Living With a Pacemaker: What to Expect Before, During, and After the Procedure

Hearing that you may need a pacemaker can stir up a mix of emotions—relief at having a possible solution, and anxiety about surgery, risks, and what life will look like afterward. Understanding what a pacemaker does, why it is recommended, and how it may affect everyday life can make the whole process feel more manageable and less intimidating.

This guide walks through the key things to know before getting a pacemaker: indications, the procedure itself, potential risks, and how people typically live with the device long-term.

What Is a Pacemaker and Why Is It Used?

A pacemaker is a small, battery-powered medical device that helps regulate the heart’s rhythm. It sends tiny electrical impulses to the heart when it beats too slowly or irregularly.

How a Pacemaker Works in Simple Terms

The device is usually placed under the skin near the collarbone.
Thin insulated wires, called leads, run from the pacemaker into the heart.
The pacemaker continuously monitors your heart rate.
If your heart is beating too slowly or misses a beat, the pacemaker sends an electrical signal to prompt a heartbeat.
When your heart beats normally on its own, the pacemaker generally stays in the background and does not interfere.

Pacemakers do not replace the heart. Instead, they work like a backup system that steps in when your natural rhythm needs support.

When Is a Pacemaker Recommended? (Indications)

Pacemakers are typically recommended for problems with the heart’s electrical system that cause slow or unreliable heartbeats. These are usually grouped under bradyarrhythmias (abnormally slow heart rhythms) and some types of heart block.

Common Heart Rhythm Problems That May Lead to a Pacemaker

While only a cardiologist or heart rhythm specialist can determine whether a pacemaker is appropriate, certain conditions are often associated with pacemaker use:

Sinus node dysfunction
The sinus node is the heart’s natural pacemaker. If it fires too slowly or irregularly, people may experience fatigue, dizziness, or fainting.
Heart block (atrioventricular block)
Electrical signals may be delayed or blocked as they travel from the upper chambers (atria) to the lower chambers (ventricles). Depending on the severity, this can cause very slow heart rates and symptoms.
Slow heart rate from atrial fibrillation or other rhythm issues
In some people, treatment for fast rhythms (like medications or ablation) may leave the heart prone to slowing too much, leading to consideration of a pacemaker.
Post–heart surgery or heart attack rhythm issues
Some individuals develop persistent slow or unstable heart rhythms after a heart attack or cardiac surgery.
Congenital (from birth) conduction issues
Some are born with abnormalities in the heart’s electrical pathways that may eventually require pacing support.

Symptom Patterns That Often Lead to Pacemaker Evaluation

People who ultimately receive pacemakers often report one or more of the following, especially if tests show an associated slow heart rate:

Frequent lightheadedness or dizziness
Fainting or near-fainting episodes
Extreme fatigue, especially with mild activity
Shortness of breath with little exertion
Palpitations or a feeling that the heart is “pausing” or skipping
Exercise intolerance or reduced ability to perform usual activities

These symptoms can have many causes—some related to the heart, some not. A pacemaker is considered only after a thorough evaluation determines that slow heartbeat or conduction problems are likely contributing.

Types of Pacemakers You Might Hear About

Not all pacemakers are the same. The kind recommended depends on the rhythm problem and overall heart function.

Main Categories

Single-chamber pacemaker
Has one lead, usually placed in either the right atrium or right ventricle. Often used when pacing is needed in just one part of the heart.
Dual-chamber pacemaker
Has two leads: one in the right atrium and one in the right ventricle. It helps coordinate timing between the upper and lower chambers, more closely mimicking normal heart function.
Biventricular pacemaker (cardiac resynchronization therapy)
Uses leads in both ventricles and sometimes in the atrium to improve coordination in people with certain kinds of heart failure and conduction delays.
Leadless pacemaker
A small capsule implanted directly inside the heart via a vein in the leg, without traditional leads. It is not suitable for everyone but may be considered in specific situations.

The decision about pacemaker type is typically based on your heart rhythm diagnosis, anatomy, and overall health rather than personal preference.

How Doctors Evaluate Whether You Need a Pacemaker

Before recommending a pacemaker, healthcare teams usually conduct a series of tests and assessments to understand how your heart is behaving.

Typical Diagnostic Steps

You may encounter some of these tests:

Electrocardiogram (ECG or EKG)
Measures electrical activity in the heart at one point in time.
Holter monitor or event recorder
Portable devices worn for a day or longer that record your heart rhythm continuously or when you activate them, capturing sporadic symptoms.
Implantable loop recorder
A small device placed under the skin to record heart rhythms over months or longer, useful for infrequent symptoms.
Echocardiogram
An ultrasound of the heart that shows structure and pumping function.
Exercise stress test
Evaluates how your heart responds to exertion and whether it speeds up appropriately.
Blood tests and medication review
To identify other causes of slow heart rate, such as medication effects, metabolic issues, or electrolyte imbalances.

Questions You Might Discuss With Your Care Team

People often find it helpful to clarify:

What specific rhythm problem has been identified?
How strongly is that problem believed to be causing my symptoms?
Are there non-device options (such as medication adjustments) that could help?
What are the goals of getting a pacemaker for my situation (e.g., preventing fainting, improving stamina, enabling specific medications)?

These conversations can support informed decision-making and help align the treatment plan with your values and priorities.

Preparing for Pacemaker Implantation

If you and your healthcare team decide to move forward, the next step is the pacemaker implantation procedure. Understanding what to expect before and after the procedure can reduce uncertainty.

Pre-Procedure Planning

Common elements of preparation include:

Medical history and physical exam
To check overall health and identify any issues that may affect the procedure.
Imaging or additional tests
Sometimes used to clarify anatomy or evaluate other conditions.
Medication adjustments
Certain blood thinners or other medications may be paused, adjusted, or continued in a specific way around the procedure. This is individualized.
Fasting instructions
You are often asked not to eat or drink for a period before the procedure, depending on the type of anesthesia.
Logistical planning
Many people arrange a ride home and some help at home for the first day or two, especially on the side of the implantation.

📝 Helpful questions to ask beforehand

How long is the procedure expected to take?
Will I be awake, sedated, or under general anesthesia?
How long will I likely stay in the hospital?
What should I bring (or not bring) the day of the procedure?

What Happens During Pacemaker Implantation?

The implantation of a pacemaker is typically considered a minor cardiac procedure, but it is still surgery and is handled with care and sterile technique.

Step-by-Step Overview

While details vary, a common sequence looks like this:

Arrival and preparation
- You change into a gown and are connected to monitors.
- An intravenous (IV) line is placed for fluids and medications.
Anesthesia or sedation
- Many procedures are done with local anesthesia to numb the site and light sedation to help you relax.
- Some situations call for deeper sedation or general anesthesia, depending on clinical factors.
Creating the pacemaker pocket
- A small incision is made near the collarbone (usually on the non-dominant side).
- A pocket is formed under the skin or sometimes under a muscle where the pacemaker will sit.
Inserting and positioning the leads
- Leads are usually threaded through a vein under the collarbone into the heart chambers.
- Imaging (often fluoroscopy, a type of X-ray) helps the physician place the leads precisely.
- The leads are secured in place using small screws or tines that anchor to the heart tissue.
Testing the system
- The leads and device are tested to ensure they sense and pace the heart correctly.
- Settings (such as the minimum heart rate) are programmed.
Connecting the device and closing the incision
- The leads are attached to the pacemaker, which is placed into its pocket.
- The incision is closed with sutures, staples, or skin adhesive, and a dressing is applied.
Recovery and monitoring
- Afterward, you are monitored for a period in a recovery area or hospital room.
- Your heart rhythm and vital signs are observed, and the device may be checked again before discharge.

Many people go home the same day or after an overnight stay, depending on health status, the type of pacemaker, and any additional procedures performed.

Potential Risks and Complications of a Pacemaker Procedure

Pacemaker implantation is widely used and generally considered safe, but like any procedure, it carries potential risks. Understanding these helps set realistic expectations.

Short-Term Procedural Risks

Some possible issues that can occur around the time of implantation include:

Bleeding or bruising at the incision site
This is relatively common and usually mild, but more significant bleeding can occasionally occur, especially in those on blood thinners.
Infection
Infection can involve the incision, the pocket, or the device and leads. This sometimes requires antibiotics or, in more serious cases, device removal.
Pneumothorax (collapsed lung)
The vein access is close to the lung, so there is a small risk of air entering the space around the lung.
Lead-related issues
A lead may shift or not function as intended, sometimes requiring repositioning or replacement.
Blood vessel or heart wall injury
Rarely, the lead can perforate a vessel or the heart wall, which may need urgent treatment.
Allergic reactions
Reactions to contrast dye, medications, or materials used during the procedure can occur in some individuals.

Long-Term Device and Lead Risks

Risks over time can include:

Lead malfunction or fracture
Leads may wear down or fail and occasionally require replacement.
Device malfunction
Pacemakers have built-in safeguards and are regularly monitored, but malfunctions are possible and may require reprogramming or replacement.
Pacemaker pocket issues
Discomfort, erosion (device coming close to or through the skin), or recurrent infections may occur in a small number of people.
Interference with other procedures
Some medical tests and surgeries need special precautions when a pacemaker is present.

Healthcare teams generally weigh these risks against the risks of not treating the underlying rhythm problem, especially when symptoms are significant or life-threatening.

Life Right After Getting a Pacemaker

The first days to weeks after implantation are focused on healing and allowing the device and leads to settle.

Immediate Recovery Period

After the procedure, people typically experience:

Soreness or discomfort around the incision and shoulder area
Mild swelling or bruising near the pocket
Fatigue from the procedure, sedation, or prior illness

These issues often lessen over several days. Pain is usually managed with medications and careful movement.

Activity Restrictions in the First Weeks

To protect the leads as they heal into place, you may be given temporary limitations such as:

Avoiding lifting the arm on the pacemaker side above shoulder level for a set period
Not lifting heavy objects on the pacemaker side
Avoiding strenuous pushing, pulling, or heavy exercise involving the upper body

Walking and light activities are often encouraged as tolerated, but recommended levels vary and are usually tailored to your condition.

What Daily Life With a Pacemaker Typically Looks Like

Once healing has progressed and the device is checked and adjusted, most people find they can return to many or most daily activities, often with improved energy or fewer symptoms.

Physical Activity and Exercise

Over time, many pacemaker users:

Resume walking, household tasks, and light exercise as allowed by their underlying heart condition.
Participate in structured cardiac rehabilitation programs when appropriate.
Are advised to avoid certain high-impact contact sports or activities that could involve hard direct blows to the device area.

Pacemakers can often be programmed to respond to physical activity, helping the heart rate rise when you move and slow down when you rest. The extent of possible exercise depends primarily on overall heart health, not just the device.

Work, Travel, and Hobbies

With appropriate precautions:

Many people go back to work, including jobs that require light to moderate physical activity.
Travel, including flying, is generally feasible. Airport security systems detect metal but are not usually harmful to pacemaker function. Informing security staff and carrying a device ID card can help streamline the process.
Everyday electronics such as phones, household appliances, and computers are generally safe when used as instructed. Keeping phones a short distance away from the device (rather than directly over it) is often recommended as a reasonable precaution.

Emotional and Lifestyle Adjustments

Living with a permanent device inside the body can raise emotional and psychological questions:

Some people feel reassured, knowing the device is there as a safety net.
Others may feel anxious about dependence on a device, its longevity, or the idea of future procedures.
Concerns about visibility of the device, body image, or intimacy are also common, especially right after implantation when the area is more noticeable.

Conversations with healthcare providers, counseling, or patient support groups can help people adapt and feel more confident over time.

Devices, Magnets, and Modern Technology: What to Know

Many people wonder how a pacemaker interacts with electronics, magnets, and medical procedures.

Everyday Electronics

In general, most modern household and personal electronics are designed to be compatible with pacemakers when used in typical ways. Still, general precautions commonly discussed include:

Keeping phones and similar devices a little distance from the pacemaker site (not carried directly over it in a chest pocket).
Using the ear opposite the pacemaker side for phone calls if advised.
Avoiding placing powerful magnets or speakers directly against the chest where the pacemaker sits.

Medical and Dental Procedures

Some procedures may require extra planning:

Magnetic resonance imaging (MRI)
Some pacemakers are labeled as “MRI-conditional” for specific scanning conditions, while older devices may have stricter limitations. This must be checked individually.
Electrocautery and surgical tools
Surgeons and anesthesiologists often consult with cardiology or device specialists before operations to plan appropriate precautions.
Shock wave therapies or certain other treatments
Special programming or temporary changes to device settings may be considered.

Informing all healthcare providers—including dentists and emergency clinicians—that you have a pacemaker is essential so they can plan safely around it.

Pacemaker Follow-Up and Long-Term Care

Pacemakers are not “set and forget” devices. Ongoing monitoring and follow-up are an important part of care.

Regular Device Checks

Routine follow-up often includes:

In-clinic visits
A specialized programmer reads data from the pacemaker, checks battery status, verifies lead performance, and adjusts settings as needed.
Remote monitoring
Many modern pacemakers can transmit information securely from home using a bedside monitor or networked system, reducing the number of in-person visits.

These checks can:

Track how much the device is pacing the heart.
Detect episodes of abnormal rhythms.
Predict when the battery is approaching the point where generator replacement should be scheduled.

Battery Life and Replacement

Pacemaker generators are designed to last for several years. The exact lifespan depends on:

How often the device needs to pace
The type of pacemaker and programmed settings

When the battery nears the end of its useful life, replacement is usually planned in a non-emergency, scheduled way. In many cases:

The leads are left in place if they are functioning well.
The generator (the main unit) is disconnected and replaced through a similar, usually smaller, surgical procedure.

Key Practical Takeaways at a Glance

Here is a quick, skimmable summary of key points to keep in mind:

✅ Before Getting a Pacemaker

🫀 Understand your specific heart rhythm diagnosis.
📝 Ask what the goal of pacing is for you (symptom relief, safety, treatment enablement).
🔍 Clarify alternatives and their trade-offs.
💊 Review your current medications and how they may interact with pacing decisions.

✅ During the Pacemaker Procedure

🩺 Expect local anesthesia with sedation in many cases.
⏱️ Plan for a short hospital stay (same-day or overnight is common in many situations).
💬 Ask who will be doing the procedure and how often they perform it.

✅ Early Recovery

🤕 Anticipate some discomfort and arm movement restrictions at first.
🧼 Keep the incision clean and dry as instructed.
🚶 Light activity is usually encouraged; heavy lifting on the pacemaker side is temporarily limited.

✅ Living With a Pacemaker Long-Term

🧭 Most people resume daily routines and many preferred activities.
📱 Use electronics normally but avoid pressing phones or strong magnets directly against the device.
🏥 Attend regular device checks and follow-up visits.
🧠 Address emotional or body-image concerns with trusted professionals or support resources.

Questions Worth Bringing to Your Care Team

To make conversations more productive, some people find it useful to keep a list of questions, such as:

What happens if the pacemaker fails or a lead malfunctions?
How will I know if my device is not working properly?
What symptoms should prompt me to seek urgent care?
Are there activities, sports, or jobs I should avoid?
How might this device interact with any other conditions or devices I already have?
What kind of remote monitoring will be used in my case?

Having these discussions can make you an active participant in your care rather than just a recipient of information.

Putting It All Together

A pacemaker is often described as a support system for the heart’s rhythm. For many, it becomes an invisible part of everyday life, quietly stepping in when needed and allowing them to live with more stability and fewer troubling symptoms.

Understanding:

Why it is being recommended,
What the procedure involves,
Which risks to be aware of, and
How life can look with the device in place

can turn a daunting prospect into a clearer, more manageable journey.

While only your own healthcare team can tailor information to your specific situation, learning the general principles of pacemakers—indications, procedure, risks, and long-term expectations—can help you ask informed questions, prepare thoughtfully, and approach the process with greater confidence.