A pacemaker is a small medical device used to help control abnormal heart rhythms. Many patients feel anxious when a pacemaker is mentioned, often because they associate it with severe heart disease. In practice, pacemakers are used in a wide range of situations, and for many people they are a straightforward and effective way of improving symptoms and quality of life. Understanding how a pacemaker works helps remove some of the uncertainty and allows patients to make informed decisions about investigation and treatment.
Why the heart sometimes needs support
The heart beats as a result of electrical signals that start in a natural pacemaker area within the heart and then travel through specialised pathways. This electrical system ensures that the heart beats in a regular, coordinated way.
In some people, these electrical signals slow down, pause, or fail to travel properly. When this happens, the heart may beat too slowly or irregularly, which can reduce blood flow to the brain and body. This can lead to symptoms such as dizziness, blackouts, fatigue, or breathlessness. A pacemaker provides support when the heart’s own electrical system is not reliable enough to maintain an appropriate heart rate.
What a pacemaker is
A pacemaker is a small electronic device that monitors the heart’s rhythm and delivers electrical impulses when needed. It does not replace the heart or take over completely. Instead, it works in the background, stepping in only when the heart rate falls below a safe level or when electrical signals are delayed.
The device consists of two main parts:
- a pulse generator, which contains the battery and electronic circuitry
- one or more leads, which are thin insulated wires that carry signals between the pacemaker and the heart
Modern pacemakers are compact, reliable, and designed to last for many years. So don’t worry about that!
How a pacemaker detects heart rhythm
A pacemaker constantly monitors the heart’s electrical activity through its leads. It can sense each heartbeat and determine whether the heart is beating at an appropriate rate. If the heart’s own rhythm is adequate, the pacemaker remains inactive. If the heart rate slows too much or pauses occur, the pacemaker delivers a small electrical impulse to stimulate a heartbeat. This process happens automatically and continuously. Most patients are not aware of the pacemaker working and do not feel the electrical impulses.
How a pacemaker corrects slow heart rhythms
Pacemakers are most commonly used to treat bradycardia, which means a slow heart rate. This can occur for several reasons, including age related changes in the electrical system, damage from previous heart disease, or certain medications. When the heart rate drops below a programmed level, the pacemaker sends a signal to the heart muscle, prompting it to contract. This ensures that the heart maintains a rate sufficient to supply blood to the body. By preventing excessively slow heart rates, pacemakers help reduce symptoms such as dizziness, blackouts, and fatigue.
Different types of pacemakers
Pacemakers are tailored to the individual and the specific electrical problem being treated. Some pacemakers have a single lead and stimulate one chamber of the heart, usually the right ventricle. Others have two leads, allowing coordination between the upper and lower chambers. In certain cases, more complex pacing systems are used to improve the timing of heart contractions. The type of pacemaker recommended depends on the nature of the rhythm problem and the structure and function of the heart.
How pacemakers are implanted
Pacemaker implantation is usually performed under local anaesthetic with light sedation. The procedure is carried out in a controlled hospital environment. A small incision is made below the collarbone. The leads are guided through a vein into the heart under imaging guidance. Once the leads are positioned correctly, they are connected to the pacemaker generator, which is placed under the skin. The procedure typically takes one to two hours. Most patients are able to go home the same day or after a short overnight stay.
Recovery after pacemaker implantation
Recovery is usually straightforward. Some discomfort or bruising around the implant site is common in the first few days. Patients are advised to avoid heavy lifting or strenuous arm movements on the side of the implant for a short period to allow the leads to settle. Normal daily activities can usually be resumed quickly. Follow up appointments are arranged to check the pacemaker settings and ensure it is functioning as expected.
Living with a pacemaker
Most people return to normal activities after pacemaker implantation. The device is designed to adapt to the body’s needs, increasing the heart rate during activity and allowing it to slow during rest.
Modern pacemakers are well shielded from everyday electrical interference. Household appliances, mobile phones, and common electronic devices are generally safe to use when basic guidance is followed. Regular pacemaker checks are required. These appointments assess battery life, lead function, and pacing patterns. Many checks can now be done remotely.
What don’t they do?
It is important to understand the limits of a pacemaker. A pacemaker does not treat blocked arteries, heart valve disease, or heart muscle weakness directly. It also does not prevent fast heart rhythms such as atrial fibrillation, although it may be used alongside other treatments in some cases. The pacemaker addresses specific electrical problems and is one part of a broader approach to heart care.
When this surgery is considered
A pacemaker is considered when symptoms are clearly linked to slow or unreliable heart rhythms, or when tests show a significant risk of dangerous pauses in the heartbeat. Assessment usually involves ECGs, heart rhythm monitoring, and sometimes exercise testing. The decision to implant a pacemaker is based on evidence and symptoms rather than age alone. Many people benefit greatly from pacing, with improvement in symptoms and confidence once the underlying rhythm issue is addressed.
Reassurance and perspective
The idea of having a pacemaker can feel daunting. However, pacemakers are among the most established and reliable treatments in cardiology. For many patients, the device provides reassurance as well as symptom relief.
Having a pacemaker does not mean that the heart is failing. In most cases, it means that a specific electrical issue has been identified and addressed in a controlled and effective way.
When to seek advice
It is sensible to seek assessment if there are symptoms such as unexplained dizziness, blackouts, extreme fatigue, or awareness of a very slow heart rate. These symptoms do not always indicate the need for a pacemaker, but they do warrant careful evaluation.
If you have been advised to consider a pacemaker, or if you would like to understand test results relating to heart rhythm, you can get in touch with me to discuss the findings and next steps in a clear and measured way. Please do note though that for bookings please use this page and not the contact form. A pacemaker is a supportive device that works alongside the heart, not instead of it. When used appropriately, it can play a key role in improving safety, symptoms, and long term wellbeing.