A pacemaker is a small device that helps maintain a healthy heart beat using electrical impulses

What is a pacemaker?
Why do I need a pacemaker?
What are the risks of having a pacemaker?
How do I prepare for a pacemaker?
What happens during pacemaker surgery?
What happens after pacemaker surgery?

What is a pacemaker?

A pacemaker is a small device that helps maintain a healthy heart beat using electrical impulses. It consists of a battery and leads, and it sits under the skin on the left or right side of your chest. The pacemaker sends electrical signals to your heart to help it to beat at a normal rate and can help increase your heart beat with exercise.

Why do I need a pacemaker?

Your doctor may recommend a pacemaker if your heartbeat has become too fast, too slow or irregular - a disorder known as an arrhythmia.

Arrhythmias can have many causes, including:

  • The natural ageing process
  • Inherited or genetic causes
  • Previous heart attack or heart valve or heart muscle problems
  • Viral infections of the heart
  • Cardiac surgery - such as valve surgery, cardiac bypass surgery and TAVI

Below, you can watch a short video from one of our specialists explaining more about a pacemaker.

Below, you can watch an animation of what happens during a pacemaker procedure.

What are the risks of having a pacemaker?

Your doctor will have a more detailed discussion about risks before you agree to the surgery. While serious risks are rare, you’re encouraged to discuss any questions or concerns with your medical team. Your doctor will ask you to sign a consent form before you have the surgery.

The most common risk for this procedure is bruising or swelling at the pacemaker site.

Less common risks are: 

  • Movement of the pacemaker generator or leads
  • Infection - There are a number of things you can do to reduce the risk of infection. Read the Healthcare Associated Infections Consumer factsheet 
  • Bleeding or blood clots
  • Vein or heart valve damage, resulting from pacemaker leads
  • Allergic reaction to medications
  • Heart attack and stroke
  • Bleeding, requring open heart surgery
  • Death from this procedure is rare

How do I prepare for a pacemaker?

There are a few simple steps you need to take to prepare for having your pacemaker put in, including:

  • Plan your transport home - It is your responsibility to arrange how you will get home after surgery. For information, including guidelines and tips for travelling home by car or plane after heart surgery, you can visit our travel page
  • Shower using a chlorhexidine wash for at least one day before your procedure - can be purchased from any pharmacy
  • Ask your doctor - if you are able to take your usual blood thinning medications. If you take SGLT2 medicine for diabetes, you will need to stop taking them at least 3 days before your surgery. Read our Patient Information Guide on SGLT2 inhibitors for diabetes.
  • Sticky dots for monitoring your heart should be placed on the left and right shoulders - the risk of infection is increased if sticky dots are placed on the upper chest area where the pacemaker will be inserted
  • Don't eat eating or drink anything - for at least 6 hours prior to surgery
  • Remove any jewellery and put on a hospital gown - just before the procedure,

What happens during pacemaker surgery?

Your pacemaker surgery takes place in the Electrophysiology Lab. You will be taken to the procedure and asked to lie on an operating table. Before your surgery begins, you will be attached to heart monitors and have a cannula inserted in a vein in your arm. You will be given medication (midazolam/fentanyl) to make you relaxed and provide pain relief during the procedure. During your pacemaker surgery, your doctor will:

  • Give you a local anaesthetic -  to numb your collarbone area
  • Make a small incision near your collarbone - to create a pocket for the pacemaker battery
  • Thread the pacemaker leads inside a large vein - and in the right side of your heart
  • Fix the end of the lead into position inside the heart - using tiny screws
  • Program the pacemaker - and perform tests to ensure it is working appropriately
  • Tuck the pacemaker battery inside the pocket - under the skin
  • Close the incision - using a dissolvable suture and apply a dressing to the area

Afterwards, there will be a bulge visible under the skin where the pacemaker has been inserted.

What happens after pacemaker surgery?

Once your pacemaker surgery is finished, you will be moved to the recovery area or to the ward to rest. You may be tender or sore and have some bruising at the site of the surgery - this should go away after a few weeks. You should be able to return home in most circumstances within 24-48 hours.

It is important to follow your doctor’s advice about medications and any recommended lifestyle changes after your surgery. Information and guidelines after having a pacemaker can be found in our How to Care for Yourself after Getting a Pacemaker or Defibrillator Information Sheet.

For information, including guidelines and tips for travelling by car or plane after pacemaker surgery, you can visit our travel page.

Also, if you have any concerns at all after your surgery, make an appointment with your doctor. You will be required to have regular follow up after the procedure at a pacemaker clinic. You will be provided with contact information for this clinic before you leave hospital.