Why would a pacemaker be required?

A pacemaker is normally used if a patient develops a bradyarrhythmia, or abnormally slow heart rhythm, due to impairment of the heart’s own conduction system. The pacemaker is able to sense the heart’s failure to produce an appropriate electrical signal. It then initiates an alternative electrical signal causing the heart to contract. 

There are a number of types of pacemakers, the simplest consisting of one wire to the right ventricle, another consisting of a wire to the right atrium and right ventricle.  In more complex pacemakers devices, such as cardiac resynchronisation therapy (CRT) there are wires connected to the right atrium, right ventricle and left ventricle.

What does the procedure involve?

Insertion of a pacemaker is normally performed with a local anaesthetic and is nowadays increasingly done on a day-case basis. The whole procedure takes approximately 40 minutes if it is straight-forward. An area of skin, normally below the left collar-bone if you are right-handed, is cleaned with antiseptic. The skin and muscle are then infiltrated with local anaesthetic where a small incision (usually about 5cm) is made. Following this a vein (usually the subclavian or cephalic) is identified and the pacemaker leads are inserted into their optimal positions. When this has been achieved, and checks have been performed to verify this, the pacemaker itself is screwed onto the leads.  Finally the pacemaker is placed under the skin and the incision is sutured.

What happens after the procedure?

You will normally be observed for several hours following the procedure due to the administration of a local anaesthetic and and in order to perform a final check on your pacemaker. Following discharge from hospital the patient should take a number of precautions. The DVLA should be informed of the procedure.  If you hold a standard license you may normally resume driving after one week.  Other license holders may not resume driving for a minimum of size weeks.

Any strenuous activity should be avoided for one month, in particular swimming or golf. Care should be taken to avoid damage to the pacemaker if participating in contact sports. In the long term, you should avoid any environments that may involve a strong magnetic field, for example some workplaces and MRI scanners. Mobile phones should be kept at least 15cm away from pacemaker devices.