Fitness & Health

Everything You Need to Know About Pacemakers

March 4, 2025

By Crusader Staff

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Find answers to all your questions, including what they are, how they work, who is a candidate, and more.

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_{Medical Reviewer David M. Axelrod, M.D.}

Pacemakers—implanted medical devices that regulate heartbeat—can be lifesavers for people who have heart conditions that slow their heart rate. In the U.S. as many as 3 million Americans are living with an implanted permanent pacemaker, according to Yale Medicine. Most who have them—more than 70%—are at least 65 years old, though younger people, even children, can have a pacemaker.

If you’re a candidate for a pacemaker, you’ll want to know what exactly they are and how they work, as well as the risks and benefits of getting one implanted. We explored these topics with top heart experts to bring you this guide to cardiac pacemakers.

What They Are

What Is a Pacemaker?

“A pacemaker is an implantable device that delivers very small electrical pulses to the heart muscle, causing it to contract to prevent the heart rate from going too slow,” says Bradley P. Knight, M.D., a professor of cardiology and medical education and director of cardiac electrophysiology at Northwestern University Feinberg School of Medicine in Chicago, IL. A slower-than-normal heart rate is called bradycardia. Some pacemakers can also correct a heartbeat that’s too fast or irregular.

Pacemakers are small—weighing about an ounce and about the size of a matchbook—and operate off a battery. (The battery can last anywhere from six to 15 years; your doctor will monitor battery life and will replace it as necessary.) In most cases, a surgeon will place it in your chest, although some newer pacemakers actually sit inside your heart. The procedure only takes an hour, and you typically stay awake while it’s implanted.

How They Work

How Do Pacemakers Work?

“The heartbeat is regulated by the flow of electric current in the heart,” says Danesh Kella, M.B.B.S. (an international equivalent of M.D.), a cardiac electrophysiologist at the Mayo Clinic in Jacksonville, FL. Normally, in a healthy heart, the top chambers, or atria, are activated by the heart’s sinus node, which sends a signal through the AV node, a group of cells that connect the electrical activity between the upper and lower chambers of the heart, and conduction system to the lower chambers, or ventricles. “So it’s top-bottom, top-bottom,” says Dr. Knight, who is also the director of the heart rhythm center at the Bluhm Cardiovascular Institute in Chicago, IL. This creates the heart’s familiar lub-dub, lub-dub.

When something is wrong with the heart’s electrical conduction system and/or the heartbeat is too slow or skips beats, the pacemaker provides electrical pulses—intermittent or continuous, depending on what’s needed—to generate heartbeats, “like a prod to the heart,” Dr. Kella says.

Reasons for a Pacemaker

Why You Might Need a Pacemaker

According to Dr. Knight, there are two main reasons people need a pacemaker:

Sinus node dysfunction
Heart block

Here’s what each of these entails.

Sinus Node Dysfunction

Also known as sick sinus syndrome, this happens when the sinus node, an area in the top chamber of the heart that normally keeps the heart beat steady, isn’t working properly. If this happens, your heart rate may slow to the 30s or 40s (beats per minute—normal is 60 to 100), or there may be a long pause between heartbeats, sometimes causing fainting. While usually not life-threatening, Dr. Knight says, “people can feel very poorly.” Sinus node dysfunction is most common in people in their 70s or 80s.

Heart Block

With heart block, also known as atrioventricular or AV block, the electrical signal that maintains the heartbeat is partially or totally blocked. The reason: The AV node fails to send signals to the lower chambers, explains the Cleveland Clinic. As a result, your heart can’t function properly. It may beat very slowly and/or skip beats, and you may feel dizzy, faint, tired, or short of breath.

Other Reasons You’d Need a Pacemaker

According to the National Heart, Lung, and Blood Institute, some people’s hearts may beat too slowly as a result of taking medicines known as beta blockers that lower blood pressure, or having certain congenital heart defects, a heart attack, or heart transplant. And if your heart is weakened by an enlarged heart muscle, heart attack, heart failure, or congenital heart defects, you may need a pacemaker to keep your heart chambers beating in sync.

Types of Pacemakers

There are two basic types of pacemakers:

Traditional permanent pacemakers
Leadless or wireless pacemakers

Here’s what each one is and what distinguishes one from the other:

Traditional Permanent Pacemaker

Also called a transvenous pacemaker, this type is made up of a pulse generator, which contains electronics and a lithium battery designed to last up to 12 years, plus one or more leads, or wires. It’s about the size of two small silver dollars stacked on top of each other, and weighs about an ounce, according to Johns Hopkins Medicine. The design hasn’t changed a lot in more than 50 years, according to a update on cardiac pacing published in Arrhythmia & Electrophysiology Review.

The pulse generator sits in your upper chest, typically on the left side, and the attached lead travels via a vein (hence “transvenous”) to the heart muscle, where it delivers electrical pulses. Sensors in the pacemaker track the heart’s rhythm and rely on that data to determine the frequency of pulses, explains Dr. Knight.

The number of leads can vary, notes the Cleveland Clinic. A single-chamber pacemaker has just one lead attached to one heart chamber, a dual-chamber pacemaker has two leads that are attached to two chambers of the heart (an atrium and a ventricle), and a biventricular pacemaker employs three wires, regulating three chambers of the heart (both lower chambers and the right upper chamber); this is also known as a cardiac resynchronization therapy device. “Heart failure patients sometimes need these specialized, three-wired pacemakers,” Dr. Kella says.

Leadless (or Wireless) Pacemaker

This newer type of pacemaker is a lot smaller than the traditional type—about the size of a “really large vitamin tablet,” Dr. Knight says—with the battery and electrodes contained inside the device. There are no leads or wires. Instead, a single-chamber leadless pacemaker is placed inside one chamber of the heart, where it sends out electrical pulses, explains Dr. Knight. A 2023 study in the New England Journal of Medicine found that a dual-chamber leadless pacemaker with a device placed in the right atrium and another in the right ventricle was safe and performed well. Shortly afterward, in July 2023, a dual-chamber leadless pacemaker made by Abbot received Food and Drug Administration (FDA) approval. These devices are just becoming available.

How to Prepare

How to Prepare for a Pacemaker

Prior to the implantation, you may undergo certain tests, have blood work done, and be asked questions about your medications and any drug allergies you may have. Different medical centers have different requirements, but here are the tests that Dr. Kella and Dr. Knight say you may expect in the lead-up to a pacemaker implantation:

Heart monitor: You may be asked to wear a Holter monitor or another ambulatory monitor for 24 hours or up to 30 days to determine what your heart rhythm is and your need for a pacemaker.
Echocardiogram: This ultrasound test examines the structure and function of your heart.
Electrocardiogram (EKG): Like the heart monitor, this test checks the heart rhythm, but over a few minutes rather than hours or days.
Stress or exercise tests: You may be asked to walk on a treadmill or ride a stationary bike while your heart rate and rhythm are monitored to see how your heart responds to physical activity.
Chest x-ray: You may have a chest x-ray if you haven’t had one recently, as a baseline. After the procedure, a follow-up x-ray can help determine if the device has been implanted in the correct place or if the lung has been damaged during the procedure.
Blood tests: You may have blood drawn to test your blood clotting rate or to check for anemia. Other blood tests may be done as well.

Additionally, your doctor will ask a bunch of questions, including:

Sensitivities or allergies: You should let your doctor know if you are allergic to any medications, iodine, contrast dye, certain antibiotics you may be given, latex, tape, or anesthetic drugs.
Prescriptions and OTC medications: Your doctor will need to know what medicines you are taking, including over the counter ones and herbal and other supplements.

The Surgery

How Is a Pacemaker Surgery Performed?

Depending on where you are having the surgery, it may be performed on an outpatient basis, where you will go home afterwards, or inpatient in the hospital, which involves an overnight stay. Here, according to our experts and Johns Hopkins Medicine, are the general steps involved in placing a permanent pacemaker (medical centers may differ):

You’ll need to refrain from eating and drinking for a time period before the implantation, usually overnight.
On the day of the procedure, an intravenous (IV) line will be started in your arm to administer IV fluids and sedation medication to help you relax. Typically, you will remain awake during the procedure.
You’ll be placed on your back on the operating table and hooked up to an EKG monitor.
Sterile towels will be placed around the insertion site—usually just below the collarbone on the side opposite your dominant side (if you’re right-handed, it will be done on the left side, for example)—which will be cleaned with antiseptic soap.
A local anesthesia will be injected into the skin at the insertion site. After it has taken effect, the physician will make a small incision there.
A plastic tube called a sheath is inserted into a vein; next, the lead is inserted into the sheath and advanced through the blood vessel into the heart. (Note: If you are getting a leadless pacemaker, the sheath is introduced into a vein in the groin, instead of under the collarbone.)
Once the lead is in the heart and attached to the muscle, testing will be done to ensure it’s in the proper place and that it works. Depending on the type of device you are receiving, one or two additional leads may be inserted. A special type of X-ray called fluoroscopy, which is displayed on a screen, may be used to check the location of the lead(s).
When the lead has been attached to the pulse generator, the generator is inserted into the incision and placed in a pocket created between the fat and fascia that covers the upper chest muscle. The EKG will give feedback that the pacemaker is working correctly.
The incision will be closed with either sutures, adhesive strips, or special glue, and then covered with a sterile bandage or dressing.

Afterwards, you will go to a recovery room for observation and rest. Your doctor will likely check in on you, give you instructions, and answer any questions. You should be careful getting up for the first time and move slowly to avoid dizziness. When you are alert and your blood pressure, pulse, and breathing are stable, you will be discharged to go home—someone will need to drive or accompany you—or taken to your hospital room. All told, the procedure and recovery take a couple of hours, Dr. Knight says.

At home, you’ll need to keep the incision clean and dry for about a week and avoid lifting the arm on the side of the pacemaker above your head or lifting more than 10 pounds for about six weeks to let things heal.

Risks

Risks Associated with Pacemakers

Like any medical procedure, getting a pacemaker does come with risks. Here’s are some you should be aware of, according to Dr. Knight and Johns Hopkins Medicine:

Bleeding. This can come from the incision or where the catheter is inserted, and is more likely if you are on blood thinners, according to Dr. Knight.
Blood clots, which can form near where the device is implanted.
Infection. Whenever a foreign object is introduced into the body there is a risk of infection.
Damage to the blood vessel at the catheter insertion site, which can cause bleeding. Usually no intervention is needed, says Dr. Knight
Injury to or perforation of the heart. Most leads are anchored to the inside of the chamber with a tiny screw that can harm the heart and may require removal of blood from the sac around the heart. Or the lead can dislodge or move, requiring a lead revision to reposition it, says Dr. Knight.
Pneumothorax. Sometimes the nearby lung can be punctured during the pacemaker implantation and air can leak out. In extreme cases, this may cause a collapsed lung.

You may have other risks, depending on your medical conditions, so be sure to bring up any concerns you have with your doctor prior to the implantation procedure.

Living With a Pacemaker

Living with a Pacemaker

Pacemakers are usually monitored with a home remote monitor that’s typically kept in the bedroom beside your bed. It can diagnose problems, track battery life, and alert your doctor to an issue with the leads.

Precautions to Take if You Have a Pacemaker

Pacemaker technology has improved a lot over the decades, so the list of things you have to avoid is much shorter now than it was in the past. For example, “household microwave ovens are nothing to be concerned about,” Dr. Kella says. “That’s one of the most common things I get asked about by patients.” Here are additional precautions to take to protect your pacemaker from Stanford Medicine:

Abstain from diathermy, a type of heat used in physical therapy to treat sore or injured muscles.
Airport security detectors are usually safe for pacemakers, but you should let screeners know you have a pacemaker (which are made of metal) before going through a detector in case doing so sets off an alarm. Since wands also have magnets, the best alternative is a pat-down.
Always carry an ID card that lets others know you have a pacemaker.
Avoid certain high-voltage or radar machinery, such as radio or television transmitters, electric arc welders, high-tension wires, radar installations, or smelting furnaces.
Avoid magnetic resonance imaging (MRI) machines or other large magnetic fields, like those in auto junkyards.
If a surgeon or dentist will be performing a surgical procedure, tell them that you have a pacemaker so that electrocautery will not be used to control bleeding (the electrocautery device can change the pacemaker settings).
Protect your pacemaker from trauma if you engage in a sport or other recreational activity that may result in a blow to your chest. If you are hit, check in with your doctor.
Turn off large motors, such as cars or boats, when working on them to avoid affecting your pacemaker’s rate.
U.S. cell phones and smart phones that put out less than three watts don’t seem to be a problem, but it’s still best to keep a cell phone at least six inches away from your pacemaker, hold it to the ear opposite the side where you have the pacemaker, and avoid stashing it in a breast pocket over the device.
You may have to take antibiotic medication before any medically invasive procedure to prevent infections that may affect the pacemaker.

Benefits

Benefits of a Pacemaker

Under most circumstances, your implanted pacemaker will help keep your heart beating normally for at least a decade—an obvious benefit. Replacing the pulse generator will keep it going even longer. But the main advantage to having a pacemaker is the improvement you’ll see in the quality of your life, says Dr. Kella. It can eliminate uncomfortable symptoms like fatigue, lightheadedness, or fainting, and if you have heart failure, it can slow disease progression. Most pacemakers adapt the heart rate to match your physical activity level. “About a hundred settings can be changed and modified to address any symptoms someone might still be having,” Dr. Knight says. Plus, “they’re generally very safe to put in. There are some risks, but the technology and experience is far greater than it was many years ago.”

This article was originally published March 30, 2019 and most recently updated April 1, 2024.