Figure 1: Transvenous (pectoral) pacemaker.
What is Pacemaker Implantation?
Pacemaker implantation refers to the surgical placement of a small electronic device, about the size of a matchbox, known as a pacemaker, into the chest or abdomen to help regulate abnormal heart rhythms (arrhythmias), mainly preventing the heart rate from dropping too low. The pacemaker consists of two main components: (i) Pulse Generator – A sealed metal container housing the battery and a tiny computer circuit that generates the electrical impulses and (ii) Leads (Wires) – One or more insulated wires that deliver the electrical impulses from the pulse generator to the heart muscle.
A modern pacemaker works on demand, so it monitors the heart rhythm continuously and only sends an electrical signal to stimulate the heart when it detects a missed beat or a rate that is too slow.
What are the Different Types of Pacemaker Implantation?
When considering pacemaker implantation, it is important to understand the different types of pacemakers based on how they are implanted, their function and cardiac leads. The conventional pacemakers, known as transvenous pectoral pacemakers, are implanted via blood vessels over the chest (Figure 1). There are also leadless pacemakers, which do not have leads and are often implanted via a delivery catheter from a blood vessel at the leg into the heart chamber (Figure 2). They can be further sub-divided into:
- Single-chamber pacemakers, which involve one lead placed in either the top chamber, known as atrium, or bottom chamber, known as ventricle.
- Dual-chamber pacemakers, which have leads in both chambers for more synchronised pacing.
- Biventricular pacemakers, also known as cardiac resynchronization therapy (CRT) devices, coordinate pacing across multiple heart chambers, beneficial for certain types of heart failure.
Regarding implantation, the most common method is the transvenous (pectoral) approach. In this procedure, the pulse generator is implanted under the skin just below the collarbone (pectoral region). The leads are threaded through a nearby vein into the respective heart chambers depending on the pacemaker type. This approach is minimally invasive, typically performed under local anesthesia, and allows for easier monitoring and adjustments.
Figure 2: Leadless pacemaker. Source: https://youtu.be/Hh2Zs63tl3Y?feature=shared (The Heart and Vascular Centre YouTube)
When is Pacemaker Implantation Recommended?
Pacemakers are typically recommended for individuals whose hearts beat too slowly (bradycardia). Patients with slow heart rhythms either have a problem with the natural pacemaker of the heart, known as sinus node dysfunction, or an issue with the central nerve linking the top and bottom chambers, known as atrio-ventricular (AV) block. A pacemaker implantation procedure is crucial to ensure the heart beats at a normal rate.
What are the Risks Involved in Pacemaker Implantation?
While pacemaker implantation is considered generally safe, like any surgical procedure, it carries some risks. During or immediately after the procedure, the risks include bleeding, bruising or infection at the surgical site, lead dislodgement which may require repositioning, puncture lung (pneumothorax) or reactions to antibiotics or anesthesia. In the long run, there can also be risks of device or lead malfunction.
How Can I Prepare for Pacemaker Implantation?
Preparing for pacemaker implantation involves several important steps to ensure the procedure goes smoothly. Firstly, your healthcare provider will give you specific instructions on fasting before the surgery and any medications you should adjust. It’s essential to inform them about any allergies or medical conditions you have. Arranging for transportation home after the procedure is wise, as you may feel groggy from anaesthesia. Additionally, having a support person with you can provide comfort during this time.
What Can I Expect During Pacemaker Implantation?
This procedure is often performed under light sedation. You will be connected to monitors to track your heart rhythm. The skin near the collarbone, typically on the left side, is cleansed and numbed with local anaesthesia. A small incision is made, usually near the collarbone, through which the pacemaker leads are threaded into a vein and guided to your heart chambers using X-ray imaging (fluoroscopy). Once in position, the leads are tested to ensure they can properly sense your heart rhythm and stimulate a contraction. The leads are connected to the pulse generator, which is then placed under the skin at the upper chest, below the collarbone. The incision is then closed with stitches which are often absorbable (dissolvable). You will not feel the pacemaker’s electrical impulses.
What is Recovery and Post-Procedure Care for Pacemaker Implantation like?
After the procedure, you may stay overnight in the hospital for observation and get discharged the next day. Keep the incision site dry and clean as instructed by your doctor. You may experience some soreness, bruising, and mild swelling which should resolve by 1-2 weeks. You are advised to avoid lifting the arm on the side of the pacemaker above shoulder level and carry heavy objects (more than 5kg) for 6 weeks. You can usually start driving again after about one week, but this depends on your underlying heart condition and local regulations. You will be given a temporary and then a permanent pacemaker identification card with the device details. Always carry this card and inform all healthcare providers that you have a pacemaker. Your doctor will schedule follow-up appointments to monitor the pacemaker and ensure it is functioning correctly. You should avoid strong magnetic fields as they can interfere with the pacemaker function. Most modern pacemakers are suitable for MRI (magnetic resonance imaging) scans but require reprogramming before the scan.
Conclusion
Pacemaker implantation is a vital procedure that can significantly improve the quality of life for individuals with slow heart rhythm disorders.
If you have further questions about pacemaker implantation or require support, contact The Heart & Vascular Centre today. Our team of specialists is here to provide expert guidance and care tailored to your needs. Take control of your heart health, reach out to us and schedule a consultation today.
References:
- Healthline. Pacemaker: What it is, how it works, and when it’s needed. Available at: https://www.healthline.com/health/heart-pacemaker. Accessed September 18, 2025.
- Mayo Clinic. Pacemaker: About. Available at: https://www.mayoclinic.org/tests-procedures/pacemaker/about/pac-20384689. Accessed September 18, 2025.
