What is a permanent pacemaker?
A pacemaker is a small device, roughly the size of a matchbox, placed under the skin below the collarbone, with one or two fine insulated wires running through a vein into the heart. It watches your heartbeat continuously and, whenever the heart is too slow or a beat is missing, it delivers a tiny electrical impulse that you cannot feel and the heart beats. When your own rhythm is adequate, the pacemaker simply stays quiet and watches.
Why is it done?
A pacemaker is needed when the heart's own electrical system fails, either because the natural pacemaker of the heart has slowed down or because the wiring that carries the signal to the pumping chambers is blocked. This causes tiredness, breathlessness, dizziness, blackouts or a very slow pulse. No tablet can reliably speed up a slow heart, so pacing is the treatment. For most people it relieves the symptoms completely and removes the danger of collapsing.
What happens on the day?
You will be admitted fasting and given antibiotics through the drip. In the catheterisation laboratory the skin below the collarbone is cleaned and numbed with local anaesthetic, and sedation is given so that you feel drowsy and comfortable. Through a small cut, the wire or wires are guided along a vein into the heart under X-ray guidance and tested to confirm good position and function. The wires are connected to the pacemaker, which is placed in a pocket under the skin, and the cut is closed with stitches. The procedure usually takes about an hour, and you remain awake but should not have pain.
What to expect afterwards
You usually stay one night, with a chest X-ray and a pacemaker check before you go home. The site will be bruised and tender for one to two weeks; keep it dry until healed, do not raise that arm above shoulder height and avoid heavy lifting for the period advised, generally four to six weeks. Driving is restricted for a short time. You will receive a pacemaker identification card to carry and to show at airport security, before any operation and before an MRI scan; most modern devices are MRI-conditional but this must be checked. Mobile phones, microwaves, induction hobs and household appliances are safe, although a phone is best kept out of the breast pocket over the device. The pacemaker is checked in the rooms at regular intervals and the battery, which lasts around eight to twelve years, is replaced with a short procedure.
Possible complications
Bruising or a blood collection at the pocket is the most common problem and usually settles by itself. Infection occurs in a small number of patients and may require antibiotics or removal of the system, so we watch the wound carefully. The lung can occasionally be nicked when the vein is entered, allowing air to leak around it, which sometimes needs a drain. A wire can move out of position, need repositioning, or twitch the diaphragm or a chest muscle. Rarely the heart wall is perforated, causing bleeding around the heart, or a vein clots or narrows. Later on, wires can fail and need replacing. Report increasing pain, redness, swelling, leaking from the wound, fever, or a return of dizziness or blackouts.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.