Pacemaker Implantation — Procedure Guide, Recovery & Risks | MyMedicPlus

A pacemaker is a small battery-powered cardiac implantable electronic device (CIED) that monitors heart rhythm and delivers electrical impulses to maintain an adequate heart rate. Developed over 50 years, modern devices include single-chamber, dual-chamber, biventricular (CRT-P), and leadless pacemakers.

Pacemaker implantation is indicated for symptomatic bradycardia from sick sinus syndrome or atrioventricular block, high-degree AV block (second-degree Mobitz II or third-degree), chronotropic incompetence, carotid sinus hypersensitivity, and cardiac resynchronisation therapy in heart failure with bundle branch block.

Under local anaesthesia and sedation, a subclavian or cephalic vein puncture provides venous access. Fluoroscopy guides lead(s) to the right ventricle and right atrium (or left ventricle via coronary sinus for CRT). The pulse generator is implanted in a subcutaneous prepectoral pocket, tested, and the wound closed.

Patients are monitored overnight and typically discharged the next day. The ipsilateral arm is restricted from overhead movement for 4–6 weeks to allow lead fixation. Device interrogation occurs at 6 weeks, 3 months, then annually. Remote monitoring is available with most modern devices.

Risks include pneumothorax (1–2%), haematoma, lead dislodgement (1–3%), infection (0.5–1%), cardiac perforation, and pacemaker syndrome from loss of AV synchrony. Electromagnetic interference from MRI requires MR-conditional device selection.

Pacemaker implantation is highly successful, relieving symptoms of bradycardia in over 95% of patients. Battery longevity is 8–12 years; generator replacement is performed as a minor procedure. CRT-P reduces heart failure hospitalisation by 36% and mortality by 24% in appropriate candidates.