Treatments - Pacemaker

A pacemaker is a medical device designed to treat patients who have, or are at risk of slow heart beats. See symptom section, dizziness and blackouts.

A pacemaker system consists of the body of the device, called the generator or pacemaker, and one, two and occasionally three pacemaker leads connecting the pacemaker to the heart. The implant procedure is carried out under mild sedation and using local anaesthetic to numb the skin. It is relatively painless. The leads are usually introduced through a small incision into a vein below the collar bone, and advanced into the heart where they attach to the inside of the heart muscle. At the other end they attach to the generator, which is placed into a pocket under the skin in front of the chest. A little pushing and pulling sensation may be felt when making the pocket. Finally the small incision is closed with stitches.

It usually takes approximately one hour to implant a pacemaker, although resynchronisation pacemakers used in some patients with heart failure take longer. See resynchronisation section. After a pacemaker is implanted the patient has a chest X-ray and also a simple pacemaker check – a ‘wand’ is placed over the skin near the pacemaker and a computer or programmer ‘talks’ to the pacemaker. If these tests are normal the patient is usually discharged the same day or the next day. Driving is prohibited for one week after the implant. Follow up is undertaken in a dedicated pacemaker clinic, typically after 6-8 weeks, and then every year. After approximately 7 years, the pacemaker generator needs replacing, as the battery runs down. Attending the pacemaker clinic (more frequently after the first few years) ensures that timely replacement of the device.

Complications do occasionally occur when implanting a pacemaker. These include bleeding, leads moving out of position and needed to be moved back, a collapsed lung and infection (the latter usually seen many weeks or months later). These complications can be treated, although a pacemaker infection rarely responds to antibiotics without removing the whole pacing system.