Pacemaker implantation

What is a pacemaker?

A pacemaker is a small electronic device, about the size of a matchbox, implanted under the skin below the collarbone and connected to the heart by one or two fine leads. It continuously monitors your heart rhythm and, whenever the rate falls too low or a beat is missed, delivers a tiny, painless electrical impulse to keep the heart beating at the right pace. Modern pacemakers respond intelligently to your activity, speeding up when you exercise and settling when you rest, and typically last eight to twelve years before a straightforward battery change.

When is a pacemaker recommended?

A pacemaker is the definitive treatment for symptomatic slow heart rhythms (bradycardia), which medication cannot reliably fix. Common indications include:

• Heart block, where the electrical signal is delayed or fails to pass from the upper to the lower chambers, causing fatigue, breathlessness, dizziness or blackouts.
• Sick sinus syndrome, where the heart's natural pacemaker cells fire too slowly or pause, common with age.
• Slow atrial fibrillation, where AF conducts too slowly, or pauses occur when it stops and starts.
• Unexplained blackouts, where monitoring, sometimes with an implantable loop recorder, has proven a rhythm cause.

The decision is made on clear evidence: your symptoms, an ECG, and usually prolonged ECG monitoring that captures the rhythm problem in the act. See also our page on slow heart rate (bradycardia).

Cardiac resynchronisation therapy (CRT)

In some people with heart failure, the two pumping chambers no longer contract in step, wasting precious pumping efficiency. Cardiac resynchronisation therapy uses a specialised pacemaker with an additional lead to restore coordinated contraction. In well-selected patients CRT relieves breathlessness, improves exercise capacity, reduces hospital admissions and improves survival, one of the most effective device therapies in modern cardiology. Where appropriate, CRT can be combined with a defibrillator (CRT-D); see our ICD page.

What happens during implantation?

Pacemaker implantation is a planned keyhole procedure performed under local anaesthetic with light sedation, typically taking about an hour.

• A small incision is made below the collarbone, usually on the left.
• The lead or leads are guided into the heart through a nearby vein under X-ray guidance and secured.
• The pacemaker box is connected and placed in a small pocket under the skin, and the incision is closed with dissolvable stitches.

Most people go home the same day or the following morning, with a device check before discharge.

Recovery, checks and everyday life

Recovery is quick: light activity within days, driving usually after one week for private licences (we will confirm your DVLA position), and full activity within four to six weeks, avoiding only vigorous overhead arm movement on the implant side while the leads settle. The wound needs simple care for the first fortnight.

Your device is then checked regularly, in clinic and increasingly by remote monitoring from home, so problems are detected early and battery life is tracked. Modern pacemakers are safe with household electronics, travel and, with appropriate precautions and modern devices, MRI scanning. You will receive a device card to carry, and airport security is straightforward.

Benefits and risks

For the right patient the benefit is immediate and often dramatic: energy returns, dizziness stops, blackouts are abolished, and confidence follows. Implantation is very safe in experienced hands; uncommon risks include bruising or bleeding at the pocket, infection, a displaced lead needing repositioning and, rarely, a collapsed lung during lead placement. We will discuss your individual risk profile openly before you decide.

Frequently asked questions

Will I feel the pacemaker working?

No. Pacing impulses are far too small to feel. What most patients notice instead is the absence of their old symptoms: the fatigue lifts, the dizzy spells stop and stamina returns, often within days of implantation.

Can I use a mobile phone, induction hob or airport scanner?

Yes, with simple common sense. Keep your phone to the opposite ear and avoid carrying it in a breast pocket directly over the device; walk through airport security normally, showing your device card if asked. Modern pacemakers are well shielded, and everyday household appliances, including induction hobs at normal distances, are safe.

Can I exercise and swim with a pacemaker?

Absolutely, and we encourage it. Once the wound has healed and the leads have settled, around four to six weeks, swimming, golf, gym work and travel are all back on the table. Rate-responsive pacemakers adjust automatically to your effort, so exercise feels natural.

What happens when the battery runs low?

Battery life is tracked at every check, so a replacement is planned months in advance, never a surprise. The generator change is a short day-case procedure through the original scar; the leads usually stay in place.

Will the pacemaker show under my skin?

Contemporary devices are slim, and in most people the result is a subtle contour below the collarbone that others rarely notice. In slimmer patients we take particular care with positioning for the best cosmetic result.

Can I drive after a pacemaker?

For an ordinary private licence, driving typically resumes one week after implantation provided you are well; professional licences have longer rules. We will confirm the current DVLA position for your circumstances in writing.

Why choose Dr Assomull?

Dr Assomull will establish beyond doubt whether your symptoms are caused by a slow rhythm, arrange implantation with London's experienced device specialists at the right moment, and remain your consistent cardiologist afterwards, overseeing device checks, medication and the whole-person factors, from blood pressure to sleep, that keep you well. Assessment and follow-up take place at 68 Harley Street, with appointments usually available within one working day.

If fatigue, dizziness or blackouts are limiting your life, book a consultation for a definitive answer.