Leadless Pacemaker Implant Procedure

Patient Information Leaflet

Introduction

You have been given this leaflet as your doctor has suggested you would benefit from having a leadless pacemaker implant.  This leaflet gives more information on what will happen to you before and after the procedure. It is designed to make sure that you know as much as possible about the procedure before you agree to it and sign the consent form.

What is a Leadless Pacemaker?

A leadless pacemaker is a small electronic device, that is implanted in the right ventricle of the heart. It monitors your heartbeat and when required, sends small precisely timed electrical impulses to your heart, to make it beat.  This will prevent the heart from beating too slowly. Some pacemakers also help synchronise the contraction of the chambers of the heart.

A leadless pacemaker system consists of a pulse generator (battery) which can detect if a pacing impulse is needed and gives this directly to the ventricle wall causing a paced heartbeat. Some leadless pacemakers are also capable of detecting the contraction of the upper chambers of the heart and timing any paced beats to occur in synchrony with these contractions.

Most pacemakers are powered by a lithium-ion battery and last between 8 and 13 years, before they need to be replaced.  The battery is checked at each follow-up check.

Implantation of the leadless pacemaker system is a surgical procedure performed under local anaesthetic, with sedation, to make you feel sleepy. It usually takes one to three hours to perform.

Most procedures can be done as a day case. If there are no complications, you will be allowed to go home after three to four hours.

Why do I need a leadless pacemaker?

A pacemaker implantation will only be requested by your doctor if they feel this is the best way to treat your heart condition and symptoms.

You may need a pacemaker if your heart is beating slowly either all the time or occasionally. It is usually due to one of the following reasons:

• If your natural pacemaker is beating slowly (sinus node disease)
• If the electrical impulses generated by your natural pacemaker are unable to spread to the rest of the heart due to a defect in the natural wiring system (heart block).
• Slow irregular heartbeats.
• Slow heart beats caused by medication, which are necessary to treat other conditions that you may have.

Patients with slow heart beats usually experience symptoms such as; dizziness, tiredness, shortness of breath and blackouts. Some may not have any symptoms. The type of pacemaker you need will depend on what your doctor decides is the most suitable for you.

What are the risks of having this procedure? 

• Bleeding from the insertion site.
• Blood collection (haematoma) at the insertion site.
• Small risk of surgical wound infection.
• A pacemaker implant involves a low dose of radiation, about the same as the amount of radiation you would normally get in 6 months of natural background radiation.
• A build-up of fluid around the heart (tamponade), which requires draining.
• Rhythm disturbances, requiring treatment.
• Pain during injection of local anaesthetic and advancement of insertion catheter.
• Allergic reaction. The dye, or contrast, we use to look at the heart chamber anatomy contains traces of iodine- some people can have a sensitivity or allergy to iodine. Please tell staff if you have an allergy to iodine. (If you are allergic to strawberries, shellfish or TCP this may be an indication of an allergy to iodine.)
• Damage to blood vessels/heart chamber damage
• Death is a rare complication of a pacemaker implantation.

What if I decide not to have a pacemaker?

If you choose not to have a pacemaker, you will continue to have the symptoms. Usually, there is no alternative way of treating the condition.

What preparation is needed?

On the day of the procedure:

• You must not eat for six hours before the procedure.
• You must not drink milky drinks six hours before the procedure. Clear fluids only.
• Bring all medication with you.
• Please take your normal medications, with a sip of water, on the morning of your procedure- see the note regarding Warfarin and anticoagulation
• Have a bath or shower
• Remove jewellery, contact lenses, make-up and nail varnish. Wedding rings can remain but will be taped for the procedure.
• Be prepared to stay overnight, pack a small bag
• Bring a book or something to do whilst you wait
• Bring reading glasses and remove contact lenses
• Avoid bringing large sums of money or valuables
• Please arrange for a relative or a friend to take you home after your procedure by car/taxi. You will not be able to drive home or use public transport. Your relative or friend will need to stay with you overnight.

Medication

What to do if on Warfarin or newer anticoagulants (NOACs):

• Stop anticoagulation (Apixaban, Dabigatran, Edoxaban or Rivaroxaban) 48 hours before the procedure
• Warfarin, please contact the day case unit 01384 456111 Ext 2573 or the Anticoagulation team Ext 2380 to discuss when to take your last dose.

Diabetes (controlled by diet or tablets)

• Do not eat at least four hours before the procedure
• You can drink clear fluids up to 2 hours before the procedure.
• If you are missing breakfast do not take your diabetes medication.
• Stop taking Metformin 48 hours before procedure and 24 hours post procedure
• Remember to bring all your diabetes medication, dextrose tablets and blood testing equipment
• If your procedure is in the afternoon, take your tablets as normal with your breakfast.
• Your blood glucose will be tested by a finger prick when you arrive and monitored

Diabetic taking insulin:

• Day before STOP SGLT2 inhibitor (dapagliflozin, empagliflozin or canagliflozin)
• Stop taking Metformin 48 hours before procedure and 24 hours post procedure
• Usually, we will try to put you first on the list. We advise you not to eat any breakfast and to omit your usual morning insulin before the procedure.
• Remember to bring all your diabetes medication, dextrose tablets and blood testing equipment
• If you are on the afternoon list, you need to take half of your morning dose of mixed insulin (minimum 10 units) with breakfast.
• If you are on insulin four times a day, please remember to take your morning dose.
• Your blood glucose will be tested by a finger prick when you arrive and monitored

What happens on the day:

• We will provide you with a gown to change into. A small canula (tube) will be inserted into a vein in your arm, this will allow us to give intravenous antibiotics
• Pre-procedure tests will include blood pressure, temperature, and ECG
• A healthcare professional will discuss your consent. Please use this opportunity to raise any concerns that you may have
• A physiologist will discuss the ‘Living with a Pacemaker’ information sheet and home monitoring
• A post operative appointment will be arranged for 6-8 weeks in the device’s clinic

What happens during the procedure? 

The procedure is performed in a dedicated Xray room within the Cardiology Department You will be cared for by a team of doctors, nurses, radiographers and cardiac physiologists.

• You will lie on an X-ray bed
• Your ECG, blood pressure and oxygen levels will be monitored throughout the procedure
• You may be given a sedative to help you relax during the procedure.
• We may give you oxygen using a face mask
• Your upper chest will be cleaned with a cold antiseptic and covered with sterile drapes. We will make a gap so you can peep out.
• After injecting the area with local anaesthetic, a small incision is made either in the groin or neck.
• The insertion catheter is guided along one of your main veins to your heart using X-ray screening. You may experience some extra ‘bumps’ in the chest and some chest pain, but they will pass. The doctor and physiologist will run a series of tests on the leads.
• Your incision will be closed with stitches and a dressing applied
• You will be taken back to recover in the day case unit

What happens after the procedure? 

• You will be taken back to recover in the day case unit
• Your heart rate, blood pressure and wound site will be monitored.
• A chest X-ray may be performed
• Once the sedation has worn off you may eat, drink and gently mobilise. You can have painkillers if required.
• You will be issued with a pacemaker identification card
• The stitches may be removed later that day or you will be given an appointment to attend the hospital the following day for them to be removed in the Cardiology department.

Going Home Advice

• You will be given oral antibiotics to take home
• You will be given a monitor to take home or a telephone number to call to order a home monitor delivery.

Driving

The DVLA regulations state that if you hold a normal driving licence, you must stop driving for one week post pacemaker implant. You must notify DVLA.

If you are a HGV/PSV licence holder then you must stop driving for six weeks post pacemaker implant. You must notify DVLA.

Please note the DVLA review their driving regulations biannually.

Wound Care

Remove the wound dressing after 48 hours. You must keep wound dry for the next 7-10 days to avoid infection.

If an infection occurs then the site would appear red, swollen, and painful, be warm & may ooze fluid. If this happens you must phone the device clinic.

Diabetic patients 

You will be discharge when you are eating and drinking normally and your blood glucose is at a safe level.

However, if you are unwell with:

• Continuous vomiting /diarrhoea or high fever
• Unable to keep food down for 4 hours or more
• High blood glucose (>15mmol)
• High ketones (0.6mmol)

You should seek medical help. Contact your usual diabetes nurse or doctor.

How to contact us:

Should you have any concerns regarding your device please contact us:

Pacemaker Clinic/ Devices Clinic

Cardiology Department
Russells Hall Hospital
Dudley
DY1 2HQ

Tel: 01384 456111 Ext 2156
Monday- Friday 08.00 – 17:00

Cardiology Day Case Unit

Russells Hall Hospital
Dudley
DY1 2HQ

Tel: 01384 456111 Ext 2573
Wednesday & Thursday 08.00 – 20.00

Cardiology Ward

Russells Hall Hospital
Dudley
DY1 2HQ

Tel: 01384 456111 Ext 2138

Additional information:

British Heart Foundation
Tel: 0808 802 1234

www.bhf.org.uk

Originator: Paula Slater. Version: 1. Date reviewed: January 2026. Next review date: January 2029. DGOH ref.: DGOH/PIL/02178