A pacemaker sounds far more dramatic than it is. It is a small device, roughly the size of two stacked coins, that watches your heart rate and delivers a tiny electrical impulse only when your own rhythm is too slow.
Most patients are surprised at how quickly life returns to normal, and how much better they feel once the slow rhythm is corrected.
Why a Heart Beats Too Slowly
The heart has its own electrical system, a natural pacemaker in the upper chamber that generates an impulse and a conducting pathway that carries it to the pumping chambers. Either part can fail.
- Sick sinus syndrome: the natural pacemaker fires too slowly or pauses
- Heart block: the signal is delayed or blocked on its way down
- Atrial fibrillation with a slow response
- Drug effects: some blood pressure and rhythm medicines slow conduction
- Damage after a heart attack or heart surgery
Ageing of the conduction system is the most common reason, which is why pacemakers are largely a treatment of later life.
The Symptoms of a Slow Heart
These are often blamed on age for months before anyone checks the pulse.
- Fainting or sudden collapse without warning
- Dizziness, particularly on standing or exertion
- Extreme fatigue and breathlessness on mild activity
- Confusion or memory difficulty in older patients
- A pulse persistently under fifty when not an athlete
Collapse without warning is the important one. Unlike a faint from standing too long, there is no preceding lightheadedness, so injuries are common. Any unexplained collapse deserves an ECG and often a rhythm evaluation with a Holter monitor.
Temporary Versus Permanent Pacing
Not every slow rhythm needs a permanent device. When the cause may reverse, such as a drug effect, an electrolyte disturbance or a rhythm problem during an acute heart attack, a temporary pacemaker supports the heart while the cause is corrected.
A permanent pacemaker is implanted when the conduction problem is established and will not recover, or when it has already caused blackouts.
What the Implant Procedure Involves
This is a minor procedure done under local anaesthetic with sedation, not open heart surgery.
- The skin below the collarbone is numbed and a small pocket is created under it
- One or two thin leads are passed through a vein into the heart chambers under X ray guidance
- The leads are tested to confirm they sense and pace correctly
- The generator is connected and placed in the pocket, and the skin is closed
It takes about an hour. Most patients stay one night, and the device is checked the next morning before discharge.
The First Six Weeks
The main restriction exists to let the leads settle into position before scar tissue anchors them.
- Do not raise the arm on the implant side above shoulder height for four to six weeks
- No lifting heavy weights with that arm
- Keep the wound dry for a week, and watch for redness, swelling or discharge
- Gentle arm movement below shoulder height is encouraged to prevent stiffness
- Driving is usually restricted for one to two weeks
Fever, an expanding swelling at the site, or the wound opening are reasons to be seen promptly rather than waiting for your appointment.
Everyday Life: Phones, Airports and Appliances
Modern pacemakers are well shielded and most everyday anxieties are unfounded.
- Mobile phones: safe. Use the ear opposite the device and avoid carrying the phone in a chest pocket over it
- Microwave ovens, induction hobs, computers, WiFi: all safe
- Airport security: carry your device card, walk through normally and ask for a hand search rather than lingering in the arch
- Anti theft gates in shops: walk through, do not stand next to them
- MRI scans: many modern devices are MRI conditional, but the radiology and cardiology teams must know in advance
- Arc welding and large industrial magnets: genuine caution needed, discuss with your cardiologist
Always tell any doctor, dentist or surgeon that you have a pacemaker before a procedure involving electrical instruments.
Follow Up and Battery Life
Pacemaker checks are usually at six weeks, then every six to twelve months. The check is painless, done with a programmer held over the device, and reads the battery status, lead performance and a record of your rhythm.
Batteries typically last eight to twelve years depending on how often the device paces. Replacement involves changing the generator only, a shorter procedure than the original, as the existing leads are usually reused. The device warns of approaching depletion many months ahead, so it is never a sudden event.
Patients who receive a pacemaker for blackouts or profound fatigue often describe the improvement as immediate. The device does nothing unless your own rhythm falters, which means for much of the day it is simply watching.
If you have had unexplained blackouts or a persistently slow pulse, our cardiology department at T. Nagar can arrange rhythm monitoring and assessment.
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