Pacemakers are small devices that use tiny electrical pulses to initiate heart activity to maintain a correct heart rate. They can also help with a range of heart rhythm-related conditions.

What is a pacemaker?

A pacemaker is a small, battery-powered device that is implanted under the skin of the chest, abdomen, or directly inside the heart, to increase a heart rate where a heart is experiencing rhythm problems (arrhythmia). It uses electrodes, connected to the heart either directly or via one or more wires (also called “leads”) to monitor for rate abnormalities. If it detects one, the device generates a tiny electrical pulse that travels down the lead/s to stimulate the heart into correcting its rate.

What is happening in a heart with arrhythmia?

The heart contains four chambers: two atria at the top and two ventricles lower down. Natural electrical charges from the brain prompt these chambers to contract so blood can be pumped around your body (a healthy heart normally beats around 60-100 times a minute). The charges are channelled through two patches of specialized cells in the heart wall – the SA node (at the top) and the AV node (lower down); these are the body’s natural pacemakers. Certain medical conditions (see below) can disrupt the electrical impulses, causing the natural pacemakers to malfunction.

Why might I need a pacemaker?

If you’re being recommended for a pacemaker, it’s because your heart is struggling to maintain a normal rate and/or rhythm on its own. It may be beating too slowly (bradycardia), too quickly (tachycardia) or irregularly. There are a number of reasons why this might be happening. Some conditions that commonly cause arrhythmia include:

Sick sinus syndrome – when the SA node stops functioning normally.

A heart block – where the impulses between the AV and SA, or from the SA node itself, are delayed or blocked.

Atrial fibrillation – where the electrical impulses become random or chaotic.

Heart failure – where the heart isn’t pumping strongly enough or in a coordinated fashion.

What symptoms could these conditions cause?

This depends on the underlying reason for your arrhythmia. For pacemaker patients, symptoms can range from palpitations or a fluttering feeling in the chest, to dizziness, fatigue, shortness of breath and chest pains. There are a number of different tests we can do to determine whether you’ll need a pacemaker. These could include blood tests, an electrocardiogram (ECG), a Holter monitor (a portable ECG that you wear for 24 hours or more) or an electrophysiological (EP) study (an in-clinic test where we examine your heart activity in detail).

Is there more than one kind of pacemaker?

Yes, there are several different types. We’ll need to analyse your heart carefully before determining which one would be best for you. The main types include:

Standard pacemaker – usually placed inside your chest, with leads connecting to one, two or three of your heart chambers

Wireless pacemaker – a new, pill-sized device that can be inserted directly into the heart, without any leads

Cardiac resynchronisation therapy (CRT) – a pacemaker for heart failure patients that sends charges to several chambers to help them beat in time with each other

Implantable cardioverter defibrillator (ICD) – a device that tracks your heart rate and can deliver an electric shock (defibrillation) to reset the heart rhythm and prevent cardiac arrest

Some devices can also provide a mixture of functions – for instance, certain CRT devices come with an additional ICD element.

How would you fit my pacemaker?

Most standard pacemakers are fitted using “transvenous implantation”, which means the leads are inserted through a vein. We do this by creating a small incision of about 5cm underneath your collarbone, usually on the left side. We then carefully direct the leads to your heart chamber/s, using an x-ray scanner to guide us. While some pacemaker operations are performed with a general anaesthetic, the majority are done using a local anaesthetic, often with a sedative to help you feel relaxed. Most ICDs are implanted in the same way, though some can be fitted just under the skin.

What happens during the procedure?

When you arrive at the clinic, the nurses will give you an assessment and go through all your details. We’ll then take you through to the theatre, where you’ll be given sedation or a general anaesthetic if you’re having one. Before the procedure starts, we clean the skin around the incision area with antiseptic and, if you’re staying awake for the operation, inject a local anaesthetic to numb the area. After making the incision, we insert the lead/s and connect them to your pacemaker. The device will usually be positioned below the skin in your chest. We then seal the incision with medical stitches. The operation usually takes around an hour to an hour and a half to complete.

What happens next?

Immediately after the procedure, we’ll take you back to the ward so you can lie down and rest for an hour or two. We’ll do some tests to check your pacemaker is working well and adjust it to the best settings for your condition. We may also monitor your heart rhythm with an ECG. Back at home, you will probably need to take painkillers for the first few days as your wound heals; we may give you a course of antibiotics to take too. Try to keep the wound dry for the first few days after your surgery, and let us know if you’re worried about it, or if you need help with the dressings. You will also need to avoid lifting the arm nearest to your pacemaker above shoulder height for the first week after surgery; this helps protect the vein as it adjusts to the pacemaker’s leads. After approximately 6 weeks, we’ll see you again for a follow-up appointment to check your pacemaker is still functioning well.

What else do I need to be aware of?

There are a few other things that are useful to know when you’re preparing to have a pacemaker:

ID card – every pacemaker comes with a card listing the device’s make and model, so the relevant medics can be properly informed if you need treatment in the future. You’ll receive this card before you leave the hospital and you will need to carry it with you at all times

Car insurance – you’ll need to let your insurance know when you’ve had a pacemaker fitted

Household equipment – most household devices shouldn’t interfere with your device, though the small print on products sometimes states you should avoid using them if you’re fitted with a pacemaker device; if you’re unsure, please check with us. However, you should avoid placing magnets near your chest, because they can interfere with your pacemaker. (Also be aware that certain devices, such as stereo speakers, can contain strong magnets.)

Mobile phones – we usually recommend you don’t carry your phone in a pocket near the pacemaker, or use it within six inches of the device, since there is some evidence that some phones can affect pacemakers

Medical scans – it’s safe to have x-rays, mammograms and CT scans while you have a pacemaker, but depending on your device you will probably need to avoid having an MRI scan; again, you can contact us for advice if you need to

Travelling – if you have to pass through an airport security scanner, it’s a good idea to show the officials your pacemaker ID card as you do so; the metal in pacemakers sometimes triggers the security alarms (though it won’t cause any harm to the device)

We will give you more comprehensive information about the Dos and Don’ts for pacemakers before you leave the hospital.

Will I be able to drive after my pacemaker fitting?

There are various restrictions around who is deemed safe to drive after a pacemaker has been implanted, and when you would be able to resume driving. These depend on the reason you needed to have a pacemaker fitted in the first place, so it’s important to discuss this with us in detail. You can also find more information about driving and pacemakers on the Road Safety Authority’s (RSA) website.

Will I need to see you again in the future?

Yes. Your pacemaker will need to be checked regularly in the hospital – at least once a year, or potentially more frequently. During the checks we’ll review your pacemaker’s settings and battery life, and use some specialised tests to examine the condition of the leads. We may then make some adjustments if they’re necessary. It’s now possible to do some pacemaker checks remotely using a home transmitter; data about the device and your heart rhythm can be sent over the internet for the hospital technicians to review. If we think you’ll be suitable for a portable monitoring device, we can discuss this with you in clinic.

What happens when my pacemaker’s battery runs out?

All batteries eventually run out, but we’ll give you plenty of warning before this happens. Modern pacemaker batteries also last a long time – usually around six to 12 years, depending on the type of device you’re using. The operation to replace a battery is similar to your original fitting, except that we won’t normally need to replace the leads running down to your device.

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