If you need to have a pacemaker fitted, a smallelectrical device called a pacemaker will be surgicallyimplanted in your chest.

The pacemaker sends electrical pulses to your heart to keep it beating regularly and not too slowly.

Having apacemaker can significantly improve your quality of life if you have problems with a slow heart rate. The device can be lifesaving for some people.

In the UK, pacemaker implantation is one of the most common types of heart surgery carried out, with many thousands of pacemakers fitted each year.

This page covers:

Pacemaker implantation


Why do I need a pacemaker?

How is a pacemaker fitted?

After pacemaker surgery



How a pacemaker works

A pacemaker is a small device about the size of a matchbox that weighs 20-50g.It consists of a pulse generatorwhich has a battery and a tiny computer circuitand one or more wires, known as pacing leads, which attach to your heart.

The pulse generator emits electrical impulses through the wires to your heart. The rate at which the electrical impulses are sent out is called the pacing rate.

Almost all modern pacemakers work on demand. This means they can be programmed to adjust the discharge rate in response to your body's needs.

If the pacemaker senses that your heart has missed a beat or is beating too slowly, it sends signals at a steady rate.If it senses that your heart is beating normally by itself, it doesn't send out any signals.

Most pacemakers have a special sensorthat recognises body movement or your breathing rate. This allows them to speed up the discharge rate when you're active. Doctors describe this as rate responsive.

Implantable cardioverter defibrillators (ICDs)

An implantable cardioverter defibrillator (ICD) isa device similar to a pacemaker. It sends a larger electrical shock to the heart that essentially "reboots" it to get it pumping again. Some devices contain both a pacemaker and anICD.

ICDs are often used as a preventative treatment for people thought to be at risk of cardiac arrest at some point in the future. If the ICD senses the heart is beating at a potentially dangerous abnormal rate, it will deliver an electrical shock to the heart.This often helps return the heart to a normal rhythm.

A conventional ICD has a pacing lead that's implanted along a vein (transvenously). There's also a newer type ofICD where the pacing lead is implantedunder the skin (subcutaneously).

Why do I need a pacemaker?

The heart is essentially a pump made of muscle, which is controlled by electrical signals.

These signals can become disrupted for several reasons, which can lead to a number of potentially dangerous heart conditions, such as:

  • an abnormally slow heartbeat (bradycardia) or an abnormally fast heartbeat (tachycardia)
  • heart block where your heart beats irregularly because the electrical signals that control your heartbeat aren't transmitted properly
  • cardiac arrest when a problem with the heart's electrical signals cause the heart tostop beating altogether

How is a pacemaker fitted?

Having a pacemaker implanted is a relatively straightforward process. It's usuallycarried out under local anaesthetic , which meansyou'll beawake during the procedure.

The generator is usually placed under the skin near the collarbone on the left side of the chest. The generator is attached to a wirethat's guided through a blood vessel to the heart.

The procedure usually takes about an hour, and most people are well enough to leave hospital the day after surgery.

After pacemaker surgery

You should be able to return to normal physical activities soon after surgery.As a precaution, it's usually recommended that strenuous activities are avoided for around four to six weeks after having a pacemaker fitted. After this, you should be able to do most activities and sports.

You'll be able to feel the pacemaker, but you'll soon get used to it. It may seem a bit heavy at first, and may feel uncomfortable when you lie in certain positions.

You'll need to attend regular check-ups to make sure your pacemaker is working properly. Most pacemakers store information about your natural heart rhythms.

When you have follow-up appointments, your doctor can retrieve this information and use it to check how well your heart and the pacemaker are working.

Most ordinary household electrical equipment is safe to use and won't interfere with your pacemaker. This includes microwaves, as long as they're in good working order.


Having a pacemaker implanted is usually a very safe procedure with a low risk of complications. The biggest concern is the pacemaker losing its ability to control the heartbeat, either because it malfunctions or the wire moves out of the correct position.

It's sometimes possible to reprogramme the pacemaker to fix a malfunction using wireless signals. However, further surgery may be needed if the pacemaker moves out of position.

For example, atrial fibrillation can sometimes be treated with medication or a non-surgical procedure called catheter ablation.

However, not all people with anarrhythmia can be treated in this way, andin many cases a pacemaker is considered to be the most effective option.

If your cardiologist recommends having a pacemaker fitted, ask them why they think it's the best option anddiscuss any possible alternative treatments you could have.

Content supplied by the NHS Website

Medically Reviewed by a doctor on 9 Jan 2017