A pacemaker is a device that can deliver a small electric impulse to the heart muscle to stimulate the muscle and make the heart beat. It is usually a small box which is put under the skin, usually in the left side of the chest, with small leads that are inserted through the veins to the bottom chamber of the heart (the ventricle). Often, there is a second lead that is put into the top chamber of the heart (the atrium).
The heart has its own system of making your heart contract and beat, which is known as the conducting system. This is through small electrical currents which pass through the tissue of the heart. Sometimes, this system doesn’t work the way it should. This means that the top chambers of the heart (the atria) don’t communicate with the bottom chambers of the heart (the ventricles). When this happens, the heart beats slower than normal. This may mean that you feel faint or light-headed. Sometimes, you may pass out. In rare cases, the heart may stop beating completely.
With a pacemaker in place, if the heart was to beat too slowly, the pacemaker would take over and ensure that the heart beats at a normal rate. Having a pacemaker can significantly improve your quality of life and, in some cases can be life saving. Your Cardiologist will discuss the different types of pacemaker with you and together, you will decide which is right for you.
The most common reason for pacemaker insertion is that the conducting system of the heart wears out and stops working effectively due to age. Sometimes, other diseases and conditions can affect how well the heart beats such as derangement of salts in the blood. Sometimes, if your heart beats too fast and needs medication to slow it down, your cardiologist may recommend having a pacemaker to make sure that the medication doesn’t slow it down too much.
This is usually done as a day case procedure using sedation (medication to make you sleepy) and local anaesthetic (medication injected under the skin to make it numb). A cut is made into the skin in the upper chest (usually the left side) and a pocket is make under the skin to fit the generator or battery of the pacemaker. Wires are then advanced via a vein in the chest (which runs all the way down to the heart) into the correct position into the heart. The other end of the wire or wires are connected to a generator which is then put into place and the wound is closed with sutures (stitches)
Pacemaker implantation is usually very straightforward. Complications occur in 1-2% of cases. The main risks from the procedure include infection, bleeding and bruising, scratching the surface of the lung (pneumothorax), bleeding around the heart and the risk of the leads moving. Almost all the complications can be treated at the same time.
You will be restricted from driving for a period of time following the pacemaker implant and will need to inform the DVLA. The length of time you cannot drive for depends on the reason for implanting the pacemaker. Your cardiologist will be able to advise you further.
The only wound that needs to heal is the cut. There may be some bruising around it. Depending on the type of sutures (stitches) that your Cardiologist uses, these may need to be removed from the skin in 7-10 days. The hospital staff will be able to tell you if and when you need to get them removed.
It is also important that you do not raise your left arm above the shoulder for 6 weeks after the pacemaker insertion. This is important as it takes 6 weeks for the pacemaker lead to bed in and fix in place. If you move your arm, the lead may dislodge and move. If this happens then the pacemaker will not be able to function normally and you may need another procedure to reposition the lead.
The pacemaker is usually checked around 1 month after it is inserted. This is to make sure that it is working satisfactorily and there is no problem with it. After that, it is usually checked every 6 months to a year.
When the pacemaker is inserted, the hospital staff will give you a pacemaker identity card which will say which type of pacemaker and when it was inserted. It is important to carry this with you at all times. They will also usually give you a contact number for the pacemaker department who you can call if there are any problems.
The pacemaker battery (or generator) will last for around 7-10 years. After this time, it will need replacing. This is a very similar procedure to the original insertion, although the only thing that is replaced is the battery, this is attached to the existing leads. The leads can stay in as long as they’re working effectively. The majority of leads never need replacing and last the rest of your life.