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Sometimes the heart's electrical system needs assistance to keep it functioning properly. Pacemakers can help the heart do this.

A permanent pacemaker is a small device implanted under the skin, usually in the shoulder area just under the collarbone. The pacemaker sends electrical signals to the heart to start or regulate a slow heartbeat.

Pacemakers are often recommended when the heart has developed an abnormally slow rhythm or if the electrical pathways are blocked.

Pacemaker components

Pacemakers have three primary components that help them sense when the heart's rate falls below the rate programmed into the pacemaker:

  • A pulse generator, which produces the signals that make the heart beat.
  • One or more insulated lead wires that carry signals to the heart from the pulse generator. One lead is attached to the pulse generator, while the other lead is placed in one of the chambers of the heart.
  • Electrodes, which are found on each lead.

Pacemaker implantation


Pacemaker insertion is done in the cardiac catheterization lab. Although the patient is awake during the procedure, sedation is usually given to help them relax.

During the procedure, an incision is made just under the collarbone. The lead of the pacemaker is then inserted into the heart through a blood vessel.

The lead is then tested to ensure that it's functional and in the right place. When the leads are confirmed to be working, they are attached to the generator, which is placed under the skin at the incision site.

You may need a night or two of observation after the procedure to ensure the pacemaker is functioning as it should.

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