At a glance
Pacemaker implantation is a surgical procedure in which a small battery-powered device is placed under the skin of the chest to control an abnormally slow or irregular heartbeat.
The heart beats because of electrical signals that travel through its muscle. When those signals are too slow, too irregular, or blocked, the heart cannot pump blood efficiently. A pacemaker sends tiny, timed electrical pulses through thin wires called leads, which are threaded into the heart through a vein. These pulses prompt the heart to beat at a safe, steady rate. The device monitors every heartbeat and only fires when the natural rhythm falls below the target set by the doctor.
Medical Condition
Doctors recommend a pacemaker when the heart's electrical system can no longer keep the heart beating fast enough or steadily enough to meet the body's needs.
- Bradycardia (a resting heart rate that is persistently too slow), causing dizziness, fainting, or extreme fatigue
- Sick sinus syndrome, where the heart's natural pacemaker node fires irregularly or too slowly
- Heart block (a delay or interruption in the electrical signal traveling from the upper to the lower chambers of the heart)
- Atrial fibrillation (a rapid, disorganised rhythm in the upper chambers) combined with a slow ventricular rate
- Fainting episodes (syncope) confirmed to be caused by an electrical problem in the heart
- Heart failure in certain patients, where a special biventricular pacemaker helps both sides of the heart contract together
A pacemaker is not suitable for every slow or irregular rhythm. Doctors will not recommend it when the slow heartbeat has a reversible cause, such as a medication effect, an underactive thyroid, or an electrolyte imbalance, because treating the underlying cause is the right first step. Patients with active infections near the implant site may also need to wait until the infection has cleared.
- Slow heartbeat caused by a medication that can be adjusted or stopped
- Hypothyroidism (underactive thyroid gland) not yet treated
- Electrolyte imbalance affecting heart rhythm that has not been corrected
- Active skin or bloodstream infection that raises the risk of device infection
Risks & Complications
Pacemaker implantation is generally well tolerated, but like any surgical procedure it carries recognised risks that the care team will discuss with you beforehand.
- Bruising, swelling, or pain at the incision site, which usually settles within a few weeks
- Bleeding around the device pocket (the small space under the skin where the pacemaker sits)
- Infection of the wound or the device itself, which may require antibiotics or, in serious cases, removal of the device
- Lead displacement (the wire shifting out of position inside the heart), sometimes needing a repeat procedure to reposition it
- Pneumothorax (collapsed lung) caused by accidental puncture of the lung during lead placement, more common when the vein beneath the collarbone is used
- Haematoma (a collection of blood) forming under the skin near the device
- Cardiac perforation (a small hole in the heart wall), a rare but serious complication requiring prompt treatment
- Pacemaker malfunction over time, including battery depletion, which is managed by a routine generator replacement procedure
- Twiddler's syndrome, where repeated movement of the device under the skin loosens the leads
- Interference from strong electromagnetic fields (such as certain industrial equipment or MRI machines without MRI-conditional settings), though modern devices are designed to minimise this risk
Preparation & Procedure
Preparation for pacemaker implantation usually begins several days before the scheduled date and involves adjustments to food, drink, and certain medications.
Most hospitals ask patients to stop eating and drinking, including water, for at least six hours before the procedure. If you take blood thinners, your doctor will decide whether to pause them for a few days beforehand to lower the bleeding risk. Patients on diabetes medications need specific guidance because fasting affects blood sugar. Smoking and alcohol are best avoided in the days before surgery, as both can affect healing and the response to sedation.
Several tests are usually arranged in advance to help the team plan the procedure and confirm that your heart and body are ready. Common pre-procedure tests include an electrocardiogram (EKG, a recording of the heart's electrical activity), a chest X-ray, blood tests to check kidney function and clotting, and sometimes an echocardiogram (echo, an ultrasound scan of the heart). The team will also review all medications you take regularly.
On the day itself, the procedure typically follows a sequence similar to this, though your hospital may do things in a slightly different order:
- You change into a hospital gown and a nurse places an intravenous (IV) line in your arm for fluids and medication
- The skin below your collarbone (usually the left side) is shaved, cleaned, and numbed with a local anaesthetic injection
- You receive sedation through the IV line to keep you calm and comfortable; general anaesthesia is rarely needed
- The surgeon makes a small incision (cut) just below the collarbone
- One or more leads are guided through a vein into the correct chamber or chambers of the heart, with X-ray imaging (fluoroscopy) used to see their position
- Each lead is tested to confirm it is sensing and pacing correctly
- The pacemaker generator (the battery and computer unit) is connected to the leads and placed in the pocket created under the skin
- The incision is closed with stitches or staples and covered with a sterile dressing
- You are moved to a recovery or monitoring area where the team checks the device and your heart rhythm
Aftercare
Most patients spend at least one night in hospital after pacemaker implantation so the team can monitor the device and check for any early complications before discharge.
- Heart rhythm monitoring continues overnight and the device is checked with an external programmer before you leave
- The arm on the side of the implant is typically kept below shoulder height for several weeks to allow the leads to settle firmly in place
- Heavy lifting, overhead reaching, and vigorous upper-body activity are usually restricted for four to six weeks, though your doctor sets the exact timeline
- The wound site should be kept clean and dry; bathing or swimming instructions vary by hospital, so follow the specific guidance you receive
- Driving is restricted for a period that depends on local regulations and your underlying heart condition
- You will be given a pacemaker identification card to carry at all times, which contains information about the device model and settings
- A follow-up check, usually within a few weeks, confirms that the device is working correctly and allows the doctor to adjust its settings if needed
- After the initial recovery period, regular pacemaker clinic visits (often every six to twelve months) are arranged to monitor battery life and device function
- Notify airport security and medical staff about the device before any scan or procedure, as certain equipment can interfere with pacemaker function
- Lifestyle changes such as managing blood pressure, staying active within the limits set by your doctor, and avoiding tobacco support long-term heart health
Cost & What Determines It
The cost of pacemaker implantation varies widely from country to country and from hospital to hospital, because it depends on several factors that are specific to each patient and each facility.
- Type and complexity of the pacemaker: a single-chamber device costs less than a dual-chamber one, and a biventricular device for heart failure is the most complex and expensive option
- Brand and generation of the pacemaker generator and leads, as newer models with longer battery life or MRI-conditional features carry a higher price
- Hospital class: a private tertiary hospital or an internationally accredited centre charges more than a public or district hospital for the same device
- Country of treatment: hospital fees, surgeon fees, and operating-room costs differ substantially across regions, which is why medical travel can result in significant savings
- Length of hospital stay, including whether complications extend the stay beyond the standard one to two nights
- Anaesthesia and monitoring fees during the procedure
- Pre-procedure tests such as EKG, chest X-ray, blood work, and echocardiogram
- Post-procedure medications such as antibiotics or blood thinners prescribed at discharge
- Follow-up device checks and pacemaker clinic visits after discharge
A hospital package for pacemaker implantation typically covers the surgeon's fee, operating room use, the device and leads themselves, standard nursing care during the hospital stay, and one or two follow-up visits. Items that are often billed separately include pre-admission tests, additional specialist consultations, extended stay due to complications, and ongoing medication costs after discharge.
BPJS Kesehatan does not cover treatment received abroad, and most Indonesian private insurance policies have the same limitation. Patients who travel overseas for this procedure almost always pay out of pocket or through a private international health insurance plan that explicitly covers overseas procedures. Requesting a detailed written cost estimate from the hospital, covering the device, the procedure, and the aftercare, before booking your travel is the most reliable way to avoid unexpected bills.
Frequently Asked Questions
How long does pacemaker implantation surgery take?
The procedure usually takes between one and two hours, though the exact time depends on the type of pacemaker being placed and your heart's anatomy. You will typically spend at least one night in hospital so the care team can monitor your heart rhythm and check the device is working correctly.
Will I feel pain during or after pacemaker surgery?
The surgery is done under local anaesthesia, meaning the chest area is numbed so you stay awake but feel no pain at the incision site, though some patients also receive sedation to help them relax. Afterwards, soreness and some bruising around the small wound on your chest are normal for a week or two, and doctors typically provide pain relief to keep you comfortable during that time.
How much does pacemaker implantation cost?
The cost varies depending on the type of pacemaker device chosen, the class of hospital room, and the length of your stay. A single-chamber pacemaker is generally less expensive than a dual-chamber or biventricular device, since the hardware itself makes up a large part of the total bill. Requesting a written estimate from the hospital before your procedure is the most reliable way to understand what you will actually pay.
What warning signs should I watch for after going home?
Contact your medical team promptly if you notice swelling, redness, or fluid leaking from the wound, or if you feel dizziness, chest pain, or a noticeably irregular heartbeat after leaving hospital. These could be signs of infection or a problem with the device's settings, both of which a cardiologist needs to assess quickly. Mild tiredness and some discomfort around the implant site are expected in the first week, but anything that feels sudden or severe should not be waited out.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
