If you have heart disease that causes symptoms like an irregular heartbeat or heart rhythm, your cardiologist may recommend getting a pacemaker. One MyHeartDiseaseTeam member shared, “I just celebrated 27 years of living on pacemakers. It’s helped a lot.” Another wrote, “I don’t yet have a pacemaker, but they said sooner or later I will need one.”

But what exactly is a pacemaker, and how does this small device work? Should you get a pacemaker if you’re living with heart disease? These eight facts can help you understand what pacemakers do and how they can help you.

1. A Pacemaker Regulates Your Heart Rate

A pacemaker is a small electrical device that doctors implant under your skin to regulate your heart rate. It includes a pulse generator (with electrodes) and a lead or wire. The device is usually implanted under the skin near your collarbone. Pacemakers have been in use since the 1950s.

If your heart rate or rhythm becomes too slow or irregular, the pacemaker sends an electrical impulse that tells your heart when to beat. Having the pacemaker switched on is painless, and you probably won’t even feel it at all. These electrical signals help your heart chambers beat in sync so the heart’s electrical system operates correctly.

Most pacemakers are programmed to activate when your heart rate drops below a certain level. They are mainly used to treat slow heart rhythms.

Some people also need a device called a defibrillator. This device can correct abnormal heart rhythms by either pacing the heart quickly or giving a small electric shock. Most defibrillators include pacemaker functions, but not all pacemakers have defibrillator capabilities.

The success rate of general pacemaker implantation is more than 99 percent, and the success rate of a three-lead pacemaker system is about 97 percent. Every year, more than 1 million pacemakers are implanted worldwide. Keep reading to learn about different types of pacemakers.

Two- Or Three-Lead Devices

Most pacemakers are two-lead devices. One lead is placed in the right atrium, and the other goes into the right ventricle.

Three-lead devices have a third lead that’s placed through a vein into an area near the left ventricle. These devices are designed to resynchronize how your heart beats by mimicking the heart’s natural electrical conduction system — that is, how electrical impulses move through the heart, causing it to beat.

Leadless Pacemakers

A leadless pacemaker is a small, one-piece device that is only about an inch long. It contains everything needed to regulate your heartbeat, which means they don’t have leads or a separate battery. These devices are placed directly into the right ventricle using a catheter.

Leadless devices have some benefits over traditional pacemakers, including:

• Fewer restrictions after surgery
• Easier insertion and removal when needed (for example, if the battery dies)
• Fewer problems with airport security and MRIs
• Less visible (no chest bump or scar)

Your doctor will help you weigh the pros and cons of leadless pacemakers. For example, a leadless device cannot deliver shocks to stop dangerous heart rhythms, so people who may need defibrillation may not be candidates for it.

2. Pacemakers Have Several Applications

There are several reasons your healthcare team might recommend a pacemaker. Cardiac pacemakers can prevent an abnormally slow heart rate for people who have experienced heart failure or a heart attack, or who have an arrhythmia (irregular heart rhythm), including atrial fibrillation (AFib).

Some people are born with congenital heart defects that can cause a fast or slow heartbeat. Others have an enlarged or thickened heart muscle. Both of these types of heart problems can lead to irregular heartbeats that require a pacemaker or defibrillator.

Some medications, such as beta-blockers, can slow your heart rate and may lead to heart complications. Other heart rhythm conditions that can be corrected or improved with a pacemaker include:

• Sinus node dysfunction — When the electrical signal from the heart’s sinoatrial node — where your heartbeat begins — slows or disappears
• Atrioventricular block, also called AV block or heart block — When the electrical signals from the top chambers of your heart (atria) don’t properly reach the bottom chambers (ventricles)

3. The Implantation Process Is a Low-Risk Procedure

Pacemaker implantation is a routine, low-risk operation, with a success rate close to 100 percent and excellent recovery outcomes. If you and your doctor have decided that you’d benefit from a pacemaker, it’s a good idea to get to know a few important facts before you go to the hospital:

• Your doctor may order blood work to make sure you’re healthy enough for the procedure.
• You’ll typically need to wash your body from the neck down with a special sterile soap the night before and morning of the procedure.
• You’ll receive specific instructions about whether or not to take your usual medications before the procedure.

Once you arrive for the procedure, you’ll be taken to the electrophysiology lab or cath lab. There, the nursing staff will sterilize the site where they’ll implant your pacemaker and attach some monitors.

For two- or three-lead pacemakers, the surgeon will make a small incision near the collarbone and create a pocket under the skin and soft tissue to insert the pacemaker and leads. Using an X-ray as a guide, the doctor will then put the pacemaker wires through a vein inside the chest and position it in your heart.

After the procedure, your doctor will want you to stay in the hospital overnight to make sure the pacemaker works correctly.

Leadless pacemakers are inserted a bit differently. These are implanted through a very small incision in your groin. Your doctor will insert a catheter into your femoral vein (in your thigh). They’ll then use an X-ray to guide the pacemaker through the catheter and up to your heart, where it will be placed in your right ventricle.

Because two- and three-lead pacemakers run on batteries, you’ll have to undergo a pacemaker battery-replacement procedure approximately 5 to 10 years from the date of the pacemaker implantation. The battery life depends on how often the device is used.

A leadless pacemaker can last about 10 years, and the battery in it may last from 5 to 15 years. If the battery or the pacemaker itself stops working, your doctor will replace the entire device rather than replacing the battery.

Your doctor can give you a personalized estimate of your device and the battery’s lifespan.

4. The Pacemaker Procedure May Have Side Effects

Although pacemaker complications after insertion aren’t common, it’s still important to look out for them. Possible side effects after pacemaker implantation include:

• Heart rhythm problems
• Blood clots
• Interference from outside factors (such as machines or magnets)
• Allergic reactions
• Pacemaker or lead malfunction

Your cardiologist or another healthcare provider will explain what to look for after a pacemaker insertion and when to call for help.

5. Having a Pacemaker May Affect Airport Security Screening

Airport security systems like metal detectors or body scanners won’t damage your pacemaker. However, the metal in a two- or three-lead device could set off a metal detector. For this reason, the U.S. Transportation Security Administration (TSA) gives the following recommendations to travelers with these types of pacemakers, as well as other internal medical devices:

• Tell TSA agents that you have a pacemaker before screening.
• Carry your pacemaker ID card to help avoid delays.
• Use a full-body scanner instead of walking through a metal detector
• Request a pat-down if you prefer not to go through a scanner.

If a handheld metal detector wand is used, the agent should avoid holding it over your pacemaker for more than a second or two.

Security processes for people with pacemakers may vary depending on where you’re traveling or the pacemaker type. For instance, leadless pacemakers are less likely to cause issues with airport screenings.

6. Certain Procedures Can Interfere With Pacemaker Function

Some medical procedures can affect pacemaker function. Be sure to talk to your doctor or specialist before undergoing procedures such as:

• MRI scans
• Microwave diathermy (used as part of certain physical therapies)
• Radiation treatments
• Shock wave lithotripsy, which helps treat kidney stones
• Electrocautery, a procedure that helps stop bleeding during surgery
• Transcutaneous electrical nerve stimulation (TENS), used to treat pain

The level of risk can vary depending on your type of pacemaker. For example, leadless pacemakers don’t typically interfere with MRI scans. Even so, always let your doctor know you have a pacemaker before any diagnostic procedure or surgery.

7. A Pacemaker Can Bring New Everyday Challenges

While a pacemaker is likely to improve your quality of life, you may also experience minor challenges in daily life.

Some people living with pacemakers have trouble sleeping and report discomfort. This can be made worse when staying somewhere new and sleeping in an unfamiliar bed. Sleeplessness or discomfort may mean that your pacemaker isn’t placed in quite the right spot. If you experience these symptoms, you should discuss having a pacemaker position correction procedure with your cardiologist.

Some people have reported feeling irritated and impatient after having their pacemaker implanted, which can make day-to-day life difficult. If you feel this way after your procedure, talk to your healthcare provider at follow-up visits.

8. Your Doctor Can Provide Tailored Advice

If you’re thinking about whether a pacemaker is right for you, talk to your cardiologist. Your doctor knows your medical history, including other health conditions, and they’re aware of your lifestyle and goals, so they can help you make an informed decision.

Your cardiology team can also help you understand the different types of pacemakers and choose the one that’s best for you. Having the right device can support your heart function and improve your overall quality of life.

Talk With Others Who Understand

On MyHeartDiseaseTeam, the social network for people with heart disease and their loved ones, members come together to ask questions, talk about heart health, and share their stories with others who understand life with heart disease.

Are you living with heart disease and using a pacemaker or thinking about getting one? Share your experience in the comments below, or start a conversation by posting on your Activities page.