Risks and benefits of pacemaker

Overview

A pacemaker is a small device placed under the skin of your chest to help control abnormal heart rhythms. It uses electrical pulses to make your heart beat at a normal rate.

Yes, hundreds of thousands of people worldwide receive pacemakers each year. It is a common and reliable treatment.

People of all ages, but most often older adults with heart rhythm problems, heart block, or certain heart conditions. It is also used in children with congenital heart defects.

Symptoms

Common symptoms

• Fainting or near-fainting (syncope)
• Extreme tiredness (fatigue)
• Shortness of breath during mild activity
• Dizziness or light-headedness
• Chest pain or discomfort
• Heart palpitations (feeling like your heart is fluttering or skipping beats)

Symptoms in children

• Lack of energy or being unusually tired
• Breathing fast during feeding or play
• Fainting or seizures
• Slow or irregular heartbeat that a doctor finds

Symptoms in older adults

• Confusion or trouble thinking clearly
• Falls or near-falls due to dizziness
• Getting tired quickly when walking
• Heart beating too slowly (bradycardia)

Causes

Main causes

• Sick sinus syndrome (the heart's natural pacemaker doesn't work properly)
• Heart block (electrical signals are blocked as they travel through the heart)
• Slow heart rate that causes symptoms
• Certain types of heart failure that need pacing

Risk factors

• Older age
• History of heart attack or heart surgery
• Certain medications that slow the heart
• Inherited heart conditions
• Damage to the heart's electrical system from disease or injury

When to see a doctor

See a doctor urgently if:

• Fainting or near-fainting
• Chest pain that is new or changing
• Shortness of breath that is getting worse
• A very slow or irregular heartbeat that you can feel

Book a routine appointment if:

• You have ongoing tiredness or dizziness that comes and goes
• You have been told you have an abnormal heart rhythm
• Your doctor recommends a check-up even if you feel fine

Diagnosis

A doctor will check your symptoms, listen to your heart, and use tests to see if your heart rhythm is abnormal. If a pacemaker is needed, it means your heart is not sending electrical signals properly.

Tests that may be done

• Electrocardiogram (ECG or EKG) – a simple test that records your heart's rhythm
• Holter monitor – you wear a portable device for 24–48 hours to catch irregular rhythms
• Event monitor – you press a button when you feel symptoms to record your heartbeat
• Echocardiogram – an ultrasound of your heart to see how it pumps and its structure
• Blood tests to check for other causes, like thyroid or electrolyte problems

What to expect at your appointment

If tests show you need a pacemaker, your doctor will explain the benefits and risks. The procedure is usually done under local anaesthetic (you are awake but the area is numbed) and takes about an hour. Most people go home the same day or the next day.

Treatment

A pacemaker is the main treatment for certain heart rhythm problems. It helps your heart beat at a normal rate and can improve energy, prevent fainting, and help you feel better.

Self-care at home

• Keep a diary of any symptoms like dizziness or fainting to share with your doctor
• Avoid heavy lifting or vigorous activities for a few weeks after the procedure
• Wear a medical alert bracelet or carry a card that says you have a pacemaker
• Avoid strong magnetic fields, such as from MRI machines or certain security systems (ask your doctor for guidance)

Medical treatments

The pacemaker itself is the treatment. It is implanted under the skin with one or more wires (leads) connected to your heart. After implantation, you will have regular check-ups to make sure the device is working well. Your doctor may also prescribe medications to manage other heart conditions, but no specific drugs are recommended here.

When is surgery considered?

The insertion of a pacemaker is a minor surgical procedure. It is done in a hospital, usually by a cardiologist or a surgeon who specialises in heart devices.

Living with this condition

Most people return to normal activities within a few weeks. You can walk, drive (after your doctor says it's safe), and do light housework. You will need to attend regular pacemaker checks, usually every 6–12 months, to make sure the battery and wires are working.

Lifestyle tips

• Avoid contact sports or activities that could hit your chest, like boxing or heavy martial arts
• Keep your cellphone away from your chest – use the ear on the opposite side
• Tell any healthcare provider you have a pacemaker before they do tests or treatments
• Travel is fine, but show your pacemaker card at airport security and avoid leaning over the metal detector

Diet and exercise

A heart-healthy diet with plenty of fruits, vegetables, whole grains, and lean protein is good. Exercise is encouraged – walking, swimming, cycling – but start slowly and follow your doctor's advice. Avoid heavy lifting or over-exertion in the first month.

Mental health and emotional wellbeing

It is normal to feel anxious or worried about having a device in your body. Some people feel more aware of their heartbeat or have trouble sleeping. Talking to your doctor, a counsellor, or a support group can help. If you feel very down or hopeless, reach out for help – you are not alone.

Prevention

The conditions that need a pacemaker are often not preventable. However, you can reduce your risk of complications after a pacemaker by following your doctor's instructions, keeping the incision clean and dry, and attending all follow-up appointments.

Screening programmes

If you have a family history of heart rhythm problems or certain heart diseases, your doctor may recommend regular heart check-ups. An ECG can detect some early warning signs.

Complications

If left untreated

• Without a pacemaker, a very slow heart rate can cause fainting, falls, injury, or lead to more serious heart problems
• In rare cases, it can cause sudden cardiac arrest (the heart stops beating) – this is a medical emergency

Long-term outlook

Most people with a pacemaker feel much better and are able to live full, active lives. The procedure is very safe, and modern devices last many years. With proper care and check-ups, the outlook is excellent.

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