Pacemaker Implantation

A pacemaker is a small device that sends electrical pulses to your heart to help it beat at a normal rate and rhythm. It is used if you have an abnormal heart rhythm, called an arrhythmia, that beats too slowly, too quickly, or irregularly. It can also help your heart chambers beat in sync so that your heart can pump blood more efficiently to your body if you have heart failure.

Pacemakers are matchbox sized and weigh about 20 to 50 grams. They consist of a box that generates pulses and one, two, or three electrode leads that deliver electrical impulses to and from your heart, contained in a metal case.

The type of pacemaker you have will depend on your condition. Pacemakers with one lead are called single-chamber pacemakers and carry electrical impulses to the right ventricle of your heart. Those with two leads are dual-chamber pacemakers. They carry electrical impulses to the right ventricle and the right atrium of your heart and help to control the timing of contractions between the two chambers. Devices with three leads are called bi-ventricular or cardiac resynchronisation therapy pacemakers and are used if you have heart failure or heartbeat problems. They stimulate your right and left lower heart chambers to work together in a coordinated way and make your heart beat more efficiently.

Most pacemakers are rate responsive. This means that they work on demand and are programmed to adjust their electrical impulse rate in response to your body's needs. So, if your pacemaker senses that your heart has missed a beat or it is beating too slowly, it sends signals at a steady rate. It does not send out any signals if it senses that your heart is beating normally by itself. Pacemakers usually have a sensor that recognises your body movement or your breathing rate and they can speed up the impulses when you are active.

A pacemaker is implanted to help control your heartbeat and treat heart rhythm disorders (arrhythmias) and related conditions including:

• Sick sinus syndrome - where your sinoatrial node is not working properly and leads to an abnormally slow heartbeat (bradycardia), an abnormally fast heartbeat (tachycardia), or a combination of both.
• Atrial fibrillation - causes your heart to beat abnormally fast. A pacemaker may be recommended for people with atrial fibrillation when medication has not been successful or if they have a much slower pulse rate than normal which may also be intermittent.
• Heart block - where your heart beats more slowly or with an abnormal rhythm.
• Heart failure - when your heart becomes less efficient at pumping blood around your body. It may cause the lower two chambers of your heart to pump out of time, called dyssynchrony, and make you feel breathless and exhausted.
• Cardioinhibitory syncope – when you temporarily lose consciousness due to a few seconds of decreased blood flow to your brain.

A pacemaker is fitted by a surgical procedure that takes around one hour. It can take longer if for example, you are having a bi-ventricular pacemaker. Most people go home within a day of their procedure.

There are two methods to fit a pacemaker:

• Transvenous implantation (also called endocardial implantation) – is the most common method of fitting a pacemaker. You can expect to have a sedative and a local anaesthetic, to help you relax and so that you do not feel pain. A small 5 to 6cm cut is made just below your collarbone, usually on the left side of your chest. Sometimes a pacemaker is placed under your breast or arm. The pacemaker leads are inserted into a vein and guided to the correct chamber of your heart using X-ray scans. The other ends of the leads are connected to your pacemaker. This is fitted into a small pocket between your upper chest skin and your chest muscle. Your skin is then closed with stitches.
• Epicardial implantation – is carried out under general anaesthetic. The pacemaker lead(s) are attached to the outer surface of your heart (epicardium) through a cut in your abdomen, below your chest. The pacemaker box is usually placed in a pocket created under your abdomen skin. Recovery is usually longer for this method. It is used for people who are having heart surgery and also need a pacemaker or if it is difficult to reach your blood vessels using transvenous implantation.

A pacemaker battery usually lasts between six and ten years. Sometimes it lasts longer.

Your doctor receives information from your pacemaker including how much battery life is left. When the battery is running low, your doctor will advise you and you will need surgery to replace it.

The procedure to change your pacemaker battery is much simpler than your original pacemaker surgery. It is a day case procedure performed under local anaesthetic and most people go home the same day. Your surgeon will reopen your wound, remove your pacemaker box, and replace it with a new one.

After you have had a pacemaker fitted you should avoid strenuous activities for up to six weeks. After that, you can resume most activities and sports. If you play contact sports, such as football or rugby, you need to avoid collisions and it is advisable to wear a protective pad. You should avoid very energetic activities, such as squash.

Several types of devices and machinery may interfere with pacemakers. Your doctor can advise you about specific devices and machinery to avoid. As a general note you should avoid:

• Electromagnetic fields – including arc welding, power generators, close contact with car-ignition systems, and high-power radio or TV transmitters. They all generate strong electromagnetic fields that can disrupt pacemakers.
• Large magnetic fields and magnets - can affect the programming or function of your pacemaker. Keep magnets six inches away from your pacemaker.
• Airport security – your device may set off the alarm and the hand-held scanner contains a magnet that may interfere with your pacemaker when it is nearby. Advise airport security that you have a pacemaker.
• Carrying your mobile phone in your breast pocket over your pacemaker. Keep it at least six inches away from your device.
• MP3 player headphones – can interfere with your device function when in very close contact. Keep them at least six inches away from your pacemaker. Don’t allow someone wearing headphones to rest their head on your chest. Don’t place your headphones in your breast pocket or drape them around your neck so that they hang on your chest.
• Some medical procedures – including magnetic resonance imaging (MRI) machines, diathermy, and extracorporeal shock-wave lithotripsy (ESWL).

The benefits of having a pacemaker include:

• it is comfortable and reliable
• most people quickly return to their normal life after a pacemaker and often have an improved quality of life
• it alleviates unpleasant symptoms of arrhythmia such as chest pain, fainting, dizziness, or breathlessness
• slowed progression of heart failure, less frequent hospitalisation, and better heart functioning
• it could save your life if you have a higher risk of ventricular tachycardia. A pacemaker can provide immediate treatment and prevent ventricular fibrillation, which is when your ventricles get out of sync and contract erratically and fast and without treatment can cause sudden death.

The cost of a coronary angiogram will depend on your Ramsay hospital of choice.

You will receive a formal quotation price for a pacemaker implantation following your consultation with one of our expert cardiologists. This formal quote will be valid for 60 days.

Ramsay is recognised by all major medical insurers, this treatment is covered by most medical insurance policies as long as they are deemed medically necessary by your doctor. We advise you to obtain written authorisation from your insurance provider. 

We have a number of finance options if you are paying for your treatment yourself with no deposit and benefit from flexible payment plans to suit your finances. Find out more about accessing healthcare with us here.