Cardiac pacemaker insertion

Overview

A cardiac pacemaker is a small, battery-powered device that is placed under the skin of the chest to help control abnormal heart rhythms. It sends electrical signals to your heart to make it beat at a steady, appropriate rate. The procedure to put in a pacemaker is called pacemaker insertion or implantation.

Yes, pacemaker insertion is a common procedure. Thousands of people receive pacemakers every year worldwide.

It affects both men and women, most often in older adulthood. However, younger people and even children may need a pacemaker if they have certain heart conditions.

Symptoms

Common symptoms

• Dizziness or light-headedness
• Fainting (syncope) or nearly fainting
• Fatigue or feeling unusually tired
• Shortness of breath, especially during activity
• Chest pain or discomfort
• Heart palpitations (feeling like your heart is fluttering or skipping beats)

Symptoms in children

• Being very tired or sluggish
• Poor feeding or trouble gaining weight
• Breathing fast or distress during feeding
• Fainting or seizures

Symptoms in older adults

• Confusion or memory trouble (because the brain isn't getting enough blood)
• Falls without a clear reason
• Getting easily tired during daily activities
• Shortness of breath that is new or getting worse

Causes

Main causes

• The heart's natural pacemaker (the sinoatrial node) is not working properly, causing too slow a heart rate (sick sinus syndrome).
• Heart block — the electrical signal is blocked or delayed as it travels through the heart.
• Damage to the heart's electrical system from a heart attack, heart surgery, or certain medications.

Risk factors

• Getting older (over 65)
• Having heart disease, high blood pressure, or diabetes
• Having had a heart attack or heart surgery in the past
• Taking certain medicines (like beta-blockers) that slow the heart rate (but these are often prescribed by a doctor for good reason)

When to see a doctor

See a doctor urgently if:

• If you faint or have chest pain, call your local emergency number right away.
• If you have new dizziness that makes you feel like you might pass out, seek same-day medical care.

Book a routine appointment if:

• If you have noticed mild but persistent symptoms like tiredness, shortness of breath, or occasional light-headedness, make an appointment with your general practitioner (GP).

Diagnosis

Diagnosis usually starts with a physical exam and a review of your symptoms. The main test is an electrocardiogram (ECG or EKG), which records the electrical activity of your heart. Sometimes a portable monitor is used to record your heart over 24 hours or longer.

Tests that may be done

• Electrocardiogram (ECG) — a quick, painless test that uses sticky patches on your chest to see your heart's electrical pattern.
• Holter monitor — a small, portable ECG you wear for 24 to 48 hours to catch irregular rhythms.
• Event recorder — a device you wear for weeks to record your heart only when you have symptoms.
• Echocardiogram — an ultrasound of your heart to check for structural problems.
• Blood tests — to check for conditions that can affect your heart rhythm, like thyroid problems or electrolyte imbalances.

What to expect at your appointment

Your doctor will talk with you about your symptoms and health history. The tests are painless and usually done in a clinic or hospital. If a slow heart rhythm is found, your doctor will explain why a pacemaker might help and go over the procedure with you.

Treatment

Treatment for a slow heart rhythm that causes symptoms is usually a pacemaker. The device is implanted during a small surgical procedure. For some people, treating an underlying cause (like changing a medication) may be tried first, but a pacemaker is often the most effective long-term solution.

Self-care at home

• Take any prescribed medications exactly as directed.
• Report any new or worsening symptoms to your doctor.
• Keep follow-up appointments to check your pacemaker's function.

Medical treatments

There are no specific medications that fix a slow heart rhythm caused by electrical problems. A pacemaker is the standard medical treatment. The procedure is done under local anesthesia (you are awake but the area is numb). The doctor makes a small cut under your collarbone, guides one or more thin wires (leads) into a vein and to your heart, then connects them to the pacemaker device. The device is placed in a small pocket under the skin.

When is surgery considered?

Pacemaker insertion is a surgery itself. It is recommended when your slow heart rhythm causes symptoms or poses a risk of serious complications. The surgery is considered minor and has a high success rate.

Living with this condition

After you recover from the procedure (usually a few weeks), you can return to most normal activities. You will need to avoid heavy lifting and vigorous arm movements on the side of the pacemaker for about 4 to 6 weeks. You may feel the device under your skin, but most people get used to it.

Lifestyle tips

• Carry a pacemaker identification card with you at all times.
• Tell healthcare providers (like dentists) that you have a pacemaker before any procedure.
• Avoid strong magnetic fields, like MRI machines (unless your pacemaker is MRI-safe) and large generators. Ask your doctor for a full list.
• You can use most household electronics, including cell phones, but keep them at least 6 inches away from your pacemaker.

Diet and exercise

A heart-healthy diet (low in salt, rich in fruits, vegetables, and whole grains) is encouraged. Regular exercise is safe and beneficial, but talk to your doctor before starting a new program. Avoid contact sports that could hit your chest near the pacemaker.

Mental health and emotional wellbeing

It is normal to feel anxious or worried about having a device inside you. Some people feel a change in body image. These feelings usually improve with time. If you feel very down or overwhelmed, talk to your doctor. Support from family, friends, or a counselor can help.

Prevention

The conditions that lead to needing a pacemaker are often not preventable, especially age-related changes. However, you can reduce your risk of heart disease by eating healthily, staying active, not smoking, and managing conditions like high blood pressure and diabetes.

Complications

If left untreated

• Fainting, which can lead to injury from falls
• Heart failure (the heart cannot pump enough blood to the body)
• Stroke (if the slow rhythm causes blood to pool and clot)
• Sudden cardiac arrest (the heart stops beating completely)

Long-term outlook

For most people, a pacemaker greatly improves symptoms and quality of life. The procedure is safe and effective. With regular check-ups and battery replacements (every 5 to 10 years), you can expect to lead a full, active life. The future for pacemaker technology continues to improve, offering even smaller devices and longer battery life.

Find support

International organisations

• Heart Rhythm Society

Local organisations

• British Heart Foundation · UK

Helplines

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