Pacemaker Insertion

Animation Movie AvailableThe Implant Procedure


The surgical insertion of an artificial pacemaker, which is a small, battery-operated device that helps maintain a normal heartbeat by sending electrical impulses to the heart.

Pacemaker Insertion

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Parts of the Body Involved

  • Heart
  • Veins in the neck
  • Tissue under the skin below the collarbone

Reasons for Procedure

An artificial pacemaker is inserted when the body's natural pacemaker, the sinoatrial (SA) node, becomes defective due to heart disease and causes the heart to beat too fast, too slow, or irregularly. Artificial pacemakers may also be used for malfunctions in the atrioventricular (AV) node, the part of the heart’s electrical system that conveys signals from the SA node to the ventricles. Pacemakers can also be used in the setting of cardiac surgery.

Risk Factors for Complications During the Procedure

  • Obesity
  • History of smoking
  • History of excess alcohol consumption
  • Bleeding or blood-clotting irregularities
  • Regular use of the following prescription medications: high blood pressure medicine, muscle relaxants, tranquilizers or sedatives, insulin, beta-adrenergic blockers, or cortisone
  • Regular use of mind-altering medications

What to Expect

Prior to Procedure

  • Blood tests
  • Urine tests
  • Chest x-rays—a test that uses radiation to take pictures of structures inside the body
  • Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle

In the days leading up to the procedure:

  • The night before, have a light meal and do not eat or drink anything, including water, after midnight.
  • Empty bladder before the procedure.

During Procedure

Anesthesia will be administered. An ECG will monitor your heart and x-rays will be taken to ensure proper placement.


Local anesthesia will be applied by injection.

Description of the Procedure

You lie flat on a hard table; your heart rate, blood pressure, and breathing are monitored. A small incision is made beneath your collarbone. The pacemaker is inserted through this incision, and the wires are threaded through a vein under the collarbone to the heart. When the procedure is complete, the incision is closed with stitches, which are usually removed one week after surgery.

After Procedure

  • Heart rate and blood pressure will be monitored.
  • Before hospital discharge, pacemaker will be programmed to fit your pacing needs.

How Long Will It Take?

About 2 hours

Will It Hurt?

There may be some discomfort during the procedure, but the local anesthesia should help minimize most pain. After the procedure, you can relieve pain in the surgical area by applying heat, such as a warm compress or heating pad. Prescription or over-the-counter medications may be taken for pain as needed, but for no longer than 4 to 7 days.

Possible Complications

  • Excessive bleeding
  • Surgical-wound infection
  • Pacemaker malfunction
  • Rupture in the heart muscle (rare)
  • Death

Average Hospital Stay

0-1 days

Postoperative Care

  • Bathe and shower as usual. The incision area can be kept clean by gently washing with unscented soap.
  • Return to work and regular daily activities as soon as you are ready; sexual activity may resume as soon as you feel able.
  • Resume driving about one week after returning home.
  • Avoid vigorous exercise, especially involving the upper body, for 4 to 6 weeks after surgery.
  • Certain devices that contain powerful magnets or electrical fields (such as certain medical equipment) may interfere with your pacemaker activity. However, most standard home appliances (such as microwave ovens, electric blankets, heating pads, etc) should not significantly change your pacing rates. Check with your doctor to determine which devices may affect your pacemaker.
  • You will be scheduled for follow-up pacemaker checks that will assess the status of the battery and how well the pacemaker is maintaining your heartbeat.


A hard ridge may form on the skin along the incision, but it usually recedes as the wound heals. Allow about two weeks to recover from surgery.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Recurrent heartbeat irregularities
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting


American College of Cardiology

American Heart Association


Heart and Stroke Foundation of Canada

University of Ottawa Heart Institute


American College of Cardiology website. Available at: .

American Heart Association website. Available at: .

Last reviewed November 2007 by J. Peter Oettgen, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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