Pacemaker: what it is, what it’s for and the risks involved

Did you know that one in every 1000 people in Portugal lives with a pacemaker? Getting a pacemaker can raise many questions, as this is a device that stays with you forever and is essential to your life and well-being.  

This article tells you everything you need to know about pacemakers: how they work, what they’re for, when they’re needed and precautions to take after implantation.  

Pacemaker: what is it? 

A pacemaker is a small device that helps regulate the heartbeat. It is comprised of a generator with an internal battery, connected to the heart through one or more electronic leads that monitor the heart rate continuously.  

When the device detects that the heart is beating too slowly or with extended pauses, the pacemaker delivers mild electrical impulses that restore a regular heart rate, to ensure adequate blood circulation for the body to function properly. 

This system functions automatically, without the patient having to worry about its daily operation. Furthermore, some pacemakers are also able to adjust to physical activity and the body’s needs in real time. Some models also allow remote monitoring, which facilitates clinical follow-up by the medical team. 

Following implantation, the patient is given the pacemaker’s identification card. This ID card contains crucial information, such as the device’s type and model, date of implantation and the responsible clinic. It is essential that the patient carries the card at all times (especially when travelling, passing through security devices or for medical appointments), to guarantee informed actions by healthcare professionals or authorities.

What are the types of pacemaker? 

As not all hearts need the same support, there are different types of pacemaker. The device is chosen by the medical team, based on the type of arrythmia, the medical condition and the patient’s lifestyle. 

Single-chamber pacemaker 

This type of pacemaker has a single electrical lead, in most cases placed inside the right ventricle, which is the lower chamber of the heart, which pumps blood to the lungs. This type of device is implanted when only this part of the heart requires stimulation. For example, it is commonly used for treating simple cases of bradycardia. 

Double-chamber pacemaker 

In this case, the pacemaker has two leads: one placed inside the right atrium (upper chamber of the heart that receives blood) and the other in the right ventricle. This device enables the electrical activity between these two chambers to be coordinated, guaranteeing a more natural and efficient heart rhythm. 

Biventricular pacemaker  

This type of pacemaker, also called cardiac resynchronization therapy (CRT), has three electrical leads, which stimulate the right atrium, right ventricle and left ventricle. The lead in the left ventricle is placed through the coronary sinus, a venous structure that drains blood from the arteries that irrigate the heart. This type of pacemaker is used in cases of heart failure, when it is necessary to synchronize the contractions of both ventricles to improve the heart’s performance.  

How is a pacemaker implanted? 

Pacemaker implantation is a safe and well-established medical procedure. It is carried out under local anaesthesia and, in most cases, with light sedation, allowing the patient to be comfortable and conscious throughout the process. 

The procedure begins by inserting one or more pacing leads (fine, flexible wires) through a vein, usually the subclavian or cephalic vein, into the heart. Guided by real-time imaging (fluoroscopy), the cardiologist positions the leads in the cardiac chambers, according to the type of pacemaker indicated for the case. These leads are then connected to a generator (a small metal device that houses the battery and electronic circuitry), which is implanted under the skin, typically below the collarbone on the left side of the chest. 

After it is implanted, the pacemaker’s operation is tested and adjusted to ensure that it is stimulating the heart as effectively as possible. The entire procedure typically takes about one hour and is generally well tolerated. 

What precautions should be taken before implantation? 

The first step is a full clinical assessment. In addition to the consultation with a cardiologist, tests are usually performed, such as electrocardiogram, echocardiogram and, in some cases, Holter or Event Monitor. These tests help confirm the need for a pacemaker and plan the most adequate type of device. 

On the day before the procedure, it may be necessary to suspend or adjust some medications, especially if the patient is taking anticoagulant or antidiabetic drugs. These decisions are always made by the medical team, which will provide clear instructions adapted to each person’s case. 

The patient should also avoid eating or drinking in the hours before the intervention, according to the hospital’s instructions (usually fasting for around 6 to 8 hours). It is essential to bring all previous tests and a list of medication taken regularly. 

On the day of the intervention, patient admission is handled by the hospital team, explaining once again every step and ensuring that everything runs as smoothly as possible. 

What to expect after the procedure? 

After the pacemaker has been implanted, the recovery time is usually brief. The patient remains under observation for a few hours or, in some cases, until the next day. During this period, the vital signs, heart rate and incision site are monitored to ensure everything is going as expected. 

It is normal to feel some discomfort in the shoulder region and in the area where the generator was implanted – similar to bruising or muscle strain. This discomfort tends to disappear in the first few days and can be relieved with simple medication prescribed by the medical team. 

In the first few weeks, it is recommended to avoid exertion with the arm on the same side as the implant, such as lifting heavy objects or raising the arm above shoulder height. This allows the leads to become firmly embedded inside the heart and for healing to occur without complications. 

Before being discharged, the device is tested and programmed according to the patient’s specific needs. The first follow-up consultation usually occurs one or two weeks after implantation. From then on, revisions are made regularly, to guarantee that the pacemaker is functioning correctly and to monitor general heart health. 

In many cases, the symptoms disappear almost immediately. Dizzy or fainting spells that were caused by a slow or interrupted heart rate cease, and energy to perform daily activities is restored. 

Pacemaker: risks 

As with any medical procedure, pacemaker implantation has some risks, although in most cases this is a safe procedure with a very low rate of complications. Nevertheless, it’s important to be aware of the possible scenarios so that each patient feels fully informed. 

Immediate risks include minor bleeding, haematomas or infection at the incision site. These side effects are usually mild and easily controlled with proper medical supervision. In extremely rare cases, a pacing lead may dislodge and require repositioning. 

Although infrequent, there is also the risk of injury to nearby structures, such as blood vessels, the lungs or the heart itself, which may require additional intervention. Therefore, the procedure is always performed by experienced cardiologists, with the support of imaging technology and continuous monitoring. 

In the medium and long term, the pacemaker may occasionally require reprogramming or component replacement, especially if the battery runs low or if there are changes in the heart’s electrical activity. These adjustments are performed in a non-invasive manner during follow-up appointments. 

Pacemaker restrictions: what to consider 

Having a pacemaker doesn’t mean life has to stop, but it does carry some important limitations that should be known to ensure the device functions safely and correctly. 

It is recommended to avoid exposure to intense electromagnetic fields, such as those generated by industrial equipment, welding machines and some magnetic resonance imaging machines. These situations can temporarily interfere with the pacemaker’s function. Therefore, before undertaking exams or work, it’s essential to always inform the healthcare professionals or individuals involved. 

Close contact with domestic appliances, such as mobile phones, televisions and microwaves, does not pose any problem. 

Activities that involve direct impact or trauma to the chest region, such as contact sports, should be avoided to protect the generator and the leads. 

In everyday life, there are no major limitations: people with pacemakers can drive, travel, work and practice many types of moderate physical exercise, always respecting medical advice. 

Precautions to be taken by people with pacemakers 

To guarantee the heart is protected, some simple but crucial precautions should be taken.  

Firstly, it is essential to keep all scheduled follow-up consultations. In these appointments, the cardiologist will check the status of the device, adjust the programming if necessary, and monitor overall heart health. These appointments help prevent problems and make pacemakers last longer. 

If unexpected symptoms arise, such as dizziness, frequent palpitations or pain at the device site, it’s important to seek immediate medical attention for an assessment. 

Finally, it’s essential to inform healthcare professionals, insurance companies and security personnel (e.g. at airports) about the pacemaker, as specific precautions or procedures may be required. 

With these simple precautions and regular medical supervision, most people with pacemakers enjoy an active, healthy and tranquil life. 

Give your heart the care it deserves with Joaquim Chaves Saúde 

Getting a pacemaker is an important step towards taking care of your heart and regaining your quality of life. Although it’s natural to feel some apprehension, with specialised medical supervision and the right care, this technology can make all the difference in your everyday life. 

At Joaquim Chaves Saúde, you will find a team of experienced cardiologists and cutting-edge technology to support every patient, from diagnosis to ongoing post-implantation monitoring. Our commitment is to be at your side every step of the way, guaranteeing safety, comfort and a humane approach. 

If you feel it’s time to find out more about this solution, or if you have a pacemaker and want to ensure the best follow-up care, our team is ready to help. Schedule your appointment now.