Ask an expert: Pacemaker FAQs

Patients preparing to have a pacemaker implanted may have concerns about the procedure or the device itself and how it will affect daily life going forward. In this informative article, highly respected consultant cardiologist Dr Simon Pearse answers commonly asked questions about pacemakers, including what to expect from the implantation procedure and which types of conditions pacemakers can be used to treat. The leading specialist also details how the battery level of the device is monitored and how it helps the heart to function normally.

How do pacemakers work?

Pacemakers are small electrical devices that are implanted under the skin, usually on the top left or the top right of the chest. Pacemakers are essentially used to monitor your heart rhythm. If the heart is going too slowly or if the coordination between the chambers of the heart goes out of rhythm, pacemakers detect this and try to correct it by pacing the heart. This is done through delivery small electrical pulses to the heart to correct any heart rhythm abnormalities that might cause symptoms such as dizziness or fainting.

How are pacemakers fitted?

Pacemakers are fitted under local anaesthetic in a procedure which usually takes less than an hour to complete. Although most patients are awake for the procedure, it is possible to provide some sedation if necessary.

In all cases, we inject local anaesthetic into the area before making a small cut which is just a few centimetres wide. One or two or sometimes three leads are then fed through this incision down a vein into the heart. The patient doesn't feel any of this at all, as the area is fully numb from the anaesthetic. We position the leads inside the heart using X-ray guidance and then we stitch everything closed.

As the implantation is performed through just a small cut to the top of the chest, it is not a big, open operation. The whole procedure usually takes less than an hour to complete so the patient usually goes home the same day.

Is the pacemaker implantation procedure dangerous?

Any procedure carries a small amount of risk but the risk of complications from pacemaker implantation is extremely low. Pacemaker implantation is not a big operation like some other heart procedures can be. The risk of serious complications is significantly less than one in a hundred and the chance of complication at all is only around two or three in a hundred.

Fortunately, should they occur, most of these complications are very mild and can be easily resolved. The benefits of having a pacemaker as and when it's required certainly hugely outweigh the risks.

When is a pacemaker required?

Pacemakers are implanted for a variety of reasons and there are also a number of different types of pacemaker.

The most common reason for implanting a pacemaker is due to slow heart rhythms, which can be caused by several different conditions of the heart or the natural ageing process. When the speed of the heart slows down, that can sometimes cause symptoms such as dizziness, fainting, breathlessness or fatigue. A pacemaker corrects the slow heart rhythm by speeding it up and keeping the heart ticking at the right speed.

There are various other reasons that a pacemaker may be required. For example, some people develop conditions where a problems related to the conduction of electricity through the heart can cause the chambers to beat in an uncoordinated fashion and pacemakers can correct this.

In some patients, we implant more complex pacemakers to treat heart failure or actually prevent potentially dangerous or life threatening heart rhythms. Your consultant cardiologist can advise you which type of pacemaker is right for you should you require one.

What happens if the battery dies?

Pacemaker batteries are similar to the battery on your mobile phone in that it’s easy to tell when the battery is going to run out. Once your pacemaker has been implanted, you will have regular check-ups in a specialist clinic during which the battery level is read. The average pacemaker battery lasts about ten years or so.

When the battery is beginning to go flat, a generator change, sometimes called the box change, is scheduled. This is done with local anaesthetic which is injected over the area where the pacemaker is. A small cut, a few centimetres wide, is made over the pacemaker so that the top part can be removed and replaced. The leads are left in place and everything is then stitched up. Usually, this only takes between twenty to thirty minutes to complete and is a relatively minor procedure, meaning you can go home the same day.

Can a pacemaker affect your sleep?

Once the pacemaker has been implanted and you have healed from the procedure, usually a couple of weeks after the operation, the pacemaker shouldn't affect your sleep at all. Nonetheless, some people find that they prefer sleeping on the side away from the pacemaker. In the majority of cases, however, pacemakers are so small and thin these days that once you have recovered from the implantation, you should hardly notice that it is there.

If you require a pacemaker and wish to schedule a consultation with Dr Pearse, you can do so by visiting his Top Doctors profile.