What is a pacemaker?

A pacemaker is a system with a pulse generator and one or more electrode leads for electric impulses to stimulate the heart to contract and produce a heartbeat. A permanent pacemaker is inserted under the patient’s skin just above the breast tissue. When the heart needs a signal the pacemaker sends electrical impulses along an electrode lead to stimulate the heart to contract and produce a heartbeat.

Pacemakers may be single (one lead), dual (two leads) or triple (three leads) chamber and you will have the appropriate one for your underlying problem.

There are approximately 25,000 pacemakers implanted in the UK every year.

Why may I need a Pacemaker?

In a normally functioning heart, each heartbeat begins at the sino-atrial node – a small group of specialized cells that form the heart’s natural pacemaker. The electrical impulses spread through the heart causing it to contract so that blood is pumped to the lungs and the rest of the body. If there is a malfunction in the conduction system or if the natural pathway of the electrical impulses is blocked, the heart rate may become slow, very fast, or irregular. This may result in dizziness, drowsiness, shortness of breath, and/or fainting. A pacemaker can treat some of these abnormal heart rhythms.

How is the procedure performed?

The procedure is not usually performed under a general anaesthetic, but you may be given sedation, which will make you relaxed and sleepy.

Before the procedure starts, the doctor will clean the skin with some antiseptic solution and inject some local anaesthetic under the skin just below your collarbone (usually on the left side as most people are right handed, however if you are left handed your doctor may be able to implant the device on the right side). This will numb the area and allow the doctor to pass a small lead or electrode through a vein into your heart. You may have one, two or three leads inserted depending on what type of pacemaker you need. The lead(s) are then connected to the pacemaker box. This will usually be placed under the skin on your chest wall. The area will then be stitched with dissolvable or nondissolvable stitches and a glue like substance may be applied to seal the wound. If your stitches need to be removed by your GP’s practice nurse or District nurse you will be informed when you leave the hospital. The whole procedure should take approximately 60 to 90 minutes.

You will be given or sent a card to carry with you at all times, stating that you have a pacemaker and documenting the make and model of the device. The pacemaker battery will last 7-10 years and can be changed by another small procedure performed as a day case when necessary.

What are the procedural risks?

The risks of the procedure are small. Generally the most common risks are;

• A small risk of infection, bleeding and bruising to the pacemaker site
• A small risk of lead displacement – the pacemaker lead can move and would then need to be repositioned
• A small risk of perforation of the lung during the procedure (a pneumothorax) – this is often detected on the chest x ray that is performed following the pacemaker implant and can sometimes rectify itself without treatment. Very occasionally a small drain may need to be inserted through your side into your lung (in the space between your ribs) this is a simple procedure and the drain will be removed prior to your discharge home.

Aftercare

You should avoid reaching up high on the side of the operation for 4 weeks – do not lift things off high shelves or hang out washing. It is also important to retain movement in the arm to prevent a frozen shoulder. Four weeks after implantation, your pacemaker will be checked in the clinic. If all is well you will only need to have your pacemaker checked every 6 to 12 months. After four weeks you should have returned to a full normal life. If all is well you may then start to drive but you should inform the DVLC and your insurance company that you have a pacemaker.

There are some limitations to living with a pacemker and you should specifically avoid anything that may damage your pacemaker – eg contact sports such as rugby or boxing.

Ordinary household electrical equipment will not affect your pacemaker. This includes microwave ovens as long as they are in good working order. If your job means that you come into contact with strong electrical fields – eg arc welding, diathermy, high power radio or TV transmitters, or direct contact with car ignition systems, then you should take advice before returning to work.