Why Might I Need a Heart Device?
Your heart’s rhythm is controlled by an internal electrical system. If this system becomes faulty, it can result in symptoms such as a slow heartbeat, dizziness, blackouts, shortness of breath, or worsening heart failure. If these problems are detected on your ECG or heart scans, your doctor may recommend a device such as a pacemaker, CRT, or conduction system pacemaker to help regulate and support your heart’s rhythm and pumping function.
Pacemaker Implantation
A pacemaker is a small, battery-powered device implanted under the skin, usually just below your collarbone. It is connected to the heart through one or two thin wires called leads. The pacemaker continuously monitors your heartbeat and sends electrical signals when it detects that the heart is going too slowly or pausing.
Common reasons for a pacemaker include:
- Bradycardia (slow heart rhythm)
- Heart block (a delay in the heart’s electrical signals)
- Unexplained blackouts or dizziness
The Procedure:
- Usually performed under local anaesthetic with light sedation
- A small incision is made below the collarbone
- Leads are passed through a vein into the heart using X-ray guidance
- The pacemaker is connected to the leads and implanted under the skin
- The procedure typically takes 60–90 minutes
- Most patients can go home the same or next day
Recovery:
You’ll need to avoid heavy lifting or raising your arm fully on the side of the implant for a few weeks. Regular follow-up is essential to monitor the device’s settings and battery life.
Cardiac Resynchronisation Therapy (CRT)
CRT is a more advanced type of pacemaker, designed specifically for patients with heart failure and a delayed or uncoordinated heartbeat. Instead of one or two leads, CRT devices have three leads—one in the right atrium, one in the right ventricle, and one placed through a vein to stimulate the left side of the heart.
This coordinated stimulation helps both sides of the heart beat together, improving the heart’s efficiency and reducing symptoms.
CRT is recommended if you have:
- Heart failure with reduced pumping function (low ejection fraction)
- A specific ECG abnormality, such as left bundle branch block
- Symptoms despite medication, such as breathlessness or fatigue
The Procedure:
- Similar to a pacemaker but more complex due to the additional lead placement
- May take up to 2 hours
- You’ll stay in hospital for observation and device checks
- Echo and ECG may be repeated after a few months to assess improvement
CRT can improve quality of life, exercise tolerance, and in some cases, survival.
Conduction System Pacing (CSP)
Conduction system pacing is a newer, more natural method of pacing. Rather than stimulating the heart muscle directly (as in traditional pacing), CSP targets the heart’s native conduction system—the His bundle or left bundle branch—to activate the heart in a way that closely mimics normal physiology.
When is CSP used:
- As an alternative to traditional pacemakers
- In patients who require lifelong pacing
- When CRT leads cannot be positioned optimally
- For patients with bundle branch blocks or needing more physiological pacing
CSP may be delivered alone or as part of a CRT system (His-CRT or LBB-CRT). It requires specialist training and expertise, which Dr Monga can offer as part of your care.
Benefits of CSP:
- More natural heart activation
- Lower risk of pacing-related complications
- Improved heart function in selected patients
Your Care After the Procedure
Following implantation, you will have:
- A wound check and dressing change after 1 week
- Regular device follow-ups in clinic or via home monitoring
- Advice on physical activity, driving, and daily care
Most patients experience improvement in their symptoms and quality of life. If you have any questions or concerns, Dr Monga and her team are here to support you.
Further Information & Standards
For detailed patient information, British Heart Foundation (BHF) offers visually engaging, patient-focused resources on pacemakers and CRT, helping you understand how devices support your heart. Some useful resources can be found at the following links.
What is a Cardiac MRI?
Cardiac Magnetic Resonance Imaging (MRI) is a safe, non-invasive test that uses magnetic fields and radio waves to produce detailed images of your heart and blood vessels. It helps your doctor understand how well your heart is working and detect any abnormalities.
Why has my doctor requested this scan?
Your doctor may request a cardiac MRI to assess:
- Heart muscle function – checking for weakness or poor pumping
- Scarring or inflammation – often after a heart attack or myocarditis
- Heart structure – including chambers, valves, and blood vessels
- Blood flow and perfusion – especially in coronary artery disease
- Congenital heart conditions – if present from birth
This scan provides valuable information that other tests like echocardiograms or CT scans may not fully capture.
What is Gadolinium and why is it used?
Gadolinium is a contrast agent injected into a vein during the scan. It helps highlight areas of the heart muscle and blood vessels, making it easier to detect:
- Areas of scarring or fibrosis
- Regions with poor blood supply
- Signs of inflammation or damage
Before Your Scan
- Complete the MRI safety questionnaire.
- Avoid caffeine for 24 hours before your appointment.
- Remove all metal items (jewellery, watches, etc.).
- Wear comfortable clothing or a hospital gown will be provided.
During the Scan
- You’ll lie on a table that slides into the MRI scanner.
- ECG electrodes will be placed on your chest to monitor your heart.
- A small cannula will be inserted into a vein for the gadolinium injection.
- The scan may take 45 to 105 minutes.
- You’ll be asked to lie still and follow breathing instructions.
Is Gadolinium Safe?
Gadolinium is generally very safe. However, it may not be suitable if you:
- Have severe kidney problems
- Are pregnant or breastfeeding
- Have had a previous allergic reaction to contrast agents
Your doctor or radiographer will assess your suitability. A blood test may be done to check kidney function if needed.
Possible Side Effects
Most people do not experience any side effects. Rarely, you may notice:
- Mild nausea or headache
- Itching or rash
- Very rarely, allergic reactions (staff are trained to manage these)
After the Scan
- You can leave the department and resume normal activities.
- The results will be sent to your referring doctor, who will discuss them with you.