A pacemaker implant is the surgical placement of a device called an artificial pacemaker. It is a treatment for arrhythmias (abnormal heartbeats). Arrhythmias happen when your heart’s electrical signal causes it to pump too slowly, too quickly, or irregularly. A pacemaker implant uses electrical pulses to help your heart return to a normal heartbeat.
Your heart is basically a pump made up of muscle tissue. It has four chambers, two upper chambers (atria) and two lower chambers (ventricles). Like all pumps, your heart requires a source of energy in order to function. Your heart's pumping energy comes from a built-in electrical conduction system.
In order for you to have a normal heartbeat, your heart's four chambers must work in harmony with one another. A heartbeat is produced when an electrical signal travels through these chambers. Any malfunction in this signal can make your heart beat too quickly, too slowly, or at an uneven rate. This causes an arrhythmia.
A pacemaker implant has risks and potential complications. It is only one method used to treat arrhythmias. Discuss all of your treatment options with your doctor to understand which options are right for you.
Types of pacemaker implants
A pacemaker has two main parts. The first part is the wires with electrodes that connect to your heart. These wires continually monitor your heart rhythm. They send the information to the second part of a pacemaker, the pulse generator. The pulse generator is a small battery-operated computer. It recognizes abnormal heart rhythms and responds by sending electrical pulses back to your heart to correct the rhythm.
The types of pacemaker implants include:
A biventricular pacemaker has three wires that connect to the right upper chamber (right atrium), the right lower chamber (right ventricle), and the left lower chamber (left ventricle). It coordinates signals between the right atrium and both ventricles. This type of pacemaker is also called a cardiac resynchronization therapy (CRT) device.
A dual-chamber pacemaker has two wires that connect to an upper chamber and a lower chamber of your heart. It corrects abnormal electrical signals between the two chambers.
An external pacemaker stays on the outside of your body to adjust your heart rate and rhythm. It is for temporary or emergency use, such as immediately after a heart attack.
A single-chamber pacemaker has one wire that connects to either an upper chamber or a lower chamber. It corrects abnormal electrical signals within a chamber.
A leadless pacemaker is a very small pacemaker that is implanted via a catheter directly in the right ventricle. It does not have a separate generator or wires. People who have a slow heartbeat due to specific heart conditions and only need single-chamber pacing may be candidates for the leadless pacemaker.
Types of pacemaker programming
Your doctor can program your pacemaker implant computer from outside your body.
The types of pacemaker programming include:
Demand programming monitors your heart rhythm and only sends pulses when it detects an abnormal heart rate or your heart misses a beat.
Rate-responsive programming also monitors your breathing, body temperature, and other factors. It uses this information to determine your activity level. It then adjusts itself either up or down to match your activity level.
Your doctor may recommend a pacemaker implant to treat a heart arrhythmia. Your doctor may only consider a pacemaker implant for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a pacemaker implant.
Your doctor may recommend a pacemaker implant to treat:
Congenital (present at birth) heart disorders, meaning they are present at birth
Heart block, a blockage in your heart’s electrical pathway
Heart failure, a condition in which the heart cannot pump enough blood to the body
Hypertrophic cardiomyopathy, a complex heart disease characterized by thickened heart muscle and ventricular stiffness
Irregular heart beat or skipped heartbeats that occur often
Too rapid or too slow heart beats, called tachycardia (too rapid) and bradycardia (too slow), that happen too often or at abnormal times
The following specialists can perform a pacemaker implant in a hospital:
Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
Cardiac electrophysiologists specialize in diagnosing and treating arrhythmias.
Interventional cardiologists specialize in diagnosing and treating conditions and diseases of the heart and blood vessels using nonsurgical, catheter-based procedures and specialized imaging techniques.
- Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.
Your pacemaker implant will be performed in a hospital. Implanting a traditional, wired pacemaker takes about an hour and generally includes these steps:
You will dress in a patient gown and lie on a procedure table.
Your team will insert an IV to provide fluids and medications.
You will receive medication (a moderate sedative) to relax you and make you drowsy. You may fall asleep.
A team member will prepare an area of your chest or abdomen (belly). This includes shaving if needed, cleaning, and covering with a surgical drape. This is the area where your surgeon will place your pacemaker.
Your surgeon will numb the area with an injection of local anesthetic. You will not feel anything in the area where your surgeon places the pacemaker.
After the area is numb, your surgeon will thread the wires of your pacemaker through a vein to your heart using real-time x-ray guidance.
Once the wires are in place, your surgeon will create a pocket beneath the skin, situated either on your chest (endocardial approach) or on your abdomen (epicardial approach) and implant the pulse generator. An endocardial approach is most common for adults, while an epicardial approach is more common for children. If your surgeon is using an epicardial approach, you will receive general anesthesia.
Your surgeon will test the pulse generator once everything is in place and connected. You may feel your heart speed up or slow down during the testing. Tell your doctor about any sensations you feel.
Leadless pacemakers do not have a separate generator and leads, so implantation does not involve a chest or abdominal incision. Doctors implant a leadless pacemaker directly in the heart using a catheter threaded into your right ventricle via the femoral vein in your upper thigh. The pacemaker is attached to the tip of the catheter—a long thin tube that fits inside blood vessels.
To access the right ventricle and implant the device, your doctor:
- Applies a local anesthetic and makes a small skin incision at the femoral vein access site.
- Inserts the catheter and threads the catheter through the vein up to the right ventricle.
- Secures the pacemaker to the inner wall of the ventricle, releases the pacemaker, and retracts the catheter. The doctor also tests the pacemaker before releasing it.
Closes the access site with sutures and applies a sterile dressing.
Will I feel pain?
You may feel a pinch or prick when the IV is inserted and stinging when the local anesthetic is injected. You may also feel pressure when your surgeon makes the cut to place your pacemaker. If you are having a catheter-based procedure, you may feel some pressure in your groin as your doctor makes the incision and guides the catheter.
During the pacemaker testing, you may feel your heart slow down or speed up. Tell your doctor about any sensations you feel during the testing. You will have sufficient sedative medications so that you stay comfortable. Tell your care team if you are uncomfortable in any way.
Any surgical procedure involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or your recovery.
General risks of surgery
The general risks of surgery include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of a pacemaker implant
Complications of a pacemaker implant include:
Blood clot or air bubbles in the vein
Heart or nerve damage
Pacemaker malfunction requiring your doctor to reprogram it or replace it
Punctured heart or lung
- Tearing an artery or vein
Leadless pacemakers are relatively new to most patients, but device safety and dependability have been studied for several years. Risks include damage to the heart or vein and movement of the pacemaker. A patient with a leadless pacemaker does not have risks associated with the wires breaking or complications related to the generator, such as infection. The rate of complications with the leadless pacemaker is, overall, lower than with traditional pacemaker surgery.
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Avoiding close or prolonged exposure to electrical devices or devices that have a strong magnetic field. Your doctor will give you specific instructions about these devices.
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a pacemaker implant by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging a ride home from the hospital. Your doctor may not want you to drive for a period of time after a pacemaker implant.
Following exactly any instructions about eating and drinking before a pacemaker implant.
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a pacemaker implant? Are there any other options for treating my condition?
Which type of pacemaker implant will I need? Am I a good candidate for a leadless pacemaker?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kinds of electrical devices should I avoid? What kinds of medical testing should I avoid?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my regular medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
Knowing what to expect can help make your road to recovery after a pacemaker implant as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. A hospital stay of one to two days is usually required. This allows your care team to monitor your heart rhythm and make sure that your pacemaker is working properly. You will go home with instructions on when to follow up and how to care for your pacemaker.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your doctor may ask you to avoid strenuous activities or heavy lifting for about a month after surgery. Full recovery times vary, but most people are back to their normal light to moderate activities within a few days.
Recovery time for a leadless pacemaker procedure is shorter, but you may still need a hospital stay for monitoring.
How will I feel after my pacemaker implant?
You may have mild pain, swelling and tenderness at the placement site for several days after the procedure. Over-the-counter pain medicines can reduce discomfort. Speak with your doctor before taking any pain medication and only take pain medication exactly as directed. Tell your doctor or care team if your pain is not well controlled by your medication because it can be a sign of a complication.
When should I call my doctor?
You should keep your follow-up appointments after a pacemaker implant. Contact your doctor if you have any concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Chest pain, pressure, squeezing or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Pain that is not controlled by your pain medication, new pain, or pain that changes
Unexpected drainage, pus, redness or swelling of your incision
How might a pacemaker implant affect my everyday life?
A pacemaker implant also causes significant changes to your body that may affect your everyday life. Important activities for you include:
Alerting all of your healthcare providers that you have a pacemaker. Certain medical procedures are avoided if you have a pacemaker. Surgical procedures require careful monitoring of your pacemaker. It’s a good idea to carry a medical identification card listing the type of pacemaker. Medical identification bracelets and necklaces are also available.
Avoiding close or prolonged exposure to certain electrical devices or devices that have a strong magnetic field, such as magnetic resonance imaging (MRI). Your doctor will provide specific instructions on which devices to avoid.
Avoiding contact sports and activities that could loosen your pacemaker wires
Driving only after your doctor has cleared it. The length of time it takes to regain driving privileges varies depending on your local laws and your recovery.
Following up several times a year with your doctor. Your doctor will need to check, or interrogate, your pacemaker on a regular basis. Your doctor will check if the battery or wires need to be replaced, if other devices have affected the signaling, if it needs to be reprogrammed, or if your heart disease has progressed.
You may need future surgery to replace the battery, wires, or the entire pacemaker device. Generally, batteries last from five to seven years.