Artificial Cardiac Pacemakers

Overview

A pacemaker is a small, battery-powered device that is placed under the skin of the chest to help the heart beat at a normal pace. It sends gentle electrical signals to the heart when it beats too slowly or irregularly. Think of it as a backup rhythm coach for your heart.

Yes. Pacemakers are widely used around the world, and thousands of people have one fitted each year. In the UK, for example, more than 25,000 pacemakers are implanted annually.

Pacemakers are most often needed by older adults, but they can also be used for younger people and even children. They help people whose hearts beat too slowly, pause, or have an irregular rhythm that causes symptoms.

Symptoms

Common symptoms

• Dizziness or light-headedness
• Feeling unusually tired or weak
• Fainting or nearly fainting
• Shortness of breath, especially with mild activity
• A sensation that the heart is skipping beats or beating too slowly

Symptoms in children

• Feeding difficulties in babies
• Being unusually sleepy or less active than expected
• Poor weight gain or slow growth
• Episodes of fainting or looking pale without a clear reason

Symptoms in older adults

• Confusion or memory problems linked to reduced blood flow
• Unexplained falls
• Frequent tiredness or low energy
• Breathlessness during daily activities

Causes

Main causes

• The heart's natural pacemaker (the sinus node) is not sending signals properly
• A block between the upper and lower parts of the heart's electrical system
• Damage to heart tissue from a previous heart attack
• Certain heart conditions present from birth
• Some medicines that slow the heart too much

Risk factors

• Becoming older
• Having coronary heart disease or heart failure
• Having had heart surgery
• Taking medicines that affect heart rate
• Having a family history of heart rhythm problems

When to see a doctor

See a doctor urgently if:

• Call your local emergency number if you faint, have severe chest pain, or struggle to breathe.
• Seek same-day medical advice if your pacemaker wound becomes swollen, red, or painful, or if you have fevers and chills.
• Contact your pacemaker clinic if you notice regular dizziness, prolonged hiccupping, or a feeling that your heart is beating oddly.

Book a routine appointment if:

• Attend all scheduled pacemaker checks to make sure the device and your heart are doing well.
• Tell your doctor if symptoms like tiredness, breathlessness, or fainting happen again.
• Ask your doctor what to do before any planned surgery, dental procedure, or hospital treatment.

Diagnosis

A doctor will talk with you about your symptoms, listen to your heart, and do tests to check your heart's electrical activity. If a slow or irregular heart rhythm is found, they may refer you to a heart specialist for a pacemaker.

Tests that may be done

• Electrocardiogram (ECG) — a quick test that records the electrical signals of your heart
• Holter monitor — a portable device you wear for 24–48 hours to track your heart rhythm during daily life
• Echocardiogram — an ultrasound scan that looks at the structure and pumping action of your heart
• Blood tests — to check for other conditions that could affect your heart rhythm

What to expect at your appointment

If a pacemaker is recommended, you will have a pre-procedure meeting to discuss the benefits and risks. The implantation is usually done under local anaesthetic, meaning you are awake but the chest area is numb. Most people go home after a short hospital stay and recover quickly.

Treatment

The main treatment is the pacemaker itself. It is placed just under the skin, usually near the collarbone, with thin wires guided to the heart. The device monitors each heartbeat and sends a small electrical impulse only when needed to keep the heart beating at a safe rate.

Self-care at home

• Keep the wound clean and dry until it heals, following the hospital's instructions
• Wear a medical ID or carry a pacemaker card telling others you have a pacemaker
• Avoid heavy lifting or strenuous arm movements for a few weeks after the procedure
• Report any unusual symptoms to your pacemaker clinic without delay

Medical treatments

Pacemakers can be programmed to meet your specific needs, and the settings can be adjusted without surgery. In some cases, medications may be prescribed to manage underlying heart conditions, but these are always chosen by your specialist. The pacemaker battery eventually needs replacing, and this is done with a minor procedure that is usually straightforward.

When is surgery considered?

The pacemaker is implanted during a surgical procedure performed by a cardiologist. This is usually a low-risk operation, and most people stay in hospital for one or two nights. If the battery runs low, a simple operation is done to replace the generator part of the pacemaker.

Living with this condition

After the first few weeks of recovery, you can usually return to work, travel, driving, and daily activities. You should avoid strong magnetic fields, such as those from certain large MRI machines, and always tell doctors, dentists, and airport security that you have a pacemaker. Modern pacemakers are safe in most household settings, but check with your clinic about specific devices.

Lifestyle tips

• Avoid heavy lifting or contact sports for at least a few weeks after surgery
• Keep mobile phones and other devices away from the pacemaker site when possible
• Do regular gentle activity, such as walking, as your doctor advises
• Limit alcohol, as too much can affect heart rhythm
• Do not smoke, as it harms your heart and blood vessels

Diet and exercise

A balanced diet with plenty of vegetables, fruit, whole grains, and lean protein helps keep your heart healthy. Regular exercise, such as daily walks or light cycling, is usually safe and encouraged. Your doctor or a cardiac rehabilitation team can advise on a safe exercise plan that suits you.

Mental health and emotional wellbeing

It is normal to feel anxious, fearful, or down when living with a heart device. Many people worry about the device failing or about how it will affect daily life. These feelings usually ease over time, but it is important to talk to your healthcare team if you feel overwhelmed. You are not alone, and support is available.

Prevention

Some conditions that lead to needing a pacemaker cannot be prevented, such as age-related changes or heart block. However, a heart-healthy lifestyle can reduce your risk of heart disease, which is one of the most common reasons for needing a pacemaker. This includes keeping blood pressure and cholesterol in check, eating well, being active, and not smoking.

Vaccines

Staying up to date with recommended vaccines, including the flu vaccine and other routine immunisations, helps prevent infections that could put extra strain on your heart. Talk to your GP or pharmacist about which vaccines are right for you.

Screening programmes

There is no general screening test for pacemaker needs. But if you have symptoms of a slow heartbeat, or if you have risk factors for heart disease, your doctor may arrange tests to check your heart rhythm. Regular pacemaker checks are essential once your device is fitted.

Complications

If left untreated

• Fainting spells that can lead to falls and injuries
• Severe dizziness and constant tiredness
• The heart beating so slowly that vital organs do not get enough oxygen
• Heart failure or worsening of existing heart conditions
• Rarely, serious heart rhythm problems that can be life-threatening

Long-term outlook

The outlook for people with a pacemaker is very good. Most people feel a clear improvement in symptoms such as dizziness, fatigue, and breathlessness. The device is reliable, and the procedure is generally safe. With regular checks and a healthy lifestyle, most people can enjoy a full and active life for many years.

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