A pacemaker continuously monitors the heart’s electrical activity and delivers a tiny electrical pulse whenever the heartbeat slows below a set threshold. This restores a normal rhythm in patients whose natural pacing system has failed, slowed down, or become unreliable. Modern devices are MRI-compatible, Bluetooth-enabled, and last 8 to 12 years before a generator change is needed.
Dr. Kiran Narang, an experienced interventional cardiologist in Mumbai, says,
“A pacemaker does not replace the heart’s own rhythm, it backs it up. The device sits quietly until the heart slows below the programmed rate, then steps in with a pulse to keep things moving. Most patients feel nothing when it fires. What they do notice is that the fainting, the fatigue, and the breathlessness are gone.”
Concerned about a slow heart rate or fainting episodes?
How Does a Pacemaker Actually Work?
The device has two parts: a pulse generator that holds the battery and circuitry, and one or two thin wires called leads that connect it directly to the heart muscle.
Sensing:
The pacemaker reads the heart’s electrical activity beat by beat. When the rhythm is normal, the device stays silent and lets the heart do its job.
Pacing:
If the heart rate drops below the set threshold, typically 60 beats per minute, the device sends a small electrical pulse through the lead to trigger a contraction.
Rate-responsive models:
A built-in sensor detects body movement and automatically increases the pacing rate during physical activity, matching the heart’s output to what the body actually needs.
Programming:
The device is entirely programmable. Rate limits, sensitivity, and output strength are adjusted non-invasively using a wand held over the chest, with no repeat surgery needed.
Most patients are discharged within 24 to 48 hours. After six weeks, the leads scar into position and full activity resumes. For a complete picture of what the implant procedure involves, see pacemaker surgery.
Who Actually Needs a Pacemaker?
Not every slow heart rate needs a device. The decision depends on whether the slow rate is causing symptoms and whether those symptoms are caused by an electrical problem that a pacemaker can fix.
Bradycardia with symptoms:
A resting heart rate under 50 beats per minute paired with fatigue, breathlessness, or dizziness that is not explained by medication or another reversible cause.
Complete heart block:
The electrical signal from the upper chambers fails to reach the lower chambers entirely. The ventricles beat too slowly on their own backup rhythm, and a pacemaker is almost always necessary.
Sick sinus syndrome:
The heart’s natural pacemaker node fires irregularly, producing alternating fast and slow rhythms. Symptoms include fainting and exercise intolerance.
Fainting episodes
Caused by documented long pauses between heartbeats, picked up on a Holter monitor or event recorder rather than a single ECG.
Diagnosis starts with a resting ECG, followed by Holter monitoring over 24 hours to 14 days. An echocardiogram rules out structural disease before any implant decision is made. Most patients sent for a second opinion find the indication either confirmed or safely avoided. For related diagnostic context, read about angiography vs angioplasty.
Why choose Dr. Kiran Narang ?
Dr. Kiran Narang holds MBBS, MD (Internal Medicine), DM (Cardiology), and DNB (Cardiology) qualifications, with over 12 years in clinical medicine and 8 years dedicated to interventional cardiology. He implants single-chamber, dual-chamber, biventricular, and leadless devices based on individual indication, not vendor preference. Every device placed is MR-conditional and Bluetooth-enabled for remote monitoring.
FAQ’s
Is a pacemaker implant a major surgery?
No. It is done under local anaesthesia and usually completed in under 90 minutes.
How long does a pacemaker battery last?
Most modern devices last 8 to 12 years before the generator needs replacing.
Can I use a mobile phone after a pacemaker?
Yes. Use the ear opposite the implant and keep the phone away from the chest pocket.
Will I feel the pacemaker firing?
Most patients feel nothing. The electrical pulse is too small to sense.
Disclaimer: This content is for educational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment.
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