Pacemaker fitting (Permanent pacemaker implantation)
A small implanted device that sends electrical signals to keep your heartbeat from going too slow, used mainly for heart block and slow heart rhythms.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A pacemaker mainly treats a heart that beats too slowly or has heart block; it does not fix a fast rhythm or prevent a heart attack.
- It is usually a day case or one overnight stay under local anaesthetic, but it is still a heart procedure with risks such as lung puncture, bleeding, infection and lead problems.
- You will need to avoid lifting the arm on that side above shoulder height for about 4–6 weeks, and not drive for at least a week.
- Most pacemakers are MRI-conditional, but the make and model must be checked first, and the battery lasts several years before a box change.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can stop blackouts, dizziness and falls caused by a slow or blocked heart rhythm
Your symptoms are not due to a slow or blocked rhythm, so a pacemaker would not help.
Keep the dressing clean and dry. Some bruising and soreness near the device is normal. You will usually have a chest X-ray before or soon after discharge...
Clear written wound-care and arm-movement instructions, plus a named contact for problems.
Keep the dressing clean and dry. Some bruising and soreness near the device is normal. You will usually have a...
Do not drive for at least a week (longer for HGV/PSV licences). Use your arm gently for everyday tasks but do not...
Wound checks happen as advised. Avoid heavy lifting, vigorous exercise and reaching high with the affected arm so...
Most restrictions ease once the leads are secure. A device check (often around 6 weeks) confirms the settings and...
What is a pacemaker?
A pacemaker is a small device, usually about the size of a matchbox, that is placed under the skin near your collarbone. It watches your heartbeat and gives tiny electrical pulses to stop your heart beating too slowly. Most people have one fitted for heart block or a slow rhythm (bradycardia) that causes dizziness, blackouts or breathlessness.
Most pacemakers have one or two thin wires (leads) that run through a vein into the heart. A 'leadless' pacemaker is a tiny capsule placed directly inside the heart with no chest cut and no wires. A special type called a biventricular pacemaker, or cardiac resynchronisation therapy (CRT), has an extra lead and is used for some people with heart failure.
A pacemaker treats a slow or blocked rhythm. It is not the same as a defibrillator (ICD), which is designed to stop a dangerous fast rhythm. Some devices do both. A pacemaker does not cure the underlying heart problem, and it does not stop a heart attack.
Fitting a pacemaker is a common procedure, but it is still a heart procedure with real risks, so it should only be done when a clear rhythm problem has been confirmed on tracings such as an ECG or a heart monitor.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Pacemaker vs implantable defibrillator (ICD)
| Feature | Pacemaker | ICD |
|---|---|---|
| Main job | Stops the heart going too slow | Stops a dangerous fast rhythm |
| Can it shock you? | No | Yes, if needed |
| Driving rules | Off driving about 1 week | Off driving 1 month or longer |
| Who it suits | Heart block, slow rhythm | High risk of cardiac arrest |
Some people need a device that both paces and defibrillates (CRT-D). Your cardiologist will explain which is right for you.
Preparing for your procedure
- Tell the team about all your medicines, especially blood thinners and antiplatelets, as some may need pausing.
- Mention any allergies, including to local anaesthetic, metals, adhesive dressings or contrast dye.
- Tell them about any recent infection, fever, or skin problem near the collarbone, as the procedure may need to wait.
- You may be asked not to eat for a few hours beforehand, especially if sedation is planned.
- Arrange a lift home and someone to stay with you for the first night, particularly if you have had sedation.
- Plan for help at home, as you should not lift the arm on that side above shoulder height for several weeks.
- Ask which side the device will go and whether it could affect seatbelts, bra straps or a rifle/shotgun if relevant.
- Confirm the make and model will be recorded so future MRI scans and airport checks are straightforward.
What happens
The procedure is usually done in a special X-ray room (a catheter lab) while you are awake but with local anaesthetic to numb the skin near your collarbone. You may be offered sedation to help you relax.
For a standard pacemaker, the cardiologist makes a small cut, passes one or more thin leads through a vein and into the heart using X-ray guidance, and connects them to the device box, which sits under the skin or under the muscle. The cut is closed with stitches or glue. For a leadless pacemaker, a tube is passed from a vein in the groin and the capsule is fixed inside the heart, so there is no chest cut.
The device is tested before you leave to check it senses and paces correctly. A standard implant usually takes about an hour; biventricular (CRT) devices can take longer because of the extra lead.
Most people stay in for a few hours or one night, have a chest X-ray to check the leads, and go home with the device already working.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your symptoms are not due to a slow or blocked rhythm, so a pacemaker would not help.
- You have an active infection, especially near the device site or in the bloodstream.
- A fast dangerous rhythm is the real risk, in which case a defibrillator (ICD) may be needed instead of, or as well as, pacing.
- Your veins or anatomy make standard leads difficult, so a leadless device or a different approach may be considered.
- A reversible cause of the slow rhythm (such as a medicine) could be corrected first.
Delay or rearrange if…
- You have a current infection, fever or a skin problem near the collarbone.
- Your blood is over-thinned and bleeding risk is high until this is adjusted.
- An urgent or different heart problem needs sorting first.
- The diagnosis is not yet confirmed on an ECG or heart monitor.
- You cannot arrange the help you will need at home for the first few weeks.
Alternatives to discuss
- Reviewing or stopping medicines that are slowing the heart, where this is the cause.
- Treating an underlying condition (such as a thyroid or electrolyte problem) that is slowing the rhythm.
- A temporary pacing wire in an emergency while the situation is assessed.
- A defibrillator (ICD) or combined device if the main risk is a dangerous fast rhythm.
- Watchful monitoring if symptoms are mild and the rhythm problem is intermittent.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can stop blackouts, dizziness and falls caused by a slow or blocked heart rhythm
- Can ease tiredness and breathlessness when these are due to the heart beating too slowly
- Lets some people safely take rhythm-slowing medicines they otherwise could not tolerate
- Biventricular (CRT) devices can improve symptoms and pumping in selected people with heart failure
- Works automatically and continuously once fitted, with settings adjusted at routine checks
Risks & complications
- Bruising, soreness or a small lump at the device site for a week or two
- A feeling of the device under the skin, especially in slim people
- Temporary tiredness for a few days after the procedure
- A lead moving out of place and needing to be repositioned
- Bleeding or a blood collection (haematoma) at the site
- Infection of the wound or, less often, the device and leads
- A punctured lung (pneumothorax), sometimes needing a chest drain
- Fluid collecting around the heart (tamponade) that needs draining
- Blood clot in the vein with the lead, causing arm swelling
- The device not working as it should and needing adjustment or replacement
- Death, which is a very rare complication of the procedure
The most talked-about early risk is a punctured lung, reported in around 1 in 100 cases in NHS information; bleeding, infection and a lead moving are the other main early problems. Device and lead infection is uncommon but serious and can mean the whole system has to be removed, so report any redness, swelling, oozing or fever near the device promptly. Ask your cardiologist about your own risk and how often the device and leads will be checked.
Published figures to discuss
Complication rates vary with your age, other health problems, the type of device, how many leads are used and the operator's experience. The figures below are cautious examples from NHS and patient-information sources and are not a personal prediction; biventricular (CRT) implants and lead extractions carry higher risk than a simple single-lead device.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Punctured lung (pneumothorax) | Around 1 in 100 (about 1%) in NHS information | May need a chest drain; risk relates to passing leads near the lung and varies with anatomy and technique. | NHS — Pacemaker implantationnhs.ukPublished figure |
| Lead displacement needing repositioning | Low single-digit percent in published series; varies by lead and device type | More likely in the first weeks, which is why arm movement is limited while leads settle. | Guide sourcesClinical context |
| Device or lead infection | Uncommon (well under a few percent in most series), but serious | Can require removing the whole system; report redness, swelling, oozing or fever promptly. | NHS — Pacemaker implantation: risksnhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Most people go home the same day or the next morning and feel back to themselves within a few days, but the wound and the arm on that side need protecting for several weeks while the leads settle.
- Bruising and tenderness around the device that fades over a week or two
- Awareness of the box under the skin, which most people get used to
- A small, slightly raised scar that softens over months
- Mild tiredness for a few days after the procedure
Aftercare
- Keep the wound clean and dry and follow the advice given about dressings and showering.
- Do not raise the arm on the device side above shoulder height for about 4–6 weeks.
- Avoid heavy lifting, pushing, pulling and vigorous arm exercise during that time.
- Carry your pacemaker identification card and show it at airport security and before any scan.
- Keep mobile phones and strong magnets a short distance from the device, as advised by your team.
- Tell any clinician, dentist or physiotherapist that you have a pacemaker before treatment.
- Attend all device checks so the battery, leads and settings can be reviewed.
- Lift home arranged and someone to stay the first night
- Loose, front-opening tops that do not press on the device
- Pacemaker identification card kept safe
- Help arranged for lifting, shopping and chores for a few weeks
- Time off driving planned (at least 1 week)
- Clinic's contact number saved for wound or device worries
- Make and model of device noted for future MRI scans
Scars and how they heal
A standard pacemaker leaves a scar a few centimetres long near the collarbone, with a small bump where the device sits. The scar is pink and slightly raised at first and usually fades over several months. A leadless pacemaker is fitted through a vein in the groin, so there is only a small puncture site rather than a chest scar.
⚠ Get urgent help if…
- Spreading redness, swelling, heat, oozing or a wound that opens at the device site
- A high temperature, shivering or feeling generally unwell after the procedure
- Severe or worsening chest pain, or sudden breathlessness
- Fainting, blackouts or a return of the symptoms the pacemaker was meant to treat
- Swelling of the arm on the device side
- Persistent hiccups or twitching of the chest muscle in time with the heartbeat
- Dizziness with a very slow or very fast pulse
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A working pacemaker should stop the symptoms caused by a slow or blocked rhythm, such as blackouts, dizziness or extreme tiredness, often very quickly. The device records information that the team reviews at checks, and the settings can be fine-tuned to suit you.
A pacemaker does not cure the underlying heart condition and does not protect against every heart problem. It will not prevent a heart attack, and a standard pacemaker cannot stop a dangerous fast rhythm. If your symptoms are caused by something other than a slow rhythm, a pacemaker may not help, which is why the diagnosis on a tracing matters before the device is fitted.
A pacemaker battery typically lasts several years, often around 6 to 10 depending on the device and how much it is used, after which the box is replaced in a smaller procedure (a box change) while the working leads are usually kept. Leads can last many years but occasionally need replacing if they fail or fracture. Lifelong follow-up, often partly by remote monitoring, tracks the battery and leads.
Related tests, treatments or support
Some people have a pacemaker fitted as part of treating atrial fibrillation, for example after AV node ablation, so the pacemaker controls the heart rate. Others move from a pacemaker to a combined pacing-and-defibrillator device (CRT-D) if their heart condition changes. Your cardiologist will explain whether any other procedure is planned around the same time.
Follow-up & long-term care
You will usually have a wound check in the first weeks and a device check at around 6 weeks to confirm the settings. After that, checks are typically yearly or by remote home monitoring, with extra checks if symptoms change or the battery is running low. Report wound problems, fever or returning symptoms without waiting for the next appointment.
- Attend routine device checks (in clinic or by remote monitoring) to track battery and leads.
- Plan for a box change every several years when the battery runs low.
- Keep your device identification card and update records if you move or change hospital.
- Always tell radiology staff before any MRI, and confirm the device is MRI-conditional.
- Mention the pacemaker before any surgery, dental work involving diathermy, or physiotherapy.
Repeat, follow-on and what comes next
- A box change is expected every several years when the battery runs low; this is planned, not a failure.
- Leads can occasionally fracture or fail and may need adding to or replacing.
- Removing leads (extraction) is more involved than fitting them and is done in specialist centres.
- Settings are often adjusted over time and do not mean the device is faulty.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written wound-care and arm-movement instructions, plus a named contact for problems.
- A device identification card and a recorded make and model for future MRI and security checks.
- A planned device check (often around 6 weeks) and a clear follow-up or remote-monitoring schedule.
- Explicit emergency advice for wound infection, fever, breathlessness, swelling or returning symptoms.
- Clear driving guidance based on your licence and condition, from the DVLA (England, Scotland and Wales) or the DVA (Northern Ireland).
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The type of device (single, dual chamber, biventricular/CRT or leadless), which differ in complexity and price
- The cardiologist's (operator's) fee and the catheter-lab and facility fees
- Whether sedation and an anaesthetist are used
- Length of stay (day case versus overnight)
- Imaging before and after, such as ECG, echocardiogram and chest X-ray
- Follow-up device checks and any remote monitoring
- The cost of treating a complication if one occurs
- The cardiologist's fee and which device is included
- Catheter-lab, facility and overnight-stay charges
- Sedation or anaesthetist fees if relevant
- Pre-procedure tests and the post-procedure chest X-ray
- Follow-up device checks and remote monitoring arrangements
- What happens, and what is charged, if a complication occurs or a lead needs repositioning
- The cancellation policy
On the NHS? Pacemaker fitting is routinely available on the NHS when a slow or blocked rhythm is confirmed; private care is generally chosen for speed or choice of consultant rather than a different device.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not confirming the slow-rhythm diagnosis on a tracing before fitting a device.
- Glossing over early risks such as lung puncture, lead displacement and infection.
- Not explaining that a standard pacemaker does not protect against a dangerous fast rhythm.
- No clear plan for MRI scans, driving rules or device checks.
- Not setting out the lifelong nature of follow-up and future box changes.
Marketing red flags
- Describing a pacemaker as a cure for the heart condition rather than treatment of the rhythm.
- Calling the procedure 'simple' or 'without risks' without discussing lung puncture, infection and lead problems.
- Promising the latest or 'best' device without explaining why it suits you.
- Pushing a private implant for a problem that has not been confirmed on monitoring.
Choosing a specialist safely
- Check the surgeon is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- What rhythm problem do my tracings show, and why do I need a pacemaker now rather than waiting?
- Which type of device (single, dual chamber, biventricular or leadless) is right for me, and why?
- What are my personal risks, including lung puncture, lead problems and infection?
- Is the device MRI-conditional, and how will future scans be handled?
- How often will the device be checked, and can this be done by remote monitoring?
- What restrictions will I have on my arm, driving and work, and for how long?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is a pacemaker available on the NHS?
Will I feel the pacemaker working?
Can I have an MRI scan with a pacemaker?
How long before I can drive?
Will airport security or shop alarms affect it?
What happens when the battery runs out?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Pacemaker implantation NHS — Pacemaker implantation: risks British Heart Foundation — Pacemakers British Heart Foundation — Driving with a heart condition British Heart Foundation — Pacemakers and MRI scans Arrhythmia Alliance — Heart rhythm information DVLA — Assessing fitness to drive DVA Northern Ireland — Telling DVA about a medical condition
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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