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INTRODUCTION
This booklet has been written to help you understand what will
happen when you have your pacemaker fitted.
NORMAL HEART CONDUCTION
Within the heart there are specialised pacemaker cells which
discharge electrically to stimulate heart muscle action. These
pacemaker cells are situated in the Sino Atrial Node within the
upper chambers of the heart. This is the heart’s natural
pacemaker which starts an electrical impulse which is then
passed to the lower chambers through connecting fibres called
the Atrio Ventricular Node to activate the lower chambers of the
heart and cause the major pumping action of the heart.
The life of a pacemaker is normally around 6 to 8 years, after
which time your pacemaker will need replacing. It will be carefully
monitored each time you visit the pacemaker clinic and when the
pacemaker begins to show signs of running down you will be
asked to come back more frequently to have it checked. When
the pacemaker needs changing, you will need to come back into
hospital for 1 or 2 days.
Now that you have your pacemaker fitted there should be no
restrictions or limitations to your lifestyle (besides those
mentioned in this booklet). It is important that you continue to live
a normal, happy, healthy life and enjoy the benefits that your
pacemaker will provide for you.
Diagram showing the Heart’s Electrical System
TOP OF
HEART
ATRIO
VENTRICULAR
NODE
SINO
ATRIAL
NODE
www.yourheart.org.uk is one of the first interactive web sites for
heart patients and their relatives and friends in the UK. This site
will offer heart and health related information available.
TRANSLATION
BOTTOM OF
HEART
If you would like this information in another language or format,
please contact the Service Equality Manager on 0116 258 4382.
Sometimes the electrical system of the heart can become
damaged leading to serious slowing of the heart. This may be
intermittent or constant and can lead to a variety of problems. A
pacemaker may then be needed to help the heart to beat normally
returning the person to improved health.
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- 10 -
When travelling abroad IT IS important that
you avoid walking through archway
weapon detector devices. Tell someone at
the security area that you have a
pacemaker
and
show them
your
pacemaker card. They will then hand
search you, to give you clearance to
continue with your travelling.
The pacemaker clinic at Glenfield Hospital has addresses of
pacemaker clinics throughout Europe. If you have
any worries about travelling abroad now that you
have a pacemaker fitted, our pacemaker clinic will
gladly give you the addresses of the nearest
pacemaker centre to where you will be staying.
Now that YOU have a pacemaker it is important that you attend
the pacemaker clinic for your check-ups.



The first check-up is after 4-6 weeks
The second check-up is after 4 months
The third check-up is after 12 months
If all is well after the third check-up then you will usually only have
to attend the pacemaker clinic once a year. If you are unable to
attend any appointments, just phone the pacemaker clinic as
soon as possible and a new appointment will be given to you.
If possible, we encourage patients to make their own way to the
pacemaker clinic or get a relative to bring you. However, if no
transport is available or no one can bring you, then you should
contact your GP at least 3 working days in advance to your
appointment and book ambulance transport (Northamptonshire
patients should telephone the pacemaker clinic at least 7 days
before their appointments).
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WHAT IS A PACEMAKER SYSTEM?
A system includes a pacemaker and connecting wire(s) that hook
to the heart. This allows internal activity to be recognised and if
absent the pacemaker will stimulate heart activity.
The wire(s) is passed into the heart along a vein and is connected
to the pacemaker, which is then positioned usually on the left side
of the chest just below the collarbone. Pacemakers may also be
fitted on the right side and less commonly these days, under the
left armpit or in the abdomen.
HOW A PACEMAKER WORKS
The pacemaker has an electrical system, which is increasingly
complex, but the basic function is to send an electrical impulse
after sensing when the heart’s natural electrical system fails and
slows the heart below a pre-set level.
A pacing system may have one or two wires (single or dual
chamber) placed in either the upper, lower or both chambers of
the heart depending on where the fault is in the heart’s electrical
system. Pacemakers usually have a variable rate although the
person’s own beats may be faster than the pacemaker at times
but should not fall below a present baseline.
WHAT ARE THE RISKS OF DISORDERS OF THE HEART
CONDUCTION SYSTEM?
The slowing down of the heart can be serious and even life
threatening on occasions and pacemaker insertion is vitally
important. Occasionally a temporary system is needed urgently
before a later permanent implant.
A pacemaker may also advised when the severity of the heart
slowing is less severe (eg be intermittent) or it is thought to be
likely to deteriorate and serious consequences can be prevented.
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WHAT ARE THE RISKS OF PACING?
As with all invasive procedures there are some risks which we feel
should be outlined in advance. Overall it should also be stated
that the complications can be remedied and are rarely life
threatening.
Microwave ovens are normally safe to use,
although unserviced or early models should
be checked.
At all times follow the
manufacturers operating and servicing
instructions.
Mobile telephones are safe to use when you follow these guidelines:
a) At the time of the procedure
 Accidental damage to blood vessels when placing the
pacemaker wires into the heart
 Puncture of lung causing an air leak from the lung (2-3%)
 Discomfort/bleeding during the procedure and damage to the
new (or old) pacing wires (rare).
b) After the procedure
 Movement of the pacemaker wires requiring repositioning
(2-3%)
 Bleeding from the wound (2-3%)
 Infection of the wound or wires within the circulation (1-2%)
 Failure of pacemaker equipment (rare)
PREPARATION FOR YOUR PACEMAKER
Some preparation will be needed before you have your
pacemaker fitted. The procedure will be explained by the nurse
caring for you.
The doctor will explain what will happen
during the procedure. You will need to sign
a consent form; if you are unsure of anything
then ask the doctor or your nurse before
signing the form.

Keep the mobile telephone 15cm (6 inches) away from your
pacemaker.

Hold the telephone to the ear opposite the pacemaker.

When the telephone is being carried, store it in a location
opposite the side of the pacemaker. This is suggested
because some telephones emit a signal when they are turned
to the ‘on’ position buy are not in use.
It is important that when attending any hospitals, clinics or dentists
for treatment that you inform them that you have a pacemaker. It
is also in your own interest that you carry your pacemaker card
with you at all times.
After your pacemaker is fitted you will not be able to drive for 1
week. But we would suggest not to drive a car until you have had
your pacemaker checked at your first out-patient appointment.
After you have had this check-up you will be able to drive your car
again, unless an adjustment has to be made to the pacemaker or
the wire, you will be told at the time and the appropriate action will
be taken by the hospital.
The procedure is undertaken using x-ray screening therefore it is
important that if you think you may be pregnant you must let us
know before coming into hospital.
It is in your own interest and indeed a requirement that you now
inform your car insurance company and the DVLA, Swansea
(telephone: 01792 772151). Explain that you have had a
pacemaker fitted, that it has been checked after 4/6 weeks and
that it is working efficiently. Inform them of your doctor’s name
and the pacemaker clinic that you are attending. Having a
pacemaker fitted should NOT affect your insurance premiums.
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-8-
Car alarms that use a remote control to switch the alarm on and
off, should NEVER be pointed at your pacemaker.
Ordinary household equipment will not present any hazards to your
pacemaker. However, some powerful electrical equipment may
generate interference if you get too close. You may experience your
heart rate speeding up or becoming irregular. These symptoms will
subside if you move away from the source of the interference.
Things to avoid are:
Before your pacemaker is fitted:

We ask that you have nothing to eat for four hours or drink for
two hours.

You will need to have a wash and put on a gown.

You may be given a tablet known as a ‘pre-med’ to help you
relax.

You will be transferred to the pacemaker room on your bed.
IN THE PACEMAKER ROOM

Household appliances that are improperly earthed.
If you are unsure, have the plugs checked to make
sure the wires are properly connected.

Short-wave therapy treatment, eg, slendertone machines,
electrolysis treatment.

Direct contact with car ignition systems.

High powered radar, radio and TV transmitters (your own TV
and radio are perfectly safe).

Welding equipment.

Close contact with electrical spark producing equipment.

Never place any large magnets near your pacemaker.

Before using any electrical exercising sports equipment, seek
advice from the gym instructor or the manufacturers to check
whether it is safe for you to use.
Tens machines can be used by people with pacemakers, however
caution is required with placement of the tens. Tens placed on
the lower back will usually cause no interference with the
pacemakers functions, however it is advisable to get thoroughly
assessed in the pacemaker clinic with the tens machines in use.
It is recommenced not to use the tens on the shoulders.
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You will be awake during the time your pacemaker is fitted. Your
skin in the area where your pacemaker will be implanted will be
cleaned with some cleaning solution and sterile green cloths
placed around the area. There will be an x-ray camera above you
and you will be attached to a heart monitor. Some medication
(local anaesthetic) will be injected to numb your skin and tissues.
Once this has taken effect, a cut about 2 or 3 inches long will be
made to fit your pacemaker.
When the wire(s) and the
pacemaker are in place, the technician will check the function of
the pacemaker. The doctor will view it on the x-ray equipment
and then your cut will be stitched and a dressing applied. The
whole procedure normally takes about 45 to 90 minutes. You will
then be ready to return to the ward
ON RETURN TO THE WARD
On return to the ward your wound
will be checked regularly for any
bleeding or swelling. You will
need to stay resting on your bed
for at least two hours or may be
longer. You will be advised to
limit the movement of your arm
on the side that the pacemaker
has been fitted in order to reduce the potential risk of the wire
moving.
-4-
You will have your pacemaker function checked to ensure it is
properly working. At this check you will be given an appointment
for four to six weeks to return to the pacemaker clinic plus a
pacemaker card containing information about your type of
pacemaker which you should always carry around with you. You
will also need to have a chest x-ray to ensure that the pacemaker
wire is in a good position and to check there are no other
complications.
Usually, you are able to go home or are
transferred back to a hospital near your home the day after your
pacemaker was fitted.
ADVICE FOR AT HOME
When a pacemaker has been fitted into a person, it will be
electronically programmed to beat at a certain rate. This rate is
written on your pacemaker card, your pulse may be higher than
this number by natural heart activity but should not fall below it. If
on taking your pulse it varies greatly from the figure shown and
you are feeling unwell, contact your doctor straight away in case
you need to have the pacemaker checked.
How to take your pulse
CARE OF YOUR WOUND
The dressing to your wound may be removed two days after the
pacemaker has been fitted and the wound should then be left
uncovered. You may see some bruising around the wound area.
It may be advisable for the first couple of weeks to wear loose
clothing, so that your clothes do not catch on your wound.
While your wound is healing you must be careful how it is
cleaned. Having a bath or shower however is fine provided that
your wound is fully dried afterwards. You are advised not to use
any strong smelling soaps, talc’s, body lotion, deodorants,
perfumes near your wound whilst it is healing.
Your wound will have a dissolvable stitch, which may have a small
anchor stitch visible at both ends of your wound. These anchor
stitches will drop off by themselves if left but this may take a few
weeks. If this does not occur, they can be cut off when you see
the district nurse or return to the clinic.
Your nurse will show you your wound before you leave hospital. If
any further bruising, swelling or bleeding develops, or if your
wound starts to ooze any secretions or becomes hot and tender to
touch, go to see your GP straight away. He may need to
prescribe anti-biotics and he will do this himself or he may prefer
you to ‘phone the Pacemaker Clinic on: 0116 258 3837
-5-
The easiest place for you to
take your pulse is in the wrist.
This can be found by holding
your hand out with the palm
upmost and placing two
fingers on your wrist in line
with your thumb. When you
have found the pulse, count
how many beats you feel for
one minute.
It is important that until you come back for your first pacemaker
clinic appointment, you are careful with any
activities you carry out using your arm on the
side of the pacemaker. This will give the
wound time to heal and the wire to settle into
place. Therefore, avoid any heavy lifting,
strenuous exercise, stretching for example,
carrying shopping bags, hanging clothes on
the washing line for the first four to six weeks.
Household jobs like hoovering, ironing, lifting
heavy saucepans must be done with caution. If you have to lift
anything heavy, make sure you use both hands to take the weight.
You may resume a normal sex life when you feel fit but for the
first four weeks avoid pressure being placed on your wound.
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Haddaad rabto warqadan oo turjuman oo ku duuban cajalad ama
qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta 0116
2584382.
GLENFIELD HOSPITAL
CARDIAC SERVICES
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HAVING A PACEMAKER
This booklet has been produced by:
The Cardio-Respiratory Patient Information Group
Origination date: September 1999
Updated: April 2003
A GUIDE FOR PATIENTS
University Hospitals of Leicester NHS Trust
Glenfield Hospital
Groby Road
Leicester
LE3 9QP
Telephone: 0300 303 1573
Fax: 0116 2583950
Minicom: 0116 2879852
University Hospitals of Leicester
NHS Trust
Glenfield Hospital