Pacemaker Surgery Explained: Experts Share Procedure, Potential Risks And Recovery

You must have heard of pacemakers? They are required when the heart's natural system malfunctions, causing it to beat too slowly (bradycardia), irregularly, or even pause. All these can hinder sufficient blood flow to the body. Some of the common causes consist of age-related damage, heart damage from a heart attack, or specific conditions such as heart block, sick sinus syndrome, and certain cases of heart failure. Read on to know everything about pacemaker surgery, its procedure, potential risks, benefits, and more.

To get an expert view on this, we reached out to Dr Arun Chopra, Director Cardiology, Fortis Escorts Hospital, Amritsar and Dr Sanjay Bhat, Sr Consultant - Interventional Cardiology, Aster CMI Hospital, Bangalore.

What Is Pacemaker Surgery?

Letus beginby understanding what a pacemaker is. Dr Chopra stated, “A pacemaker is a small device that helps control an irregular heartbeat. It helps to keep the heartbeat regular and safe.” “The pacemaker sends gentle electrical signals to the heart so that it can beat at a normal and steady pace. This surgery is usually advised for people with conditions like slow heart rhythm, heart block, or certain types of heart failure,” adds Dr Bhat.

According to the National Heart, Lung, and Blood Institute (NHLBI), pacemakers send out electrical pulses that help your heart beat at a normal rate and rhythm. They can also help your heart chambers beat in sync, which further aids the heart in pumping blood more efficiently to your body. This may be required when someone suffers from heart failure. 

As per the Cleveland Clinic, the type of cardiac pacemaker one needs determines the type of procedure they may need. These approaches include:

• Catheter-based approach: For leadless pacemakers, a medical professional inserts a catheter (tubelike device) into an artery (usually the groin area).
• Transvenous (through a vein) approach: A small incision is made to access a vein near your heart (most commonly in your upper chest).
• Surgical-based (epicardial) approach: A surgeon makes a small cut in your chest and inserts the lead(s) through that cut, and then it is attached to your heart.

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Benefits of Pacemaker Surgery

As per a 2025 PubMed study, published in the Cureus journal, pacemakers have long been crucial in managing cardiac rhythm disorders, transforming the treatment of bradyarrhythmias and heart block. It further noted that these small, implantable devices can restore and maintain normal heart rhythms, greatly improving patients' quality of life and reducing mortality associated with arrhythmias. 

“Most people can return to normal activities within a few weeks of the surgery. A pacemaker can greatly improve the quality of life by reducing symptoms such as dizziness, fatigue, and fainting. With proper care, the device can last for many years and help the heart function safely,” shares Dr Bhat.

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What Is The Procedure Of Pacemaker Surgery?

So what does the procedure of pacemaker surgery entail? “It is a very simple and safe process. It is carried out under local anaesthesia and mild sedation. This ensures the patient is comfortable and awake during the process. An incision is made below the collarbone, and thin wires are inserted into the heart through a vein. These wires are then connected to the pacemaker, which is implanted under the skin,” explains Dr Chopra.

On this note, the expert lists down some points regarding the procedure:

• The entire procedure takes about one or two hours.
• In most cases, patients recover quickly and are discharged within a day or two.
• It is normal to feel some pain, swelling or discomfort in the area for a few days.
• In most cases, it is advised to restrict the use of the arm on the side of the procedure for a few weeks.
• Regular follow-ups ensure proper functioning of the device.
• The new pacemakers available today are very reliable and long-lasting.
• For most patients, this little device can bring relief and help them lead a much more active and confident life.

According to NHLBI, you may require a temporary (short-term) or permanent (long-term) pacemaker. A temporary pacemaker is normally inserted into a vein in the neck. It remains outside the body. On the other hand, a permanent pacemaker is placed inside your chest or abdomen. 

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Tests Before Pacemaker Surgery

Dr Bhat shares that before the surgery, the doctor will do the following tests:

• Blood tests.
• ECG.
• Sometimes imaging scans to understand the heart condition. 

Shedding more light on the process, Dr Bhat adds, “The procedure is usually done under local anaesthesia, which means the patient is awake, but the area is numb. A small cut is made near the collarbone, and the pacemaker device is placed under the skin. Thin wires, called leads, are guided through a vein into the heart and connected to the device. The surgery usually takes about 1-2 hours.”

As per Mayo Clinic, you may need the following tests to understand which pacemaker is right for you:

• Electrocardiogram (ECG or EKG).
• Holter monitor.
• Echocardiogram.
• Stress or exercise tests.

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Recovery After Pacemaker Surgery: What to Expect

“After the surgery, the patient may need to stay in the hospital for a day or two for monitoring. There may be mild pain, swelling, or discomfort near the surgery site, but this usually improves in a few days. Doctors will check if the pacemaker is working properly before discharge,” explains Dr Bhat. 

The expert adds, “At home, patients are advised to avoid heavy lifting and sudden arm movements for a few weeks. It is important to keep the wound clean and dry to prevent infection. Regular follow-up visits are needed to check the pacemaker and battery life.”

Risks And Potential Complications After Pacemaker Surgery

The Journal of the American College of Cardiology (JACC) mentioned in research that permanent pacemaker implantation may be associated with an increased risk of mortality and heart failure after surgical aortic valve replacement (SAVR). This proves that pacemakers do come with a host of benefits, but they have some cons too. Let’s take a look at what our expert has to say about this.

As per the Cleveland Clinic, pacemaker procedures may have the following complications:

• Allergic reactions: A certain medication or one of the materials in the pacemaker may trigger allergic reactions. Your doctor should check for allergies well in advance.
• Blood clots: Doctors often prescribe blood-thinning medications to reduce the risk of developing a blood clot.
• Infection: Around 1% of people may develop an infection after a pacemaker surgery.
• Injury to your lung: There’s a very small risk of lung injury, which can lead to an air leak (pneumothorax) during pacemaker placement.
• Device malfunctions: In some cases, a pacemaker may move from its position or break free.
• Unexpected heart rhythm problems: Some people, even though rarely, may develop heart rhythm problems because of the pacemaker. 

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When To Opt For Pacemaker Surgery

According to the American Heart Association, a medical professional may suggest a pacemaker to make your heart beat more regularly if:

• Your heartbeat is too slow and often irregular.
• Your heartbeat is sometimes normal and sometimes too fast or too slow.

When To Visit A Doctor

After pacemaker surgery, if you experience signs of infection such as fever, increased redness, swelling, or drainage, chest pain, dizziness, fainting, or persistent hiccups, then contact a doctor immediately. A routine follow-up to monitor the device’s function is usually scheduled within 4-6 weeks of the surgery. 

ALSO READ - Can Heart Failure Be Reversed? Experts Explain

Conclusion

Pacemaker surgery is a medical procedure where a small device called a pacemaker is placed inside the chest to help regulate an irregular or slow heartbeat. The surgery generally takes around 1-2 hours; patients recover quickly and are discharged within 1-2 days. Regular follow-ups after the surgery ensure proper functioning of the device.