Pacemakers

Pacemakers can be used to treat slow or irregular heartbeats called arrhythmias. Find out how a pacemaker works, how it’s fitted or implanted, what to expect after getting one, and how it can help you to feel better. 

What is a pacemaker?

A pacemaker is a small device that helps to increase your heartbeat if it’s slow or irregular (beating in an uneven pattern). Most pacemakers have two main parts:  

• An electronic circuit and long-lasting battery in a metal case. It is placed under the skin on your chest.     
• One or more leads (thin wires). These connect the pacemaker to your heart muscle.  

A new type of pacemaker, without leads, has also been recently developed. 

Why do I need a pacemaker?

Your heart beats to keep blood moving around your body. It speeds up and slows down depending on what you’re doing. This pattern is controlled by your heart’s electrical conduction system. Sometimes the electrical signals in your heart don’t follow the usual pattern, which can make your heartbeat slow or uneven. This can cause symptoms like light-headedness, tiredness, shortness of breath or fainting.  

A pacemaker helps control or increase your heartbeat. This can make a big difference to your daily life – you’ll have more energy, feel less dizzy or tired, and find it easier to stay active. For some people a pacemaker can save their life.  

How a pacemaker works

Your pacemaker monitors your heartbeat and sends a small electrical signal to your heart when it’s beating too slowly. This signal tells your heart when to beat. When your heart beats normally, the pacemaker doesn’t send any signals.  

Modern pacemakers are very reliable and comfortable.  

Types of pacemakers

There are different types of pacemakers: 

• Single-chamber: one lead connected to one chamber of the heart. 
• Dual-chamber: two leads connected to two chambers of the heart. 
• Biventricular: three leads connected to the right atrium and both ventricles of the heart. Also known as a cardiac resynchronisation therapy (CRT) device. 
• Leadless: a newer type of pacemaker with a battery, circuitry and pacing electrodes all enclosed within a small capsule that is implanted inside the heart. It is different from a traditional pacemaker because the battery is much smaller, there are no additional pacing wires, and the device sits entirely within the heart. 

What is the difference between a pacemaker and an ICD?

A pacemaker sends a small electrical signal to your heart to tell it when to beat.  

An implantable cardioverter defibrillator (ICD) resets the heartbeat when you have a dangerous heart rhythm. Most ICDs also have a pacemaker function. 

How do I get a pacemaker?

Your doctor will refer you to a cardiologist (heart specialist). The cardiologist will talk with you about your options. If a pacemaker is right for you, they’ll recommend the type that best suits your needs. They will then refer you to a hospital to have it fitted/implanted.

How is a pacemaker implanted (fitted)?

The majority of people in New Zealand currently receive a pacemaker that has leads. The process for the fitting of this kind of pacemaker is outlined below. 

The process for fitting the newer kind of leadless pacemakers will differ slightly. Discuss this with your doctor or nurse. 

Before the procedure: 

1. Your cardiology team will ask if you’re on blood thinners. You may need to stop taking them for a short period of time.  
2. 1–2 days before the procedure you’ll need to have a blood test. 
3. You may also have other tests (ECG, chest x-ray, or echocardiogram (echo)). 
4. You might be given antibacterial sponges and iodine nasal swabs to use the night before and morning of your procedure.     
5. Take your usual medications on the day unless you’ve been told not to.  

During the procedure:  

1. You’ll be awake but given medication to help you relax. You’ll also be given an injection to numb the area (local anaesthetic), so you shouldn’t feel any pain. 
2. A small incision (cut) will be made below your shoulder to place the pacemaker under your skin.   
3. The leads are inserted into a vein near your shoulder and gently guided down into your heart.   
4. The leads are attached to the inside wall of your heart.  
5. X-rays are taken to check the leads are in the right place.  
6. The leads are tested and connected to the pacemaker. 
7. The cut is closed with stitches, that dissolve on their own, and skin glue. 

You may feel some pressure but shouldn’t feel any pain when your pacemaker is being fitted/implanted.

When can I go home?

The procedure usually takes about an hour but can vary. Your pacemaker will be checked about 4 to 5 hours afterwards.  

Most people can go home once this check is done, but sometimes you’ll need to stay overnight. You’ll need someone to drive you home.  

Before you go home, your cardiology team will let you know which medications are safe to take if you have any pain or discomfort after the procedure.

Recovery from your procedure (the first six weeks)

You might feel sore or have bruising for a few days. Your cardiology team will tell you which medications are safe for you to take if you have any pain or discomfort.  

Serious problems are rare. It’s normal to feel tired at first, but most people find they’re able to get back to their normal lifestyle quickly.       

Caring for your wound

• Keep your wound dry for 5–7 days.  
• Don’t use plasters, creams or talcum powder on the wound.  
• Avoid touching the wound. It’s important not to pick at the glue or stitches so your skin can heal.   

Call your doctor or cardiac device clinic immediately if you notice:   

• symptoms like the ones you had before getting a pacemaker 
• hiccups or twitching in your chest  
• your heart feels like it’s racing 
• your wound becomes red, swollen, hot, painful or leaks (this could mean an infection).   

What should I avoid?

It takes a few weeks for your pacemaker wires to heal fully and stay secure. While you’re healing:     

• avoid heavy lifting or raising your arm above your shoulder   
• avoid sports and activities that involve arm movements, like swimming and golf  
• you may need help with everyday tasks like hanging out the washing, reaching into high cupboards, washing your hair or getting dressed.  

If you notice any problems with your pacemaker at any time, call your cardiac device clinic right away.  

When can I start driving again? 

You will have a follow-up appointment about two weeks after your procedure. At this appointment, your pacemaker will be checked. It’s important you don’t drive until you’ve had this check-up and your cardiologist or cardiac device clinic says it’s safe for you to drive.   

If you haven’t had your check-up after two weeks, ask your doctor when it’s safe for you to drive.   

The New Zealand Transport Agency (NZTA) states you must not drive for at least two weeks after having a pacemaker inserted. This will be at least four weeks if your job involves driving a large vehicle like a truck or bus.  

When can I return to work?

It’s usually recommended to take two weeks off work after the procedure. If your job involves heavy physical labour, or driving large vehicles, talk to your doctor about when to return to work.

Life with a pacemaker

You will have regular follow up at your local cardiac device clinic. The timing of these appointments will depend on your heart rhythm and how the pacemaker is working.

Home (remote) monitoring 

Some pacemakers have remote monitoring. This means the cardiology team can check your pacemaker data from their office while you’re at home. Your data is not monitored all the time, it is just reviewed by your cardiology team before your appointment. 

Your cardiology team will discuss this option with you if: 

• they think it will benefit you  
• you have good mobile phone coverage at home.  

If you have remote monitoring, you might need less frequent visits to the cardiac device clinic.  

Pacemakers with remote monitoring use Bluetooth or an antenna to send information to a small monitor by your bed. Some can also connect to an app on your phone. The data is sent safely over a mobile phone network to the pacemaker company, which creates a report for your cardiology team. 

If your pacemaker is inserted at a private hospital, your follow-up care is usually done at your local public hospital.  

How long does a pacemaker battery last? 

Most pacemaker batteries last between six and 12 years. This depends on the type of pacemaker and how often it sends signals to the heart.  

You’ll have appointments every six to 12 months to check your pacemaker and the battery. A new pacemaker will be fitted before the old battery runs out. This is done in hospital, under a local anaesthetic. You won’t be able to drive for two days afterwards.  

Exercising with a pacemaker

Returning to exercise can help you get back to the activities you enjoy. Being active is great for your heart and helps with your recovery.  

For the first six weeks, focus on low-impact exercises like walking and gentle cycling while you heal. Avoid heavy lifting, pushing, pulling or activities that involve swinging your arm.      

After six weeks, slowly increase how long and how hard you exercise. Remember to warm up and cool down to prevent injuries.  

You should avoid most contact sports, but check with your doctor about what’s safe for you. 

Important: If you feel chest pain, dizziness or shortness of breath while exercising, stop right away and consult your doctor or nurse.   

Pacemaker ID card

You’ll be given an identification (ID) card for your pacemaker. Always carry this card and a list of your medications. You may also consider getting a MedicAlert bracelet.  

You may need to show your ID card when walking through metal detectors, for example, at an airport.   

Travelling with a pacemaker

Most airport body scanners are safe, but always tell security staff you have a pacemaker. Ask them not to hold the hand-held metal detector over your chest. 

Using electronics with a pacemaker

Most everyday electronic devices are safe with modern pacemakers. 

Some larger devices can send out strong electrical signals. If a device makes you feel dizzy or lightheaded, or you notice an unusual heartbeat, move away from it. If you’re unsure if a device is safe, ask your cardiac device clinic. 

Mobile phones 

When using a mobile phone use the opposite ear from your heart. Don’t put a mobile phone, earbuds or earphones in a chest pocket. Don’t wear earphones around your neck.   

MRI scans 

Magnetic resonance imaging (MRI) scans use strong magnets to create images of the inside of your body. Most modern pacemakers are safe with MRI scans, but will need special programming during the scan. The MRI centre will check with your cardiac device clinic prior to your scan to ensure it is safe.  

Avoid other strong magnets or places with strong magnetic fields.

Other medical procedures

Tell your healthcare team you have a pacemaker before any medical procedure or treatment. Your pacemaker may need to be checked before and after.   

If you have any problems with your pacemaker after a procedure, let your cardiology team know as soon as possible.

At the end of your life

Depending on your wishes for your body, your pacemaker may need to be removed after the end of life. This has important considerations for you and your whānau.  

Even if you are not near the end of your life, it is important to discuss this with your medical provider and whānau to make sure everyone is clear about what should happen.  

Cremation  

Current New Zealand law does not allow for cremation with a pacemaker, so the pacemaker will need to be removed first. Leadless pacemakers are harder to remove, so it could delay the release of your body for cremation. Discuss this with your healthcare team if you have further questions. 

Burial  

If you choose burial at the end of your life, your pacemaker can remain where it is on death.