Pacemakers: fitting, recovery and living with one

A slow heartbeat can cause dizziness, tiredness, breathlessness or fainting. Some people have heart block: the electrical signal travelling through the heart is delayed or interrupted. Heart block is an electrical problem, not the same thing as a blocked coronary artery.

An ECG records the heart's electrical activity. A monitor worn during everyday life can help show whether symptoms happen at the same time as an abnormal rhythm. Blood tests, an echocardiogram (ultrasound of the heart) and sometimes a chest X-ray may also form part of assessment.

Some causes are reversible and can be treated. Depending on the cause and urgency, some people need temporary pacing, while others need a permanent implant. Ask why pacing is recommended for you and what alternatives or risks of waiting apply.

The benefit depends on the condition. Pacing may relieve symptoms caused by a slow rate, but other conditions, medicines and treatments still need follow-up. NHS — heart block · NHS — pacemaker implantation

• Single-chamber or dual-chamber pacemaker: a generator usually sits beneath the upper chest skin. One or two leads carry its pulses to the heart.
• Leadless pacemaker: a small device sits inside the heart without a separate chest generator or leads. For selected people it is usually delivered through a vein in the groin.
• CRT-P: cardiac resynchronisation therapy with pacing helps coordinate the main pumping chambers in selected people with heart failure.
• CRT-D: combines resynchronisation with a defibrillator. An ICD treats dangerous rhythms and can sometimes provide pacing too.

Standard pacing does not give a defibrillator shock. Do not apply standard pacemaker driving or recovery advice to an ICD or CRT-D without checking. Your team will explain the device proposed and why. British Heart Foundation — pacemakers · NHS — pacemaker implantation

Your hospital may arrange pre-assessment and tests. Bring a list of prescribed medicines, over-the-counter products and allergies. Follow your own hospital's fasting and medicine instructions.

Ask specifically about blood thinners and diabetes medicines. Do not stop, reduce or change them yourself. If the instructions are unclear, contact the hospital before the appointment.

Arrange a lift and the support you may need at home. Tell the team if you live alone, have mobility difficulties or need an interpreter, accessible information or communication adjustments. Ask whether you should bring your medicines and what belongings you will need. Chelsea and Westminster Hospital — your pacemaker

A cardiology specialist fits the device in hospital. For a standard implant, local anaesthetic numbs the chest; sedation may also help you relax. A small upper chest cut is made, leads are guided through a vein to the heart, then tested and connected to the generator beneath the skin near the collarbone. The wound is closed.

A standard fitting usually takes about an hour, but can take longer depending on the device or other procedures. A leadless device is fitted through a catheter without a chest incision.

The device is checked before discharge. Some people go home the same day, particularly after a leadless implant; others stay overnight. The hospital decides according to the procedure and your recovery. NHS — pacemaker implantation

Risks to discuss with your team

Possible problems include bleeding or bruising, infection, a lead moving, a collapsed lung, and rare damage to the heart or bleeding around it. A leadless implant has a different risk profile, including problems at the groin access site. Ask about risks for your procedure rather than relying on a general percentage. Chelsea and Westminster Hospital — your pacemaker · British Heart Foundation — pacemakers

Soreness and tiredness are common at first. Follow your discharge instructions about dressings, washing and keeping the wound clean. After a leadless implant, follow the access-site advice for your groin.

Ask how and when to move your shoulder, raise your arm, lift things and do shoulder exercises. Gentle movement as advised can help, but many standard implants need several weeks of activity limits while the wound and leads settle. Do not use a generic timetable instead of your team's plan.

Returning to work or sport varies with your job, device and recovery. Ask about lifting, repetitive arm movement, contact sport and workplace equipment; adjusted duties may be needed.

Keep your discharge contact details handy. If the wound changes, you develop fever or chills, or old symptoms return, use the clinic or local urgent service described above. For emergency symptoms, call 999. NHS — pacemaker implantation · Chelsea and Westminster Hospital — your pacemaker

Checks assess the device's function, settings, leads and battery. Your clinic sets the schedule and may offer remote monitoring. Remote monitoring is not an emergency service and does not replace urgent help.

Batteries last several years, depending on the model and how much pacing it provides. Your clinic plans replacement before the battery runs down. For a standard pacemaker, the generator is usually replaced while working leads remain in place. A leadless device may need a different replacement plan.

Attend checks even if you feel well, and tell the team about new symptoms or a change in your contact details. NHS — pacemaker implantation · British Heart Foundation — pacemaker questions

• Device ID: carry your identification card. Tell doctors, dentists and imaging staff about your implant.
• MRI scans: suitability depends on the complete system, including leads, and a specialist scanning protocol. Ask the imaging and device teams before a scan; do not assume every pacemaker is MRI-compatible.
• Household appliances: most can be used as directed. Follow device-team advice on strong magnets, mobile phones, magnetic chargers and workplace equipment. Ask about your specific model rather than guessing distances.
• Airport security: tell staff and show your device ID. Avoid a handheld security wand being held directly over the device.
• Travel: discuss plans if recently implanted or unwell. Take your device details and clinic contact information, and tell your travel insurer about your condition and device.

Ask the clinic about concerns, including sleeping, relationships and exercise, so advice fits your device and circumstances. British Heart Foundation — pacemaker questions · NHS — pacemaker implantation

England, Scotland and Wales — DVLA

Tell DVLA after pacemaker implantation. You do not need a separate notification for a routine generator or ‘box’ change.

After fitting or a box change, the standard minimum restriction is one week for car and motorcycle drivers, and 6 weeks for bus and lorry drivers. These are minimums, not automatic permission to drive: there must be no other disqualifying condition, regular device checks are required, and you must be fit to drive.

Notify your motor insurer. ICD and CRT-D restrictions differ. Follow your cardiology team's advice and the official licence rules. GOV.UK — pacemakers and driving · DVLA — pacemaker implantation and box change: licence standards

Northern Ireland — DVA

Tell DVA after a pacemaker is fitted. nidirect exempts routine box changes from notification. Check DVA requirements and your team's instructions before returning to driving; do not assume the Great Britain timetable settles your Northern Ireland licence position. Tell your insurer. nidirect — heart conditions and driving

Before

• Bring your medicine and allergy list, follow your hospital's instructions, and arrange transport and help at home.
• Ask: why this device, what alternatives exist, and what are the risks of waiting?
• Ask which restrictions apply to your work, movement, driving and MRI scans.

During your visit

• Tell the team about symptoms, worries and communication needs.
• Ask who to contact after discharge and when to seek urgent help.
• Ask when your first check will be and whether remote monitoring is available.

After

• Keep your discharge advice, device ID and clinic number together.
• Follow the wound, movement and medicine instructions you were given.
• Attend checks and use urgent help if needed rather than waiting for an appointment.

Chelsea and Westminster Hospital — your pacemaker · NHS — pacemaker implantation