Pacemakers: The expert's view

Karen Hogg

Karen Hogg, Consultant Cardiologist at the Golden Jubilee National Hospital in Glasgow, regularly inserts pacemakers, implantable cardioverter defibrillators and cardiac resynchronisation therapy devices.

I'm not surprised that a patient's experience of having a pacemaker fitted was a positive one - that's usually the case.

Pacemakers can be fitted in people of any age, including children, but are most often fitted in the over-60s. In most cases, the natural pacemaker has begun to deteriorate with age or due to certain conditions. For this type of patient, a pacemaker can have a significant and positive effect on quality of life because it puts an end to debilitating blackouts.

A more sophisticated pacemaker called a cardiac resynchronisation therapy (CRT) device can be fitted for some people with heart failure - when the heart no longer pumps efficiently. CRT can help to improve the symptoms associated with heart failure such as breathlessness and tiredness, but it doesn't cure the condition - around seven in 10 people who have CRT device feel better afterwards, but three in 10 don't.

When can you go home?

As most procedures are done under local anaesthetic, recovery is usually reasonably quick. You'll have to stay in overnight and will need to take mild painkillers, and keep the wound clean and dry for a few weeks.

"A pacemaker won't stop you living an active life in the long term - in fact, it should make physical activity much easier"

If you're a woman, avoid wearing a bra for the first few days because the strap might rub against the wound. But if you prefer to wear one, cover the wound with a light, dry dressing during the day and leave it uncovered at night.

Six weeks later you'll have an outpatient appointment to check the pacemaker setting suits your personal needs - this is important. If you get dizzy spells in the first few weeks, this means the box probably needs to be adjusted. But that's easy to do and painless.

If you drive, you must tell the DVLA that you've had a pacemaker fitted so it can advise you on short-term driving limitations, according to the type of licence you have and your medical history. Also avoid lifting your arms above your head, or doing heavy housework, gardening, golfing or DIY for about six weeks.

However, the good news is that a pacemaker won't stop you living an active life in the long term - in fact, it should make physical activity much easier. Just follow your doctor's advice on what's appropriate after the procedure.

Is it affected by gadgets?

Most modern, well-maintained household items won't interfere with your pacemaker's functioning. However, it's a good idea not to keep your mobile phone in the breast pocket right next to your pacemaker because there's a very small chance that it could interfere with the box's function.

Avoid contact with magnets and don't wear magnetic fasteners on clothes close to your pacemaker because they may switch it off. And don't use a TENS machine for pain relief - this could also interfere with the pacemaker setting.

If you use an induction hob for cooking, keep a distance of at least 60 centimetres (2 feet) from your pacemaker, as this type of hob generates an electromagnetic field that may interfere with your pacemaker settings.

What if it stops working?

"Replacing the battery of a pacemaker is a simple procedure"

The pacemaker is usually checked at the pacing clinic at least once a year. It's important to attend these appointments because the battery will eventually need to be replaced and the regular checks allow you to plan for that. Replacing just the battery is a simple procedure. If the leads also need replacing, it can be easier to leave the old ones in place, which does no harm, because removing them can be difficult.

What happens at the end?

People often ask whether a pacemaker needs to be switched off when someone is dying. The answer is no - a pacemaker responds to the natural electrical activity in the heart, so it can't restart the heart or keep someone alive and it won't cause discomfort to someone who's dying. However, if someone is going to be cremated, the pacemaker should be removed first because the heat could cause it to explode.

A defibrillator should be deactivated before death because it attempts to restart the heart and could cause shocks that may be distressing for the patient and their family.

What could go wrong?

As with any procedure, there are risks of complications. But these are relatively low: about one in 100 with standard pacemakers and five in 100 with CRT devices. Happily, in most cases complications are short term. They include:

  • Infection of the wound, which may spread to the area around the box or leads. It's important to nip this in the bud by reporting telltale signs such as high temperature, redness or swelling to the wound to your GP right away
  • Bleeding and bruising at the time of the implant, especially if you're taking blood-thinning medication such as warfarin
  • Pneumothorax - an air pocket in the lung that can occur when the lead is inserted
  • Movement of the leads - they will need repositioning and the wound will have to be reopened to carry out this procedure.

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