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Why do I need to have a pacemaker?

A pacemaker is fitted if you have a very slow heartbeat or if your heartbeat pauses occasionally. You may have experienced symptoms due to this such as blackouts, falls or dizzy spells.

What is a pacemaker?

A pacemaker is a small, electronic pulse generator that stimulates the heart to beat. It is implanted under the skin. It is a small device which is implanted under the skin, and occasionally under the muscle, usually near the left shoulder. It has thin leads (one or two leads) connected to it, which are placed through your veins and into the heart. There, they produce a small signal telling your heart to beat.

Pre-procedure assessment and care

  • You will be asked to have a pre-assessment appointment prior to the procedure a few days before the procedure. This is to ensure you are suitable for the procedure which will include a blood test and take an ECG. This is an opportunity for you to ask questions too.
  • During your pre-assessment appointment, the nurse will give you specific instruction about your meal intake prior to your procedure.
  • Bring all your medications with you in their original packaging. The nurses will review your medications and explain which tablets you can or cannot take before the procedure. If you take Warfarin or Direct Oral Anti-Coagulants (DOACs) for example Apixaban, Rivaroxaban, Dabigatran or Edoxaban you will be given advice  on when to take these medications prior to your procedure.
  • Please make sure you have a shower, bath or wash before you come into hospital, or on the ward before you come for your procedure This helps to make sure your skin is clean and reduces the risk of infection.
  • If applicable and if needed, please shave your chest prior to procedure.
  • Avoid applying cream or lotion on your chest.
  • Make sure that nails are free form nail polish.
  • Bring your dressing gown and slippers (or slip on shoes) with you. You will be given a gown to wear for the procedure which does up at the back.
  • Remember to bring your reading glasses with you and something to read or to occupy you whilst you are waiting before and after the procedure.
  • Do not bring any valuables or cash with you, other than small change for a newspaper, as your belongings may be left unattended while you are having your procedure. 
  • Before your procedure a small tube (cannula) is inserted into your arm so that we can give you medicines during the procedure
  • You will be asked to put on a hospital gown and taken to the specialised treatment area in the cardiac catheter labs.
  • You will be given intravenous antibiotics going to procedure room.

During the procedure

  • The procedure is carried out by Specialist Doctor, supported by other staff including a nursing team, a cardiac physiologist and a radiographer. 
  • The procedure typically takes about 1 hour (but occasionally may take longer than this).
  • We will clean your skin with an antiseptic solution, which may feel cold and your chest will be covered in sterile drapes.
  • You may be given medication to help you feel relaxed and help you stay still during the procedure. If so, you may feel sleepy but will still be awake. You are then given a local anaesthetic as a small injection under the skin.
  • During the procedure you will feel some soreness and pressure. Other sensations include fluttering of your heartbeat. Please let the medical team know if you feel uncomfortable. 
  • A small incision will be made in the skin to allow the pacemaker and its wires to be implanted. This is done using X-rays to guide the positioning. The cardiac physiologist will check the lead position to make sure the pacemaker is working.
  • At the end of the procedure, the Doctor will use stitches to close the wound, and cover this with a layer of glue.

After the procedure

  • We will observe you including your blood pressure and breathing until you are fully awake. You will then be offered refreshments.
  • You may experience some discomfort at the site - please ask for painkillers if this is the case.
  • A cardiac physiologist will check the pacemaker by placing an electronic ‘wand’ over the area. After we have confirmed the pacemaker is working you will be able to go home. This is usually on the same day, but in some cases, you may have to stay in overnight.
  • You should travel home with a friend or relative and must travel by car not public transport. This is to ensure you will be able to return quickly if there are problems on the way home.
  • Once you have a pacemaker implanted, you should not drive for at least 1 week. If you drive for a living, drive trucks or lorries, or hold a special license (DVLA Group II), you MUST NOT DRIVE until you have spoken to the DVLA.
  • As with any surgical procedure, there will be a scar, and there will be a bump at the site where the pacemaker has been implanted.

What happens when I get home?

  • The stitches used will usually dissolve by themselves.
  • If a dressing was used to cover the wound, this should remain in place for 7 days. Please keep it as dry as possible in that time. After 7 days, you can remove it and wash as usual.
  • If you notice redness, swelling or discharge at the site of your implant which are signs of infection please contact us the same day. We are available everyday including weekends.
  • You should avoid lifting your arm above the level of the shoulder for a few weeks. We may provide you with a sling to help with this.
  • We will provide you with a card stating what type of pacemaker you have and when you had it fitted. You should show this to any doctor or dentist who treats you in future, or if you need to through a security at the airport.
  • You will receive an appointment to come back to the Pacemaker clinic after 6 weeks for a pacing check, and will have a pacing check every year after this. 

What are the benefits of having the procedure?

A pacemaker helps protect you from the symptoms and dangers of having a heartbeat that is either too slow or too fast.

What are the risks of having a pacemaker?

All procedures on the heart carry some risk. Common or unavoidable complications are:

  • Bruising and discomfort at the area of insertion, which usually settles within a few days. In less than 1 in 100 cases, you may need a further procedure to treat this.

There are other complications you should be aware of are:

  • Damage or collapse of a lung because of a needle making a hole in the lung (about 1 in 100 people). This often requires no treatment but may require the insertion of a chest drain to help re-inflate the lung.
  • A tear in the wall of heart, resulting in blood collecting around the heart (about 1 in every 100 people). You may require emergency treatment for this including drainage of collected blood, or some form of heart surgery.
  • The needle may puncture the wrong vessel (about 2 in 100 people), which may lead to excess bleeding. This often requires no treatment, but sometimes you may require a blood transfusion, or further emergency treatment.
  • The leads may slip out of place (about 2 in 100 chances, for each lead). This will mean you need a repeat procedure to put them back in the correct position.
  • Infection around the pacemaker or its leads (about 2 in 100 people). We minimise this risk with antibiotics, but if infection still occurs; you will need another procedure to remove the pacemaker.

Overall risks

  • The overall risk of complications in the first 30 days is about 5%.
  • In the case that a serious complication occurs, your doctors may arrange for emergency procedures to save your life or save you from significant harm. If you are unwell at the time, it may not be possible to discuss these with you, and your doctors will act in your best interests. The risks under these circumstances are not predictable in advance. If needed, you may be transferred to another hospital where more specialist services are available.
  • The risk of death is about at 1 in 2000 people, but could be much higher if you experience a serious complication.
  • These are average risks, and if you need to have this procedure done in an emergency, the risks are higher.

What alternatives are there?

Your doctor has recommended that this is an appropriate procedure for your condition and that the benefits outweigh the risks. There may be alternative ways to manage your condition. If you wish to discuss alternatives, please let us know before you sign the consent form and the procedure will be deferred, you will be referred to see your usual doctor.

Further information

The following websites may be helpful to you as a patient or carer

Who can I contact for further information?

If you have any questions or concerns about having a pacemaker please contact:

  • Frimley Park Hospital Clinical Investigations 03006 133300
  • Frimley Park Hospital Cardiac Catheter Labs 03006 133339
  • Wexham Park Hospital Clinical Investigations 03006 154685
  • Wexham Park Cardiac Catheter Labs 03006 139572
  • For queries relating to you appointment contact the Cardiology Appointment Team on 03006 133344

Contact us

If you have any queries relating to this information, please contact the Cardiology service.

About this information

Service:
Cardiology

Reference:
C/038

Approval date:
9 January 2025

Review date:
9 January 2028

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Important note 

This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.