Pacemaker

A pacemaker is a device that sends electrical impulses to the heart to help it beat at a normal rate. It consists of a battery and leads (thin wires) that are connected to your heart.

The pacemaker is placed under the skin. Usually on the upper left or right side of your chest, just below the collarbone.

Your doctor might suggest a pacemaker if your heart has an irregular beat, or if it is beating too fast or too slow. This is a type of arrhythmia.

There are different types of pacemakers. Your doctor will discuss which one is best for you.

Temporary pacemaker

Your doctor may suggest you have a temporary pacemaker to control your heart rhythm for a short period. This could be:

• after a heart attack
• while your heart recovers from a heart surgery
• while you wait to have a permanent pacemaker inserted

If you have a temporary pacemaker, you'll usually need to stay in hospital for monitoring.

Permanent pacemaker

A permanent pacemaker (PPM) is used when heart problems stop your heart from keeping a regular rhythm. You may need one if you have:

• arrhythmias — such as bradycardia
• sick sinus syndrome — where the heart's natural pacemaker doesn't work properly, leading to irregular heartbeats
• heart block — when the heart's electrical signals are delayed or blocked
• other conditions that affect your heart rate

These heart conditions can make you feel tired, short of breath, dizzy or faint and can be life threatening. A pacemaker helps regulate your heart's rhythm and manages these symptoms permanently.

A pacemaker and an implantable cardioverter defibrillator (ICD) are both electronic devices that help the heart. The 2 devices work differently:

• A pacemaker sends a regular electrical signal to keep your heart beating normally.
• An ICD is similar to a pacemaker. It can signal your heart to beat normally and give your heart a small shock to help manage a dangerous abnormal heart rhythm.

Your doctor will let you know if you have a pacemaker or if it also includes an ICD function.

A pacemaker is inserted during minor surgery under local anaesthetic. The procedure usually takes between 1 and 3 hours. During the surgery, your doctor will:

• numb your collarbone area with a local anaesthetic
• make a small cut in your skin to create a 'pocket' in the upper chest, usually just below your collarbone
• guide 1 or 2 electrical leads through a vein, towards your heart and connect them to the pacemaker
• test the pacemaker to make sure it is working
• close the cut with stitches and cover it with a dressing

You will have a bulge visible under your skin where the pacemaker was inserted.

To prepare for your pacemaker procedure, here are some tips to ensure everything goes smoothly:

• Ask your doctor if you need to stop taking medicines such as blood thinners or diabetes medicines.
• Ask your doctor how long before the surgery you should stop eating or drinking.
• Arrange how you will get home after surgery.

Read more on preparing for surgery.

Read more on preparing to go home after a hospital stay.

Most complications from pacemaker surgery are rare. Some people may have:

• movement of the pacemaker device or leads
• an infection
• blood vessel or nerve damage from the pacemaker leads
• bleeding or blood clots
• a reaction to medicine used during the surgery

It's a good idea to discuss the risks and benefits of surgery with your doctor.

After surgery, you may feel some soreness or bruising at the site, which should ease within a few weeks. Most people go home within 24 to 48 hours and will need to follow up at a pacemaker clinic.

Here are tips for a smooth recovery:

• Sleep on your back or the side opposite to your wound for 1 to 2 days after surgery.
• Avoid lifting anything heavier than 5kg with the arm on the pacemaker side for a month.
• Avoid sports with lots of movement and stretching, like golf or swimming, for 2 months.
• Follow your doctor's advice about when to start driving again.

After your pacemaker is inserted, it's important to follow your doctor's advice about medicines and lifestyle changes.

• Regular check-ups — visits to a pacemaker clinic are important to make sure it's working properly. This includes checking the pacemaker's battery, which usually lasts between 5 to 15 years.
• Physical activity — most people with pacemakers can play sport, swim, have sex and keep up other physical activities. Avoid contact sports such as football which could impact your chest.
• Electrical devices — a strong magnetic field can sometimes interfere with a pacemaker. Try not to carry your mobile phone close to your pacemaker. Tell healthcare providers you have a pacemaker before medical procedures like MRIs.
• Travelling — let airport security staff know you have a pacemaker, as it may set off the metal detector.
• Work — if your job involves working with welding equipment or heavy electrical devices, talk to your doctor to check it's safe.

Your doctor will arrange a medical ID bracelet or a card for you to keep in your wallet. This lets people know you have a pacemaker in case of emergency.

Not all arrhythmias need a pacemaker. Your doctor will talk with you about whether a pacemaker is the best treatment for your condition.

Pacemakers are usually recommended if your heart's electrical system is not working properly, or you are experiencing severe symptoms. If you decide not to have a pacemaker it could be life-threatening. It is important to speak with your doctor about any concerns you may have about having a pacemaker.

The Heart Foundation has information on pacemaker surgery and living with a pacemaker.

St Vincent's Hospital Heart Health has a helpful video, explaining what happens during a pacemaker procedure.

St Vincent's Hospital Melbourne has information to help you understand the permanent pacemaker procedure.

The Therapeutic Goods Administration's has a guide on what to ask before you get a medical implant.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Looking for information for Aboriginal and/or Torres Strait Islander people?

HealthInfoNet has advice on heart health for Aboriginal and/or Torres Strait Islander people.