I Had to Have a Pacemaker Fitted: A Case Study

Tim's fainting episode

Tim, a secondary school maths teacher, had felt worn out for months. He put it down to the run-up to exams and the extra work that brings, along with caring for his elderly mother after her stroke earlier that year.

He saw his GP after fainting in front of a class of 16-year-olds during a GCSE lesson.

When the GP examined him, Tim was told his heart was beating too slowly, known as bradycardia, and that he needed to go to hospital straight away. He remembers the doctor seeming taken aback and more abrupt than usual, which he took as a sign of how seriously his condition was being treated. Tim recalls being taken to hospital in Leeds by a non-emergency transport service.

Tim initially attributed his tiredness to work and caring responsibilities. Tiredness, dizziness and breathlessness can have everyday causes, but a blackout should always be checked by a doctor. Do not drive after fainting until you have been assessed.

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What bradycardia is

Bradycardia means the heart beats more slowly than usual, generally under 60 beats per minute at rest. Some fit people and athletes naturally have a low resting heart rate and feel well.

It becomes a concern when the heart is not pumping enough blood for the body's needs. Symptoms can include:

• tiredness or lack of energy
• dizziness or lightheadedness
• shortness of breath
• fainting or near-fainting
• confusion or difficulty concentrating

Causes include age-related wear to the heart's electrical system, scarring after a heart attack, heart conditions present from birth, an underactive thyroid and some medicines, such as beta blockers. Sometimes no clear cause is found.

A doctor can detect a slow pulse during an examination, but an electrocardiogram (ECG) is needed to identify the type of rhythm problem, such as heart block. Some people wear a portable monitor for a day or longer to look for episodes of slow heartbeat, pauses or other rhythm problems that a short ECG might miss.

Your situation may be slightly different. ask a question below ↓ and our editorial team will reply with our advice.

Pacemakers and how they are fitted

Whether you need a pacemaker depends on the type of rhythm problem, your symptoms and whether there is a reversible cause. Some types of heart block need treatment even if they are not causing symptoms. If a medicine may be responsible, only change or stop it on the advice of the clinician who prescribed it, as it may be treating another important condition.

A pacemaker is a small battery-powered device that sends electrical impulses when needed to prevent the heart beating too slowly. Fitting one is a common NHS procedure, usually done under local anaesthetic, sometimes with a sedative. It typically takes around an hour.

For a conventional pacemaker, the doctor makes a small cut, usually below the left collarbone, passes one or more thin wires called leads through a vein into the heart, and places the device in a pocket under the skin. Other types exist, including leadless pacemakers placed directly in the heart through a catheter, usually from a vein in the groin. Many people go home the same day or the next.

Your team will explain the risks before you consent. These include infection, bleeding or bruising, and a lead moving out of position. Less common complications include a collapsed lung.

Recovery and living with a pacemaker

The wound may be sore and bruised for a few days. Follow your hospital's instructions on arm movement, lifting and exercise, including how to keep your shoulder gently mobile.

You must tell the DVLA. Under DVLA guidance, car and motorcycle drivers generally stop driving for at least one week after implantation, and bus or lorry drivers for at least six weeks, subject to conditions. A previous blackout may bring further restrictions, so the waiting period is not automatic clearance to drive. Check the current guidance before driving.

Return to work and exercise depends on your recovery, your underlying condition and the activity involved. Other points to remember:

• Carry your device ID card and show it at airport security.
• Keep phones and magnetic items at least 15 cm (6 inches) from the device, use the opposite ear for calls and avoid magnetic phone accessories over it. Follow any device-specific advice.
• Tell doctors, dentists and other health professionals about your pacemaker. MRI scans may still be possible, but the teams involved must check compatibility first.
• Attend follow-up checks, which may include remote monitoring. The device is replaced when its battery runs low.

Seek prompt advice from your pacing clinic, GP or NHS 111 if the wound shows increasing redness, swelling, discharge or breakdown, or if you develop a fever. If your earlier symptoms return or you faint again, get medical help that day rather than waiting for a routine appointment. Call 999 for suspected heart attack, severe symptoms, or if someone collapses and is unresponsive or breathing abnormally. If they are unresponsive and not breathing normally, start CPR and follow the call handler's instructions.

Further information is available from the NHS website, the British Heart Foundation and Arrhythmia Alliance.

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