Pacemaker and CRT Insertion

What is a pacemaker?

Your heart rate is normally controlled by your heart’s own natural pacemaker. It automatically increases your heart rate in response to your body’s needs. If your own pacemaker isn’t working properly you may be given an artificial pacemaker.

A Cardiac Resychronization Therapy Device (CRT) is a special type of pacemaker. It is a  similar to a pacemaker but is also designed to allieviate the symptoms of heart failure.

Why might I need a pacemaker?

There are different reasons why you may need a pacemaker but the most common one is because your natural pacemaker does not speed up your heart rate when you need it to, giving you a slow pulse. This may result in you feeling tired, weak, dizzy, or short of breath. Some people may have blackouts if their heart rate is too slow.

How do they fit my new pacemaker?

The artificial pacemaker consists of two main components: a small metal case and one, two or three leads. The metal case is placed under the skin usually on the upper left-hand side of the chest (occasionally the right side is used) and the lead(s) are inserted into a vein that runs directly to your heart. This will be performed in the operating theatre under a local anaesthetic where there is x-ray equipment available to guide the insertion of the pacemaker lead(s). Occasionally a stronger anaesthetic is used, but your consultant will discuss this with you. The procedure takes between 1-2 hours, with CRT devices typically taking slightly longer.

It is natural that some patients feel nervous undergoing medical procedures, therefore we are able to provide options for sedation that do not normally affect your recovery. Options for this can be discussed with your operator before your procedure.  Sometimes during this type of procedure patients may experience some discomfort. If this is the case it is important to tell the staff caring for you, as they can provide pain relief.

What happens afterwards?

The majority of pacemakers can be fitted as a day case procedure. This means that after your pacemaker is fitted, you will be required to stay in recovery for approximately four hours, before having a chest x-ray. Once this x-ray has been reviewed by a doctor arrangements can be made for discharge. During this recovery time, Pacemaker Technicians (also known as Physiologists) will also need to check and programme your device before you can go home. They will also advise you on how to look after your new pacemaker, will inform you of any follow-up appointments you require and they can answer any questions you might have.

Pacemakers have a built-in battery that eventually require changing. This is also done by our department, although this is normally performed as a day-case. The device is carefully removed and a new one is attached, with the majority of patients being able to go home the same day.

Patient Information Video

The following video has been produced by one of our Consultant Cardiologists, specialising in Pacemaker devices. This video can help you to understand the processes involved in having a pacemaker fitted. This video shows the procedure being undertaken in one of our Cardiac Labs and how patients are followed up post-procedure.

For further information from The British Heart Foundation on pacemakers click here.