Pacemakers

A pacemaker is made up of two main parts, the generator and lead. The generator is a tiny, sealed box containing the electric circuit and a battery. The battery in most pacemakers will last 7-10 years. (There are several factors that affect battery life but none that you can control yourself). The lead is a flexible, insulated wire. One end is attached to the generator and the other end is passed through a vein into your heart. You may have one, two, or three leads depending on the type of pacemaker.

What are the different types of pacemaker? 

• Single chamber pacemaker - this will pace the right atrium or right ventricle. It has one lead.
• Dual chamber pacemaker - this will pace the right atrium and the right ventricle. This has two leads.
• Bi-ventricular pacemaker - in some cases you may benefit from both ventricles being paced. This improves the ability of the heart to pump. This has three leads.
• Single pass VDD pacemaker - this is a special type that has only one lead, but can sense in the top chamber and pace in the bottom chamber.

Eating and drinking

If your procedure is in the morning you can have an early, light breakfast before 06:30. You must not eat any solid food after 06:30. You can keep drinking water if you are thirsty, If your procedure is in the afternoon you need to eat no solid food from 10:00. You can have water after this if you are thirsty. You can eat and drink as normal after the procedure.

Medication

Before your procedure, you will have a pre-op assessment with a cardiology nurse. They will talk to you about your medications at that appointment. Please keep taking all your medications until then. If you need to stop any of them before your procedure, the nurse will tell you.

The procedure and risks are explained below, and you will be asked to sign a consent form to confirm you understand them.

• In the procedure lab you will lie relatively flat on a narrow X-ray table.
• In most cases the pacemaker will be placed on the side opposite the hand you write with. You may be shaved in the upper chest area.
• The doctor will clean your skin with some antiseptic solution. You will be covered with sterile drapes. It is important to keep your hands by your side to avoid contamination.
• The procedure is normally done using local anaesthetic. You will be awake but the area will be numb. You won’t feel pain but may feel a bit of pushing. If you feel any pain, tell a member of the team.
• If you are anxious about the procedure, you may be given a mild sedative to help you relax.
• A small cut is made, and a pocket formed for the pacemaker to sit in.
• A lead will be passed along the vein into your heart using X-ray imaging to help, a the lead will be connected to the generator (pacemaker).
• The would is stitched with dissolvable stitches and covered with a dressing.
• You will be taken to the recovery area for a short while, and then moved to a ward or go back to the ward you were on before.
• The procedure can take between 40 minutes to 2 hours depending on the number of pacing leads and how easy it is to access.

Looking after the wound 

Your wound might feel sore and look bruised for a couple of weeks which is normal. If you have pain, you can take painkillers. Keep the wound clean and dry for about 7-10 days, after this you can take off the dressing. Allow the paper stiches to fall of on their own. 

Using your arm

It is important to be gentle with the arm on the same side as the pacemaker. Use it normally, but avoid raising it above your shoulder or lifting heavy objects. This is because over time new tissue will grow around the lead in your heart, helping to hold it in place. Until that tissue forms there is a slight chance that the lead could move out of position (this would mean we need to reopen the wound to fix it).

If you have any questions about how to use your arm, please ask for help.

Before you leave hospital you will have the pacemaker checked and a chest X-ray of the pacemaker and leads. You will be given a pacemaker ID information sheet. This identifies you as a patient with a pacemaker and has information about your pacemaker and lead(s), and information about your cardiologist and GP. Keep this information sheet with you at all times.

Every medical procedure has some risks, including having a pacemaker fitted. You can discuss these in more detail with your doctor. The most common risks are: 

• Infection - you will be given antibiotics to reduce this risk.
• Lead displacement - there is a very slight risk that the wire moves from its original position (becomes displaced).
• Pneumothorax - very rarely the lung is perforated (punctured) during the implant. This causes air to leak from the lungs into the chest. The follow-up chest X-ray after your implant would show this.
• Pain/discomfort/bruising - some bruising can happen as the skin is stretched to fit the pacemaker. You may also have some discomfort around the wound site.

Once the wound has completely healed you can mostly return to normal life. The pacemaker is checked every so often to make sure it is working as it should.

The follow-up for pacemakers usually involves checking it 24 hours after implant, and again at six weeks - this also includes a wound check. You will have checks every year, six months, or three months depending on the age of the pacemaker.

The checks take about 15-20 minutes. These are separate from other appointments with the cardiologist and are only to check the pacemaker.

When you come for a check-up your heart rate will be monitored. The pacemaker will be scanned with an external device that the physiologist will place over your chest.

If you have had any symptoms since your last check, tell the physiologist. During the check you may feel your heart beat slightly differently - faster or slower. If you become uncomfortable tell the physiologist. The pacemaker may be adjusted to get the best performance.

At the end of the check you will be told if there are any problems and when your next appointment is. Please make a note of the date and time.

Do 

• Tell all medical staff you have a pacemaker. Some hospital equipment may interfere with pacemakers, and some procedures like an MRI (magnetic resonance imaging scan) may not be suitable. Some medical procedures may need to use antibiotics if you have a pacemaker. These can be discussed with your doctor.
• Carry your pacemaker ID information sheet with you at all times and show it at hospital appointments.
• Tell the DVLA and your car insurance company (if you drive) that you have a pacemaker. This is a legal requirement. It should not affect your premium costs. You can access the DVLA guidelines at Check if a health condition affects your driving: Overview - GOV.UK
• Tell your GP or pacing clinic if the wound site becomes red and inflamed, if you feel unwell with a fever, or if you have oozing from the site.
• Hold your mobile phone to the ear on the opposite side of your pacemaker when making phone calls.
• Tell airport security you have a pacemaker if travelling abroad.
• Keep all follow-up appointments. If you cannot go to an appointment please phone us so we can rearrange.
• Contact you GP as normal if you feel unwell. They will be able to help you and will contact us if they suspect a problem with your pacemaker.
• Contact your GP if your symptoms return once you have a pacemaker fitted.
• Avoid any strenuous activity for about six weeks after the pacemaker has been fitted. After that you can continue most sports and activities.

Don’t

• Don’t drive until you have had your pacemaker checked at the 6-week appointment. If this is a problem speak to the cardiac physiologist at your 24-hour check.
• Don’t lift your pacemaker side arm above shoulder height or six weeks.
• Don’t carry your mobile phone in a shirt pocket over your device.
• Don’t do arc welding.
• Avoid going near strong magnets.
• Avoid certain massage chairs.
• If you have any queries about what to avoid or can do, please phone the pacing clinic on 0117 414 0791

Regular exercise is beneficial for most people. You are advised not to exercise (including golf and swimming) until you 6-week check, after this you can begin gradually.

Modern pacemakers are designed with modern life in mind and are usually not affected by electrical items such as hairdryers, washing machines, and TVs. Modern microwaves are fine to use as long as they are in a good state of repair.

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