Before having a pacemaker fitted, you are likely to have a pre-operative assessment. The team looking after you will check that you are fit for surgery. You can also discuss the operation and ask any questions you have.
Tests, such as blood tests and X-rays, can be arranged at this stage so that there are no delays when you are called into hospital. You will be asked about your general health, your heart problems and how these affect you. You'll also be asked about any additional medical problems and previous operations you've had, as well as any problems or reactions you or your family have had with anaesthetics.
Taking steps to improve your fitness and health, such as quitting smoking if you smoke and eating a healthy diet, should help speed up your recovery time and reduce the risk of complications.
Read more about preparing for surgery.
The procedure will be carried out by a heart specialist, known as a cardiologist, who will probably have a special interest in pacemakers. If you are being treated in a large heart hospital, the operation will often be carried out by an electrophysiologist. This is a cardiologist who specialises in heart rhythm disorders.
Fitting the pacemaker
The most widely used method to fit a pacemaker or an implantable caridoverter defibrillator (ICD) is known as transvenous implantation.
In transvenous implantation, the wires of the pacemaker (pacing leads) are inserted into your heart through a vein. This is the most common method of fitting a pacemaker and is done under local anaesthetic, where the area is numbed.
Medication is given through your IV line to relax you and make you feel drowsy, but you will be awake during the procedure.
You will feel an initial burning or pricking sensation when the cardiologist injects the local anaesthetic into a blood vessel. You will soon become numb, but you may feel a pulling sensation during the operation.
During the procedure:
- The cardiologist makes a 5-6cm cut below the collarbone and inserts the pacing lead into a vein.
- The pacing lead is guided into the correct chamber of your heart using X-rays, and becomes lodged in the tissue of your heart.
- The other end of the lead is connected to the pacemaker, which is fitted into a small pocket created under the skin of your upper chest.
The procedure usually takes 30-60 minutes. It may take longer if you're having a biventricular pacemaker (with three leads) fitted or other heart surgery at the same time. You will usually need to stay in hospital overnight and have a day's rest after the procedure.
Epicardial implantation is an alternative and less widely used method of fitting a pacemaker.
In this method, the pacing lead or leads are attached to the outer surface of your heart, which is called the epicardium. Epicardial implantation is often used in children and people who have heart surgery at the same time as the pacemaker implantation.
The procedure is done under general anaesthetic so you will be asleep during it.
The surgeon attaches the tip of the lead to your heart and the other end of the lead to the pacemaker box. This is placed in a pocket created under the skin in your abdomen (below your chest).
This usually takes one to two hours, but could take longer if you are having other heart surgery at the same time.
Recovery usually takes longer than when using the transvenous approach.
Testing and setting the pacemaker
Once the leads are in place and before they are connected to the pacemaker, the cardiologist will test them to make sure they work properly and can increase your heart rate (called pacing). Small amounts of energy are delivered through the leads into the heart, which cause it to contract.
When the leads are being tested, you may feel your heart rate increase or your heart beat faster.
Tell the medical team what symptoms you feel.
Your doctor will determine the settings of your pacemaker after deciding how much electrical energy is needed to stimulate your heartbeat.