Pacemaker restrictions to lifestyle
After pacemaker surgery, you should quickly return to health - and you may find that you feel better than before. However, you will have to make some changes to give your body time to recover from the procedure.
Most people with pacemakers live full and active lives, but there may be some restrictions to your lifestyle after pacemaker surgery.
What happens in pacemaker surgery?
“Your doctor will insert your pacemaker in a specialist cardiac catheter lab, known as a cath lab. It is usually a day case procedure, but the team may recommend that you stay in hospital for one to two days to keep a close eye on your recovery,” explains our consultant cardiologist and electrophysiologist, Dr Shouvik Haldar.
“You will have a local anaesthetic and often sedation during pacemaker surgery so that you are comfortable, relaxed, and free from pain. The team will ensure that the surgical area is carefully cleaned and sterilised and give you antibiotics to protect against infection.”
There are two different pacemaker insertion procedures. Your physician will recommend the best approach for your needs:
Transvenous pacemaker implantation
Most people have this procedure, which is also called endocardial implantation. Your cardiologist makes a small cut under your left collarbone. They carefully insert one or more leads and thread them through one of the blood vessels to your heart. When in place, they’ll take an X-ray to check they're in the correct position and connect the leads to the pacemaker. They will then adjust the settings to ensure the device is effective and provides the right stimulation for your heart.
The specialist will make a small ‘pocket’ under the skin below your left collarbone. They will place the pacemaker box in the pocket. The tissue usually hides the small device, but if you're very slim, your doctor may place the pacemaker under the chest muscle to make it less noticeable (although this is rarely needed these days given the slim profile of pacemaker devices). Finally, the cardiologist will stitch to close the wound, place some glue on the surface of the skin and apply a dressing.
Epicardial pacemaker implantation
For a small number of people, it can be better to insert the pacemaker directly through the heart's outer surface. This may suit you if you're having cardiac surgery or if the doctor finds it difficult to insert the leads through your veins. In this technique, your cardiologist or cardiac surgeon will usually place the pacemaker box under the skin in your abdomen.
How long is pacemaker surgery?
“On average, pacemaker surgery takes around an hour to an hour and a half, but it can take longer, particularly if you need a biventricular pacemaker or have epicardial implantation,” explains Dr Haldar.
How long are you in hospital after pacemaker surgery?
Most people can go home on the day of pacemaker surgery, but you may need to stay in hospital for 2-3 days for monitoring. Longer stays may be recommended if you have other medical problems. You will also need to stay longer if you have heart surgery.
What to expect after a pacemaker surgery
After pacemaker surgery, the recovery nurses will check your pulse, heart rhythm and blood pressure regularly. Your hospital team will also monitor your wound for bleeding and swelling and give you medication to relieve pain and discomfort.
You'll need to rest and stay in bed immediately following surgery. When the sedation has worn off, the nurses will support you to sit up and eat and drink. They will help you get out of bed and walk around. It's natural to be nervous, but the experienced staff will help you mobilise so that you feel comfortable and confident before going home.
You shouldn’t drive for at least a week after pacemaker surgery, so arrange for someone to take you home from the hospital. For up to a week after the procedure, you may notice swelling and bruising. It's also normal to experience pain, which should settle in a few days. The team will prescribe painkillers or recommend over-the-counter pain relief.
Recovery after pacemaker surgery
After your operation, it's essential to let your wound heal and give your body time to recover. Don't lift the arm on the side of your scar above your shoulder for 4-6 weeks. Avoid picking things off high shelves and hanging out washing. However, it's important to keep your arm mobile to prevent your shoulder from freezing and becoming stiff. A physiotherapist or one of the ward team will show you gentle mobilisation exercises to move your arm safely.
You will usually need to take between three and seven days off work, but, depending on your job, you may need more time to recover. Most people can safely return to normal activities in 4-6 weeks. Your cardiologist will be able to give you individual advice about your health and recovery.
Living with a pacemaker
Your cardiology team will give you a pacemaker registration card to carry at all times. The card shows your pacemaker's make and model in case you need emergency treatment. You could also wear a MedicAlert device which details your essential personal and pacemaker information.
How does a pacemaker restrict your lifestyle?
Most people find that a pacemaker improves their health and quality of life and you will probably feel better than you did before pacemaker surgery. However, after pacemaker insertion, there are some important things to consider:
Driving after pacemaker surgery
You must tell the Driver and Vehicle Licensing Agency and your motor insurance provider that you have a pacemaker.
You can usually start driving a week after surgery if you feel well, have regular check-ups, and aren't experiencing fainting or dizzy spells. You may need to wait longer if you've had a heart attack or cardiac surgery. People who drive HGVs or passenger-carrying vehicles must wait 6 weeks before starting to drive again.
Find out more about driving and pacemakers by visiting the government website.
Sport after pacemaker surgery
You should avoid sport for 4-6 weeks after surgery then gradually reintroduce exercise. Talk to your cardiologist if you enjoy contact sports like rugby or martial arts; they can tell you what is safe and recommend pads or shields to protect your pacemaker from damage.
What can’t you do with a pacemaker?
Strong electromagnetic fields can affect your pacemaker. Modern pacemakers are designed with metal casings to prevent interference. However, you should keep a safe distance from some electrical equipment:
- Household electrical equipment: Most things, like hairdryers, drills, and microwave ovens, don't cause problems as long as they're in good condition. Keep them at least six inches or 15cm from your pacemaker to reduce the risk of interference.
- Induction hobs: These create a strong electromagnetic field. Avoid them if possible or keep the hob 60cm or two feet away from your pacemaker.
- Mobile and cordless phones: It’s safe to use mobiles, tablets, and smartwatches, but try to keep them at least 15cm or six inches away from your pacemaker and don’t hold them directly over the pacemaker.
- Hands-free and Bluetooth devices: are thought to be safe but check your manufacturer's information. They may suggest using the ear on the other side from the pacemaker. Always keep headphones over 3 cm or an inch away from your pacemaker.
- Games consoles: There’s no evidence that these interfere with pacemakers, but check with your pacemaker manufacturer before gaming
- TENS machines and body-toning equipment: These may affect your pacemaker. Contact your pacemaker clinic or the manufacturer for more advice.
- Airport and store security systems: Security systems rarely cause problems, but you should take your pacemaker identification card to show the security staff. If they search you with a hand-held metal detector, ensure they don’t hold it directly over your pacemaker. If you go through the security system, you should have no problems, but try to walk briskly without lingering.
- Metal detectors: Try to avoid using these unless you have checked with your pacemaker clinic.
- Magnets and fasteners: There is a small risk that magnetic devices on bags and computer cases could interfere. It's sensible to avoid holding them close to your pacemaker.
- Workplace electromagnetic fields: Some jobs involving arc welding, car-ignition systems, diathermy, or radio or TV transmitters bring you into contact with strong electromagnetic fields. Check with your cardiologist before going back to work.
- Medical and dental tests: Always let health professionals know you have a pacemaker. Most tests are safe and won't cause problems. Previously, MRI scans weren’t safe, but modern pacemaker models are safe during MRI scanning. Check your manufacturer’s recommendations.
How long does a pacemaker last?
“Your pacemaker battery will last for 6-10 years. When it reaches the end of its life, your cardiologist will replace the whole box in a simple procedure. The leads generally do not need changing,” explains Dr. Haldar.
Pacemaker battery replacements
Most pacemakers are driven by lithium batteries which last 6-10 years. It's essential to attend regular pacemaker checks so that you know when the batteries need changing.
How can I check that my pacemaker is working properly?
It's natural to worry that your pacemaker may fail. You will have regular checks both remotely and less frequently in person every 3-12 months to make sure everything is working well. A specialist will check your battery, pacemaker settings, the electrical impulse, and the effects the impulses have on your heart.
If your pacemaker ever stops working (this very rarely happens), you may notice:
- a slow, abnormal, or irregular heartbeat (cardiac arrhythmia)
- dizziness or fainting
- chest pain
- feeling weak or unwell.
If you’re worried about your pacemaker or your health, get in touch with your pacemaker clinic, GP or call NHS 111 urgently.