Before having a pacemaker fitted, you are likely to have a pre-operative assessment. The team looking after you will check that you are fit for surgery. You can also discuss the operation and ask any questions you have.

Tests, such as blood tests and X-rays, can be arranged at this stage so that there are no delays when you are called into hospital. You will be asked about your general health, your heart problems and how these affect you. You'll also be asked about any additional medical problems and previous operations you've had, as well as any problems or reactions you or your family have had with anaesthetics.

Taking steps to improve your fitness and health, such as stopping smoking if you smoke and eating a healthy diet, should help speed up your recovery time and reduce the risk of complications.

You will usually be told when you have to stop eating or drinking before surgery during the pre-operative assessment.

Read more about preparing for surgery.

Your specialist

The procedure will be carried out by a heart specialist, known as a cardiologist, who will probably have a special interest in pacemakers.

If you are being treated in a large heart hospital, the operation will often be carried out by an electrophysiologist. This is a cardiologist who specialises in heart rhythm disorders.

Fitting the pacemaker

The most widely used method to fit a pacemaker or an implantable caridoverter defibrillator (ICD) is known as transvenous implantation.

Transvenous implantation

During transvenous implantation, the cardiologist makes a 5-6cm cut just below the collarbone (usually on the left side of the chest) and inserts the wires of the pacemaker (pacing leads) into a vein.

The pacing leads are guided along the vein, into the correct chamber of your heart, using X-ray scans. They then become lodged in the tissue of your heart.

The other ends of the leads are connected to the pacemaker, which is fitted into a small pocket created by the cardiologist between the skin of your upper chest and your chest muscle.

Transvenous implantation is carried out under local anaesthetic, which is given as an injection. This means the area where the incisions are made is numbed, but you remain awake during the procedure.

You will feel an initial burning or pricking sensation when the cardiologist injects the local anaesthetic. The area will soon become numb, but you may feel a pulling sensation during the operation.

A thin tube, called an intravenous (IV) line, will be attached to one of your veins before the procedure. Medication to make you drowsy will be given through the IV line to keep you relaxed while the procedure is carried out.

The procedure usually takes about an hour, but it may take longer if you're having a biventricular pacemaker (with three leads) fitted or other heart surgery at the same time. You will usually need to stay in hospital overnight and have a day’s rest after the procedure.

Read more about recovering from a pacemaker implantation.

Epicardial implantation

Epicardial implantation is an alternative and less widely used method of fitting a pacemaker.

In this method, the pacing lead or leads are attached to the outer surface of your heart (epicardium) through an incision in your abdomen (below the chest). Epicardial implantation is often used in children and people who have heart surgery at the same time as the pacemaker implantation.

The procedure is performed under general anaesthetic, so you will be asleep while it is carried out. 

The surgeon attaches the tip of the pacing lead to your heart and the other end of the lead to the pacemaker box. This is usually placed in a pocket created under the skin in your abdomen.

This usually takes between one and two hours, but can take longer if you are having other heart surgery at the same time.

Recovery after epicardial implantation usually takes longer than after transvenous implantation.

Testing and setting the pacemaker

Once the leads are in place and before they are connected to the pacemaker, the cardiologist will test them to make sure they work properly and can increase your heart rate (called pacing). Small amounts of energy are delivered through the leads into the heart, which cause it to contract.

When the leads are being tested, you may feel your heart beat faster. Tell the medical team what symptoms you feel.

Your doctor will determine the settings of your pacemaker after deciding how much electrical energy is needed to stimulate your heartbeat.