What is Involved in a Pacemaker Replacement?

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  • Written By: Erin J. Hill
  • Edited By: Bronwyn Harris
  • Last Modified Date: 24 August 2019
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In most cases, a pacemaker replacement is a minimally invasive surgery that involves opening a small area beneath the collarbone, usually at or near the original implantation incision site, and changing the device’s generator. The wires, or leads, which span from the generator to the heart are typically left in place. A replacement may need to be done occasionally when the batteries begin to weaken or if the device malfunctions.

The pacemaker is a device which attaches to the heart and sends tiny electrical signals to stimulate a contraction, or “heartbeat,” if the heart begins to pump too slowly. It consists of a small generator and two leads which are inserted into the right ventricle and right atrium. The generator is a very small computer which can be programmed to intervene if the heart rate drops below a certain level. More sophisticated models can even detect when the person is exercising, walking, climbing stairs, or breathing rapidly and will regulate the heart rate based on physical activity levels.

Occasionally, the batteries which power the generator will weaken and a pacemaker replacement will be needed. This typically involves the removal of the old generator and the insertion of a new one. A small opening is cut on the patient’s chest and the old device is removed. Then, a new generator is inserted and attached to the leads. This procedure is typically guided by a specialized x-ray machine.


Most patients can receive a pacemaker replacement at an outpatient procedure using local anesthesia. The incision is normally around three inches (7.6 cm) long and causes minimal pain and few complications. Occasionally infection or bleeding may occur, although risks are not common with this type of surgery.

Very rarely, a pacemaker replacement may be needed due to a faulty generator or other system malfunction. This is unlikely, but it has been noted with a few patients. Routine maintenance visits are required to ensure that the device is working properly and that no complications have occurred. The procedure required in case of a faulty device is the same as is required during a routine replacement.

Patients should request exact information regarding pacemaker replacement surgery before the procedure will be done. Although typically uncomplicated, every patient is an individual and certain health conditions may mean the operation will be performed in a different way. Additional instructions and information may also be offered while scheduling the appointment, such as whether or not colon irrigation is required, the type of surgery being done, and aftercare arrangements during recovery.


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Post 3

@Mor - They should worry more about propagating the right kinds of cells instead of developing better pacemakers. They will never be able to make a better alternative than a natural pacemaker (particularly for children), and we can grow most other kinds of cells now, so why not these ones?

I know they are researching this even now, but it seems like a very obvious way to go to me. It's not like they have to grow cells in a complicated shape or anything. It's basically just a patch of tissue that happens to do a particular job.

And it would mean never having to worry about pacemaker implantation or replacement because it would just be a natural part of your body.

Post 2

@bythewell - Honestly, we are almost at the point or even beyond the point where they would need to replace pacemakers at all. They have ways of charging devices without directly plugging them in, so batteries wouldn't be an issue. And a cardiac pacemaker isn't having to work against bone or muscle like a replacement joint does, so in theory it could keep going indefinitely if it had the power to do so and was built from good enough materials.

Post 1

My mother has a pacemaker and it is apparently designed to work for about ten years without needing any kind of replacement. It was something we joked about a little after she first had it done, because there were a lot of post-apocalypse movies that year and it kind of makes you think about your dependence on technology.

Basically, if modern society collapsed she might only have ten years to live, because there would be no one to replace her pacemaker.

I told her that in ten years I could teach myself how to do it, so she didn't have to worry. But hopefully the worst will never happen and I'll never have to learn pacemaker surgery!

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