Pacemaker: Why It Is Fitted and What Living With One Is Like

A pacemaker is a small device that helps the heart keep a steady rhythm. Having one fitted is a common procedure, and many people go on to live active lives. This article explains what the NHS says about why a pacemaker is used, how it is fitted and what to expect afterwards.

What is a pacemaker?

The NHS describes a pacemaker as a small device placed under the skin of the chest. It sends electrical signals to help control the heartbeat and treat heart rhythm problems. It sends small electrical pulses that make the heart pump and keep its beat steady.

Why might someone need one?

The NHS says a pacemaker can be used to treat heart block, arrhythmias (irregular heart rhythms) and heart failure. The NHS also mentions a pacemaker among the options for some people with atrial fibrillation. A cardiologist decides if you need one after tests.

How it is fitted

Before the procedure you have an assessment, which may include blood tests, a chest X-ray or an echocardiogram, and a cardiologist explains the procedure. According to the NHS:

• A cardiologist fits the device in hospital under local anaesthetic, sometimes with sedation. It usually takes about an hour.
• In a standard fitting, a small cut is made on the left side of the chest, wires are guided through a vein to the heart and the device is placed under the skin near the collarbone. The cut is closed with stitches or glue.
• Most people stay in hospital overnight.
• For a slow heartbeat, a leadless pacemaker may be offered. It is guided through a vein directly into the heart, with no wires or chest cut, and people can usually go home the same day.
• The pacemaker is checked before you leave.

Recovery

The NHS says that for the first few days you may feel tired and have soreness on the left side of your chest. Keep the wound clean and follow your care team's advice on showering, dressings and exercise. Gentle shoulder exercises may be recommended. Do not drive for at least the first week. For 4 to 6 weeks, avoid carrying heavy objects, vigorous exercise and lifting your elbow above shoulder height. Full recovery can take a few weeks or months.

Risks

The NHS says the procedure is common and serious complications are unlikely. Infection is possible. Contact your pacemaker clinic or a health helpline urgently if the wound becomes more swollen, tender or red, leaks blood, pus or clear fluid, if you have a high temperature or feel hot, cold or shivery, or if your earlier symptoms return or get worse.

Living with a pacemaker

The NHS describes this follow-up pattern: an appointment about 6 weeks after fitting at the pacemaker clinic, another at 3 to 6 months with a cardiologist, and then at least every 12 months at the clinic. The battery usually lasts 6 to 7 years, and the device is checked more often as replacement gets closer. You receive a pacemaker ID card to show to health professionals. Airport security is permitted, but a handheld metal detector should not be passed over the device, so you can ask for a hand search. Tell the driving licence authority and your insurer that you have a pacemaker, as the NHS advises, and check the rules where you live.

When to see a doctor

Keep your follow-up appointments, and get urgent advice if you notice signs of infection or your symptoms return.

Call emergency services at once for severe breathing difficulty, chest tightness or heaviness, pain spreading to the arms, back, neck or jaw, pale, blue or grey lips or skin, or sudden confusion. The NHS says not to drive yourself to hospital.

In an emergency, call your local emergency number (112 in India, 911 in the United States).