A pacemaker insertion is a procedure that inserts a small device underneath your skin to correct electrical signalling abnormalities in the heart

What is a pacemaker?

A pacemaker is a small cardiac device that sits under your collar bone and maintains the normal electrical pattern of your heart. Depending on your requirements, leads are placed into one or two chambers of the heart and connected to the generator under the skin.

Why has my cardiologist recommended a pacemaker?

The electrical current in your heart is generated in a small area of the top right side of your heart called the sinoatrial node (SA node). The SA-node is the natural pacemaker of your heart, a bit like a spark plug in your car. Sometimes it stops making enough impulses which leads to your heat beating too slowly or pausing. You might hear this referred to as ‘sick sinus’ syndrome.

Sometime the SA node might be generating enough impulses but there might be a problem with how the electrical system is transmitting the impulse through your heart. This is known as heart block and can also result in your heart beating too slowly or pausing, causing symptoms.

    What are the risks associated with a pacemaker insertion?

    A pacemaker insertion is a common and safe procedure, but as with all procedures there are some risks associated.

    The main risks your cardiologist will discuss with you before the procedure are:

    • Haematoma (Large bruise) – This can sometimes occur at the pacemaker insertion site and usually settles within 14 days.
    • Pneumothorax – this is a condition where air leaks into the space between the lungs and chest wall. During the procedure there is a small chance that a small hole is made in your lung when inserting the pacemaker leads. If this does occur, it usually heals by itself. It may extend your recovery time in hospital and rarely the doctor may have to insert a small tube into the lung space to remove the air.
    • Lead dislodgement – if this is going to occur it usually happens within the first 24 hours following the procedure. You will have your pacemaker tested prior to leaving the hospital to minimise this risk but it is important to follow all of the information given to you by the staff to minimise the risk.
    • Infection – This is a very uncommon, but sometimes an infection develops around the insertion site. If this occurs, it may necessitate removal of the pacemaker.
    • Cardiac Perforation – in an exceedingly small number of patients the insertion of the lead can make a small hole in the heart. This is a rare occurrence, and your cardiologist will deal with this immediately.

    Your individual risks will be discussed by your cardiologist before the procedure. They will depend on your age, your co-existing medical conditions, and other factors.

    What should I expect when undergoing a pacemaker insertion?



    Your cardiologist may request that you stop taking some of your medications before the procedure, especially blood thinners or SGLT2 inhibitors used to treat diabetes and heart failure.

    Avoid eating for at least six hours and drinking fluids for two hours before the procedure, and remove all jewellery before coming to hospital.


    At SouthWest Cardiovascular your pacemaker insertion will be performed by a cardiologist who is highly trained in performing this procedure and has undergone additional specialist training in this field. For your convenience, all of our procedures take place at St John of God in Bunbury. This procedure takes place in a specially designed cardiac procedure room. You will be awake for the procedure, but our team will give you a medication to help you feel relaxed (a sedative) and pain free (local anaesthetic).

    Your cardiologist will then:

    • Prepare the skin around your chest and collar bone with a special sterile solution, this may feel cold.

    • Make a small incision below your collar bone.

    • Inset the pacemaker device into the space they have created under your collar bone. You may feel firm pushing in the collar bone area. It should not feel painful, please let the team know if you are in pain.

    • Use x-rays to guide the pacemaker leads into your heart through a vein running past your collar bone.

    • Attach the required number of leads onto the wall of the chamber of your heart using a small hook or screw. Your pacemaker may require, one, two or possibly three leads. Your individual lead requirement will have been discussed with you before the pacemaker procedure.

    You should expect the procedure to take about an hour.


    Following your pacemaker insertion, you will be moved to the recovery area or the cardiology ward to rest. You may feel a little tender around your collar bone

    You will be required to stay in hospital for 2-4 hours for observation and monitoring.

    A sterile waterproof dressing will be placed over the insertion site, you can shower with this dressing. This must remain in place for six days and can then be removed safely at home.

    Please avoid strenuous activities such as swimming, golf, lawn bowling as well as lifting your arms above your head for four weeks.

    You will not be able to drive for two weeks following the procedure, so it is advisable that you arrange to be collected by family or friends from St John of God Bunbury.

    A follow up appointment with your cardiologist will be scheduled where long term management and lifestyle advice will be discussed.

    It is possible to monitor your pacemaker remotely. This is considered the best standard of care and ensures that if there are any unexpected rhythm problems or new findings, they are picked up and dealt with quickly and efficiently. SouthWest Cardiovascular have partnered with Cardiac Rhythm Connect to provide this service for a small fee. Your cardiologist will discuss this with you further.