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. Therefore, it is unlikely general household appliances will interfere with your pacemaker. It is safe to use appliances such as kettles, toasters, electrical blankets, radios, remote controls, electric shavers and microwave ovens.

It is safe to use mobile phones but keep it 15cm away from your pacemaker site. Do not keep it in a shirt pocket over te pacemaker.

Induction cooktops generate an electromagnetic field and pacemaker manufacturers recommend you keep your pacemaker site at a distance of 60cm from the cooktop. This is equivalent to about an arm's length.

Before the Procedure

Fasting: Please stop eating four hours before your procedure time. You may continue to drink clear fluids (water, weak BLACK tea and weak BLACK coffee) up to two hours before your procedure time. Do not consume milk as this is considered food. You may take your regular medications with sips of water. 

Allergies: Please tell Intra staff at the time of booking if you have any medication or food allergies, or any previous reaction to X-ray contrast (dye).

Diabetes: If you are a diabetic, please tell Intra staff at the time of booking. You may need to discuss your insulin/diabetes medication doses with your cardiologist.

Anticoagulation (blood thinner): If you are taking blood thinners e.g. Warfarin, Dabigatran (Pradaxa), Rivaroxaban, Clopidogrel and Enoxaparin (clexane) please advise Intra staff at the time of booking. Your cardiologist will advise you if you need to stop this medication temporarily for a day or two before the procedure.

Other regular medications: Please continue these unless advised otherwise by your cardiologist. If you are taking a diuretic or water pills (e.g. frusemide, spironolactone) please inform Intra staff.

During the Procedure

Your chest will be exposed and prepped with an antiseptic solution where the pacemaker will be implanted. You will be covered with a large sterile drape and the chest area will be completely numbed with local anaesthetic. Local anaesthetic stings when going in, but the area quickly becomes numb.

You may still feel pressure while a pocket is made under the skin for the pacemaker to sit but you should not feel any pain. If at any time you feel pain or are uncomfortable, please let your cardiologist know and more local anaesthetic or medication to help you relax can be given.

Using X-ray the pacemaker lead/s are guided into your heart via a vein just under the collar bone. The pacemaker is then connected to the lead/s and testing is performed using a pacemaker programmer to check the lead/s are in the correct place and are working. Once this is confirmed, the incision site is closed using sutures and a special skin glue.

After the Procedure

You will be taken to the recovery area or back to the ward where a chest X-ray will be taken.

Your pacemaker will be checked with a pacemaker programmer about four hours after the procedure to ensure the leads and device are working appropriately (this is not required if you have had a pacemaker replacement).

Most patients can go home after their post-op pacemaker check, usually 4-5 hours after the procedure. Very occasionally you may have to stay overnight.

Going home and recovery

Usually, you will be able to go home after your post-op pacemaker check. This is done 4-5 hours after the procedure.

  • Please arrange for someone to drive you home or accompany you in a taxi after your procedure
  • It is a Land Transport Safety Authority (LTSA) requirement that you do not drive for two weeks after a pacemaker implantation.
  • You will need to arrange someone to be at home with you on the day of your discharge and overnight to support you in your recovery.
  • We advise that you do not travel outside of the Auckland area on the day of your procedure

Prior to your discharge, the nursing staff and pacemaker specialist will give you more in-depth information about resuming your normal activities, wound care, follow-up appointments and other information that is important for your recovery

What are the risks?

As with any procedure, there are potential risks involved. Your cardiologist will explain the procedure, discuss possible risks and answer any questions you may have. You will then be asked to sign the consent form. This will occur either at an earlier appointment, or on the day of your procedure.

Do pacemaker batteries need replacing?

Pacemakers last 7-15 years depending on many individual factors. Regular checks are done to monitor the battery, and you will be reffered for a replacement about 3 months before the battery is depleted. 

The pacemaker battery is sealed in the pacemaker. Therefore, the entire pacemaker is replaced. The pacemaker lead/s are unplugged from the old device and plugged back into a new one. The battery is not re-chargable.