Living with permanent pacemaker living

Overview

A permanent pacemaker is a small, battery-powered device that is placed under the skin of your chest. It sends gentle electrical signals to your heart to help it beat at a normal, steady rhythm. This can help people whose hearts beat too slowly or have irregular rhythms.

Yes, pacemakers are widely used around the world. Many thousands of people of all ages have one to help keep their heart rhythm stable.

People of any age can need a pacemaker, but they are most common in older adults. Children with certain heart conditions may also need one.

Symptoms

Common symptoms

• Dizziness or light-headedness
• Fainting or near fainting
• A pounding or irregular heartbeat (palpitations)
• Chest pain or discomfort
• Shortness of breath, especially with activity
• Unusual tiredness or weakness

Symptoms in children

• Fatigue or sleepiness more than usual
• Poor feeding in babies
• Irritability without a clear reason
• Noticeably slow or irregular heartbeat
• Fainting or breathlessness during play or exercise

Symptoms in older adults

• Confusion or memory problems due to poor blood flow
• Falls or balance problems
• Reduced ability to do everyday tasks
• Persistent tiredness or weakness
• Shortness of breath or swelling in the feet and legs

Causes

Main causes

• The heart beats too slowly (bradycardia), which can make it hard for the body to get enough oxygen-rich blood.
• The heart's electrical system does not send signals properly (heart block), causing the heartbeat to be irregular or slow.
• Certain heart conditions, such as heart failure or previous heart surgery, that harm the heart's natural pacemaker.
• Some medications may slow the heart, but a pacemaker is only considered when medicines no longer help or cause serious side effects.

Risk factors

• Older age, as the heart's electrical system can wear down over time.
• Heart disease, including narrowed arteries or a previous heart attack.
• High blood pressure or diabetes.
• Certain infections that can damage the heart muscle.
• Some inherited conditions that affect the heart rhythm.

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if you have signs of infection around the wound, a rapid or irregular heartbeat, or new symptoms like fainting or chest pain.
• Contact your pacemaker clinic if you hear a beeping sound from the device, as this may mean it needs a check.
• If you have any symptoms listed under 'urgent' above, do not wait and see — get medical advice promptly.

Book a routine appointment if:

• Attend all scheduled pacemaker checkups, usually every few months to a year.
• Tell your healthcare team if you notice any changes in how you feel, even if it is between appointments.
• Carry your pacemaker ID card with you and show it to any doctor or nurse you see.

Diagnosis

Your doctor will review your medical history, heart symptoms, and any tests you have had. A pacemaker is usually recommended after tests show that your heart rhythm is too slow or irregular for daily life. The doctor will explain why you may benefit and what the device will do.

Tests that may be done

• Electrocardiogram (ECG or EKG) — a quick test that records the heart's electrical activity.
• Holter monitor — a small portable device that records every heartbeat over 24 hours or longer.
• Echocardiogram — an ultrasound scan that checks the heart's size, shape, and pumping strength.
• Blood tests — to check for underlying causes such as thyroid problems or heart damage.

What to expect at your appointment

If a pacemaker is recommended, you will have it placed during a small surgical procedure. The procedure is usually done under local anaesthetic (the area is numbed) plus light sedation. A small cut is made near your collarbone, and the pacemaker is slipped under the skin. Thin wires (leads) are guided to your heart. The whole process typically takes an hour or two. You will usually stay in hospital for a day or two for monitoring and then go home to recover.

Treatment

The main treatment is having a pacemaker implanted and then making sure it is properly adjusted and checked. The pacemaker constantly watches your heart and only sends electrical signals when needed. It does not replace your heart's own rhythm; it acts as a safety net.

Self-care at home

• Keep the wound clean and dry for the first few days as instructed by your care team.
• Avoid heavy lifting or strenuous arm movements for about 4 to 6 weeks to let the leads stay secure.
• Wear your pacemaker ID card and tell any other doctors or dentists you have a pacemaker.
• Handle magnets and electronic devices according to the guidance you receive — most everyday gadgets are safe, but keep mobile phones a few inches away from the chest area.
• Ask your healthcare team before having any medical scans or procedures that involve strong magnets or electrical equipment.

Medical treatments

Your doctor may adjust the pacemaker's settings at checkups to make sure it is working at its best for you. Some people also take medicines for heart conditions, but your doctor will decide what is right for you. The pacemaker itself may need a new battery every 5 to 10 years, which usually involves a straightforward procedure.

When is surgery considered?

The implantation of the pacemaker is the main surgical step. Sometimes a replacement or adjustment of the leads may be needed later. Your doctor will discuss this with you if it ever becomes necessary.

Living with this condition

For the first couple of weeks after implantation, take it easy and allow the wound to heal. After that, you can gradually return to your normal routine. Most people find that their energy and stamina improve because their heart rhythm is more stable. You will still attend regular pacemaker checks, but these are quick and painless.

Lifestyle tips

• You can usually travel by air and through airport security, but show your pacemaker ID card and ask for a manual search instead of a metal detector walk-through.
• Avoid contact sports that might cause a hard blow to the chest area.
• Keep mobile phones and smart speakers at least 15 cm (6 inches) away from the pacemaker site, and do not put them in a breast pocket.
• Large magnets, powerful speakers, and industrial equipment may interfere — follow the safety advice from your care team.
• Do not put pressure on the chest area, for example with a tight seatbelt or carrying a backpack strap over the pacemaker site.

Diet and exercise

A balanced, heart-friendly diet and regular light exercise are good for everyone, including people with a pacemaker. Walking, swimming, cycling, and gentle strength training are usually safe once you have recovered. Always ask your doctor or physiotherapist before starting a new exercise routine. Avoid heavy lifting or contact sports for a while after the procedure.

Mental health and emotional wellbeing

It is normal to feel anxious or worried about having a device inside your body. Many people feel better once they have recovered and see how much the pacemaker helps them. If you feel low, anxious, or afraid, talk to your doctor or nurse. You can also reach out to a mental health professional or a friend — you are not alone.

Prevention

Pacemakers are used to treat heart rhythm problems that often cannot be fully prevented. However, you can reduce the risk of complications by keeping your heart as healthy as possible, attending regular checkups, and protecting the pacemaker area from injury.

Vaccines

It is generally recommended that people with heart conditions stay up to date with vaccines, such as flu and pneumonia vaccine, because infections can put stress on the heart. Ask your doctor or pharmacist which vaccines are appropriate for you.

Screening programmes

Once you have a pacemaker, you will have routine checks to make sure it is working well. These checks are a form of screening for potential problems with the device or your heart rhythm.

Complications

If left untreated

• If a pacemaker problem is not addressed, you may have fainting spells, which can lead to falls and injuries.
• A very slow heartbeat can cause chronic tiredness, confusion, or shortness of breath.
• In serious cases, an untreated pacemaker failure could lead to heart failure or a life-threatening emergency.
• Infections near the pacemaker can spread if not treated promptly.

Long-term outlook

For most people, living with a pacemaker means a return to a fuller life with fewer symptoms and a lower risk of dangerous heart rhythm events. The device is reliable, and modern pacemakers are small and long-lasting. With regular checkups and a few practical precautions, you can look forward to many years of active and enjoyable living.

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