, a small incision is made, and the old pacemaker removed.  If the existing lead/s are still working well, they can stay in place.  The new pacemaker is inserted and attached to the leads then tested. 

What happens after the procedure?

After the procedure a chest x-ray will taken before going to the ward to recover and for observation. The pacemaker technician will check the pacemaker about four hours after the procedure to ensure the leads and device are working appropriately. This is not required for pacemaker replacements.

Most patients go home after the post procedure pacemaker check. Very occasionally patients may need to stay overnight.

Before leaving:

  • an appointment will be made with the local pacemaker clinic for long-term follow-up checks
  • information will be given regarding:
    • Wound care and recovery information
    • Pacemaker booklet from the manufacturer of the pacemaker
    • Discharge form
    • Pacemaker ID card

When can I resume travel and other activities?

Unless your job involves heavy lifting, you will usually be able to return to work within a week of having the procedure.

It is a Land Transport Safety Authority (LTSA) requirement not to drive for 2 weeks following pacemaker implantation.  If you usually drive a bus or truck, it is advisable not to drive for up to six weeks following your procedure. 

What are the risks?

Pacemaker implantation is a very low risk procedure. Your doctor will discuss these with you before the procedure. The risks are:

  • Infection near the site in the heart where the device is implanted
  • Swelling, bruising or bleeding at the pacemaker site, especially if you take blood thinners
  • Blood clots (thromboembolism) near the pacemaker site
  • Damage to blood vessels or nerves near the pacemaker
  • Collapsed lung (pneumothorax)
  • Blood in the space between the lung and chest wall (haemothorax)
  • Movement (shifting) of the device or leads