Pacemakers in London: Specialist Assessment, Implantation and Care

One Clinic, Focused Entirely on Devices Like Yours

Pacemaker Care in London, From First Assessment to Long-Term Follow-Up

If you have been told you may need a pacemaker, or you already have one and want expert care, the depth of the team looking after you matters. London Pacemaker Centre is dedicated solely to pacemakers and cardiac devices, which means your assessment, your procedure and your long-term follow-up are all handled by specialists for whom this is everyday, core practice rather than an occasional sideline. This page explains the full picture: how we assess whether a pacemaker is right for you, what implantation involves, how generator changes and revisions work, and the newer options of leadless pacemakers and conduction system pacing.

Living with a Pacemaker" patient guide cover with a countryside bench and a heart illustration

Why Choose London Pacemaker Centre

Because we concentrate on one field, we can offer a level of expertise and continuity that general cardiology services rarely match. That means fast access to specialist assessment, often within days, the latest device technology including leadless and conduction system pacing, MRI-compatible devices, and a dedicated long-term follow-up and optimisation service so the care does not stop the moment the device is in. We see both self-funded and insured patients, in modern facilities on Wimpole Street in London’s Harley Street medical district and at the internationally recognised Harefield Hospital in North West London.

Above all, we believe good cardiac care begins and ends with communication. We explain things clearly, answer honestly, and make recommendations rather than decisions, so the path you take is genuinely the right one for you.

What a Pacemaker Is

A pacemaker is a small device that helps control the heart’s rhythm, most often when the heart beats too slowly. It sends tiny electrical impulses to keep the heart beating at a normal rate. In most patients it is programmed to step in only when needed, and simply to monitor the rest of the time, which also helps preserve battery life. A pacemaker may be recommended for a slow heart rate (bradycardia), fainting caused by irregular rhythms, certain types of heart block, and some cases of heart failure.

There are several types. A single-chamber pacemaker stimulates one chamber of the heart, a dual-chamber device coordinates the upper and lower chambers, and a biventricular device, used in cardiac resynchronisation therapy, helps both sides of the heart beat in synchrony. Newer approaches, leadless pacemakers and conduction system pacing, are explained in detail below.

The main types

Single-chamber

Stimulates one chamber of the heart.

Dual-chamber

Coordinates the upper and lower chambers of the heart.

Biventricular (CRT)

Used in cardiac resynchronisation therapy to help both sides of the heart beat in synchrony.

Pacemaker Assessment

Before any treatment, the priority is an accurate diagnosis. The aim of assessment is to capture what your heart is doing at the moment you feel unwell, and to confirm whether a pacemaker is genuinely the right answer.

Assessment usually begins with the basics: a careful history and an ECG, the simple heart tracing that remains one of the most valuable tests we have. From there we build as needed. We may record your heart rhythm continuously over a period, draw on data from your own wearable such as a smartwatch, recommend a simple handheld recorder you can use the instant symptoms strike, or, for infrequent symptoms, fit a small implantable loop recorder that monitors your rhythm for up to three years and alerts us automatically to any event.

Honest assessment also means recognising when a pacemaker is not the answer. Some blackouts are caused by a drop in blood pressure rather than a slow heart rhythm, a pattern known as vasovagal syncope, which is treated differently. Some patients have a fast rhythm rather than a slow one, which follows another pathway altogether. Identifying the true cause spares you an unnecessary procedure and points you toward the right care.

Pacemaker Implantation

The idea of a device being placed into your heart can feel daunting, but for a standard implant this is a short, low-risk procedure that most patients find far more straightforward than they expected.

Pacemaker implantation is a minor surgical procedure that usually takes from around thirty minutes to a couple of hours, depending on the device. Beforehand you will have tests such as an ECG and blood tests, and your medications will be reviewed, as some, including blood thinners, may need to be paused. During the procedure you are awake but offered sedation to help you relax. The area below the collarbone is numbed with local anaesthetic, thin wires (leads) are guided through a vein into the heart, and the device is placed under the skin and connected to the leads. You should not feel pain, only some pressure or movement, and intravenous sedation and pain relief are available throughout.

For a standard implant, no. It is, in honest terms, a form of surgery, but not a major one. The risk of the procedure itself is very low, the risk of serious complications is low, and the risk to life is vanishingly small. Serious complications are uncommon, occurring in around one percent of cases, and can include bleeding or bruising, lead displacement, infection at the site, and rarely a lung complication. Your team monitors closely to catch any issue early.

Most people go home the same day or the next. The area may feel sore for a few days and usually heals within a couple of weeks to a month. You will be asked to limit movement of the arm on the implant side, generally the left, and to avoid lifting above shoulder height for around four to six weeks. Importantly, you should not keep the arm completely still, as that can lead to a stiff or frozen shoulder. You can shower within a couple of hours, but should avoid baths and swimming for the first month. Your follow-up check is arranged within a few weeks, after which monitoring is often done remotely.

Pacemaker Generator Change and Revision

A pacemaker is not permanent in the sense that its battery lasts forever. The device, sometimes called the generator or box, contains a sealed battery that gradually depletes over a number of years.

When the battery approaches the end of its life, the generator is replaced in a short procedure. This is typically more straightforward than the original implant, because in most cases the existing leads are working well and can be left in place and simply reconnected to a new device. Crucially, a generator change is rarely a surprise: battery status is monitored at every routine check, so a replacement can be planned comfortably in advance rather than left to chance.

Revision covers situations where the system itself needs attention rather than just the battery. That might mean addressing a lead that has moved or is not performing as it should, or upgrading an existing system to do more, for example adding to it or upgrading to cardiac resynchronisation therapy when a conventional pacemaker is no longer meeting a patient’s needs. As with all device work, the right approach is individual, and we will explain clearly why a revision is being recommended and what it involves.

Leadless Pacemakers (Micra and AVEIR)

A leadless pacemaker is a very small device implanted directly inside the heart, without the wires that a conventional pacemaker uses. Everything is contained in a single capsule about the size of a large vitamin pill.

A conventional pacemaker has a generator placed under the skin near the collarbone, connected to leads that run into the heart. A leadless pacemaker combines all of this into one capsule that sits entirely within the heart. It is inserted through a vein in the groin using a catheter, guided into the right ventricle, and attached to the heart wall with small prongs. There is no chest incision and no visible lump under the skin.

Because there are no leads, leadless devices avoid lead-related problems such as wire fracture, and they tend to be smaller, less visible and quicker to recover from. They are not suited to everyone. Traditionally a leadless pacemaker works in the lower chamber of the heart only, although newer systems can sense from the upper chamber or pair two devices together to provide more complete pacing. They are not designed for patients who need more complex pacing, and when the battery is depleted a new device is implanted rather than the generator simply being swapped. A leadless pacemaker is a minimally invasive option for selected patients, particularly those who mainly need straightforward pacing support or who are at higher risk of complications from a conventional device. Your consultant will discuss whether it is right for you.

Think we should probably avoid referencing specific products as we need to ensure a healthy relationship with the major manufacturers!

Conduction System Pacing

Conduction system pacing is one of the most significant recent developments in this field, and it is an area in which a specialist centre comes into its own.

Your heart has its own electrical network, the cardiac conduction system, which controls how each heartbeat spreads. Traditional pacemakers usually stimulate the right ventricle, which works well and is proven over many years, but can create a slightly less natural pattern of contraction. Conduction system pacing instead stimulates the heart’s natural wiring directly, producing a more natural activation pattern.

For some patients, this more natural pacing can improve the efficiency of the heart compared with standard pacing, and it may reduce certain long-term complications associated with conventional pacing. It is increasingly regarded as the gold-standard approach for some patients who need a pacemaker, and over time it may come to replace cardiac resynchronisation therapy in selected cases. It is, however, more technically challenging to implant, is not suitable for every patient, and requires a clinician specifically trained in the technique, which is precisely the kind of expertise concentrated in a dedicated device centre. Your consultant will discuss the merits for your individual situation.

Frequently Asked Questions

Pacemaker Assessment

Assessment usually starts with a clinical history and an ECG, and may include continuous rhythm monitoring, data from your own wearable, a handheld recorder, or a small implantable loop recorder that monitors your heart for up to three years. The goal is to capture what your heart does when you have symptoms.

No. Some blackouts come from a drop in blood pressure rather than a slow heart rhythm, in which case a pacemaker is not the right treatment. Accurate assessment tells the two apart.

We offer fast access to specialist assessment, in many cases within days.

Pacemaker Implantation

You should not feel pain during the procedure. The area is numbed with local anaesthetic, and sedation and pain relief are available. It may feel a little uncomfortable at the time and somewhat sore afterwards, usually settling within about a month.

Most implants take from around thirty minutes to two hours. A standard pacemaker is usually completed in about an hour.

For a standard implant, no. It is a form of minor surgery with very low risk and a short procedure time. Serious complications are uncommon, at around one percent.

Often not. Many patients go home the same day, though some stay overnight for monitoring.

In an ideal recovery, a pacemaker is an inconvenience for a few weeks rather than something requiring major recovery. Limit heavy lifting and overhead arm movement on the implant side for the first four to six weeks, then build back up.

Generator Change and Revision

Battery life varies by device and how often the pacemaker is needed. It is monitored at every routine check, so a replacement can be planned well in advance.

The generator is replaced in a short procedure. The existing leads are usually working well and can be left in place and reconnected to a new device, which makes this typically simpler than the first implant.

A revision addresses the system rather than just the battery, for example correcting a lead that has moved, or upgrading the system, such as to cardiac resynchronisation therapy, when a conventional pacemaker is no longer enough.

Leadless Pacemakers

A leadless pacemaker is a single small capsule, about the size of a large vitamin pill, implanted directly inside the heart through a vein in the groin, with no chest incision and no visible lump.

It is better for some patients, not all. It avoids lead-related complications and recovers quickly, but it is generally suited to straightforward pacing needs. Your consultant will advise whether it fits your situation.

Conduction System Pacing

It is a newer pacing technique that stimulates the heart’s own natural electrical wiring directly, rather than pacing the heart muscle more generally, producing a more natural heartbeat pattern.

For some patients it offers a more natural activation pattern and may improve efficiency or reduce certain long-term effects of conventional pacing. It is more technically demanding and is not suitable for everyone, so it requires a specially trained specialist.

In selected cases it may, and it is increasingly seen as a gold-standard option. Whether it is right for you is an individual decision your consultant will discuss.

Book an Appointment

Whether you are being assessed for a pacemaker, due a generator change, or interested in newer options such as leadless or conduction system pacing, London Pacemaker Centre offers expert, specialist care from first assessment through to long-term follow-up. Contact us to arrange a consultation or make a referral, and our team will ensure you receive prompt, expert and personalised care.