From the procedure to recovery: Frequently asked pacemaker questions

An X ray of a pacemaker device implanted into a body
Over half a million pacemakers have been implanted in the UK. But how do they work? Senior Cardiac Nurse Emily McGrath speaks to Dr Anthony Li, Consultant Cardiologist and Electrophysiologist at St George’s Hospital London.

How big is a pacemaker?   

A pacemaker is approximately 5 by 4 cm and the thickness is about 6/7mm. It is a flat oval shape. You might be able to feel it in your chest, particularly when lying down. Sometimes you can see the shape of the pacemaker under your skin, though this depends on your body shape. Modern pacemakers are smaller so often they can’t be seen.  

How does a pacemaker work? 

The pacemaker senses through the wires what the heart is doing at any given time and if it senses that the heart has slowed down or missed a beat then it will send an electrical impulse to stimulate the heart to restore it to its normal rate. Most people don’t feel the electrical impulse, but you may feel the rate or rhythm of your heartbeat change. Often people probably get used to this and stop noticing.  

Does the heart need to be stopped during a pacemaker operation?

No, it doesn’t. The heart continues beating at its normal rate during the procedure.

Would I have anaesthetic for the procedure?

The vast majority of pacemakers are put in under local anaesthetic. Usually there is an option of sedation too if you need it and if it is safe. The procedure is generally very well tolerated, with only very minor discomfort when the local anaesthetic is injected. Occasionally we need to perform the procedure under general anaesthetic (for example for those with a diagnosis of dementia), but we usually don’t do this as general anaesthetic has added risk, although small.

Man holding a pacemaker between his fingers

A pacemaker is approximately 5 by 4cm.

Will I feel the pacemaker working?

Most people don’t feel the electrical impulse, but you may feel the rate or rhythm of your heartbeat change. Often people get used to this and stop noticing.

How long will a pacemaker last? What happens when you need a new battery? 

The average lifespan of a pacemaker battery is about 6-7 years and the procedure for changing the battery is much simpler than when pacemakers are put in. It is performed as a day case under local anaesthetic.
 
The wound is reopened and the pacemaker box is removed, but the leads stay in place. The new box is substituted and the wound is sewn up. Most people go home the same day. There is plenty of warning before the battery runs out and patients are regularly checked for that. 

How often does my pacemaker need to be checked?

Your pacemaker will be checked the day after the implantation and then at six weeks. After that it will be checked every year, and more often towards the end of the battery life.

Man having his heart check up

What do I need to do or not do after having a pacemaker fitted?

You shouldn’t get the wound wet until it has healed and you will be given dressings to help keep it dry.
 
We advise no strenuous activity for the first six weeks to give the wound the chance to heal up and the leads to bed in place. That means avoiding sports, particularly contact sports, or doing anything where you lift, push or pull heavy objects.

We advise no strenuous activity for the first six weeks to give the wound the chance to heal up

 
We also ask patients not to lift the left arm above the head in those six weeks. The reasons for that are firstly that it can be uncomfortable until it heals up, and secondly, although the leads have been secured in place with stitches, there is a small chance of them moving in the first few weeks.
 
Other gentle arm movements like cooking, housework or carrying shopping are usually fine, as long as you’re not lifting your arm above your head.  

Can you exercise with a pacemaker? Will the battery wear out faster if I exercise more?   

For the vast majority of people exercise has a negligible effect on the battery over the lifetime of the device. The overwhelming message is that exercise will benefit your heart.

A person running

What are the risks? 

There are risks with any procedure, but the risks are low with pacemaker insertion. About 1 in 100 people experience serious complications during the procedure or immediately afterwards. These complications can include bleeding around the heart, or deflating the lung on one side, or leads moving once they have been secured in place, but all these can be treated.
 
A small amount of bleeding and bruising is normal after a procedure like this and it may be a little worse if the patients are on blood thinners (such as warfarin), but in general it is not a problem, as we have equipment to stop the bleeding.  

What is the difference between a CRT pacemaker and a normal pacemaker? 

A CRT pacemaker involves putting an extra lead into a vein that wraps around the bottom left chamber of the heart (the left ventricle), as well as in the bottom right chamber (the right ventricle) and the top right chamber (the right atrium).
 
We do this in patients who have a very specific type of heart failure, in which the heart chambers contract in an uncoordinated way. This re-coordinates the pumping action of the heart to make it beat more efficiently. 

Do I need to notify DVLA if I have a pacemaker? 

You cannot drive for a week after the pacemaker is inserted (six weeks if you have a HGV or PSV license), but you should be able to resume normal driving afterwards. You should notify the DVLA once the pacemaker has been inserted. Visit gov.uk/DVLA, or call 0300 790 6806. 

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