Permanent pacemaker

What happens during a permanent pacemaker procedure?

Your doctor will inject local anaesthetic into the chest wall. A small pocket will be made under the skin and electrodes (wires) will be introduced into the right side of the heart via a vein. The electrodes will be positioned under X-ray and tested.

The pacemaker is then attached and the skin is sealed with dissolvable stitches.

Why are permanent pacemakers used?

The heart consists of four chambers. The upper two chambers (atria) fill the lower chambers (ventricles) which pump blood to the lungs and body. The heart’s natural ‘beat’, the sino-atrial (SA) node, is located in the right atria.

In order for the heart to beat, this node sends regular impulses to the atria and stimulates the atria to contract and empty blood into the ventricles. The impulse then continues down a pathway to the atrio-ventricular (AV) node where the impulses spread down the ventricles causing the ventricles to contract and pump blood to the lungs and body.

A permanent pacemaker is required when there is a disturbance in the heart’s ability to transmit electrical impulses.

This may result in the heart beating too slow and/or too fast or irregularly. Disturbances in the rhythm of the heart can cause dizziness, fatigue, fainting spells or shortness of breath.

A permanent pacemaker delivers electrical impulses to the heart via one or two flexible insulated wires to restore normal function and rhythm.

How long does the procedure take?

A permanent pacemaker procedure normally takes about one hour.

How long will I be at the clinic for?

Most day stay patients (those not staying overnight) are normally at the clinic for at least six to eight hours from the time of admission to the time of discharge. However your cardiologist may require you to stay overnight. Your doctor will discuss this with you.

How do I prepare for a lead extraction procedure?

Provide informed consent

Your doctor will explain your procedure to you and answer any questions you may have. You will then be asked to sign a consent form. 

You will find a copy of the consent form below. Please download and read this document in advance of your visit. Your doctor will discuss this with you on your arrival, if they have not already done so.

Permanent Pacemaker Consent

Download Form

Biventricular Permanent Pacemaker Consent

Download Form

Permanent Pacemaker Generator Change Consent

Download Form

If you are not sure of the exact name of your procedure, please check with your doctor’s rooms. If you have any questions or concerns, or require any additional information about your procedure in advance of your visit, please let your doctor know.

If you have access to a printer, then please print your consent form and bring it with you on the day of your procedure. Otherwise we will provide you with a copy on the day to sign with your doctor.

If you have already signed the consent in your doctor’s rooms, then please disregard this instruction.

Contact us the day before your procedure

Please ring us between 12 noon and 3pm on the day before your procedure [tel: 02 9382 0700] to confirm your time of arrival, fasting and medication instructions. Please ring on a Friday if your procedure is on a Monday.

If you have special needs (these are outlined in the Before my visit patient guide) please let us know one week in advance of your visit.


All patients attending Eastern Heart Clinic are fasted prior to their procedure. Please follow the fasting instructions that are given to you when you ring us the day prior to your procedure.


  • All patients must cease solid food six hours before their admission time
  • All patients must cease clear fluids two hours before their admission time (note: clear fluids are NOT cloudy or milky drinks)
  • From two hours before your admission – nil by mouth

For example, if your admission time is 7:00 am (please tailor this to your admission time)

  • You can eat food up until 1:00 am
  • You can have clear fluids (water, black tea/coffee, clear juice etc) up until 5:00 am

We will confirm the time of your procedure and when you need to start fasting when you call the clinic the day before your procedure (please refer to our detailed instructions in the Before my visit patient guide).


Patients prescribed Warfarin

If you take the medication Warfarin you will need to consult with your referring cardiologist who will advise you if you need to stop taking your Warfarin three days before your procedure. Your cardiologist may also advise that you need to take a substitute anticoagulant (blood thinner). It is very important that you do not stop taking your Warfarin until you have discussed this with your cardiologist.

Patients prescribed Lasix

On the day of your procedure:

If your procedure is scheduled for before 12:00 pm: Withhold your Lasix and bring in your tablets so staff can give them to you after your procedure

If your procedure is scheduled for after 12:00 pm: you may take your Lasix

Patients with diabetes        

If you are prescribed insulin we suggest you take half your regular insulin dose on the day of your procedure. Remind the booking staff that you are on insulin and we will attempt to schedule your procedure as early as possible.

Insulin dependent (IDDM):  You should take half (½) of your regular insulin dose (please bring in insulin)

Non-insulin dependent (NIDDM) – tablet controlled: You should continue your medication as normal

Non-insulin dependent (NIDDM) – diet controlled: Fast as per the instructions above

Other medications

Oral Sodium Glucose Inhibitors

If you take any of the following medication – Forxiga, Xigduo, Qtern, Jardiance, Jardiamet, Glyxambi, Steglatro, Segluromet, Steglujan – please contact Eastern Heart Clinic for instructions prior to your procedure.

Aspirin, Plavix, Prasugrel, Ticagrelor, Pradaxa, Apixaban, Rivaroxaban

Your cardiologist will provide advice regarding if and when to stop other medication. All other medications include Aspirin, Plavix, Prasugrel, Ticagrelor, Pradaxa, Apixaban, Rivaroxaban. 

We will discuss your medications with you when you call the clinic the day before your procedure (please refer to our detailed instructions in the Before my visit patient guide).

Skin and nails

There are no special requirements before your procedure in terms of skin care, so just shower or bath as usual. However, please do not wear nail polish to your appointment.

What to bring

Please bring your current medications as well as any blood results. Please read our patient guide Before my visit for other items to bring with you on the day, and for how to prepare for your procedure.

Can I drive (or fly) afterwards?

You are advised not to fly for 24 hours after your procedure. Please arrange for someone to drive you home if travelling by car, or to accompany you if you are travelling by taxi or Uber.

Please note that some airlines place restrictions on patients flying after certain procedures. Our staff will be able to provide you with guidance and advice.

As a general rule, you should not drive for at least two weeks following the implantation of your pacemaker. This is to ensure that the leads have had time to become fixed into position. It is important that you abide by your surgeon’s instructions about when you can return to driving as there may be legal implications if you have an accident even if you are not the driver at fault.

What do I need to do after discharge?

​Please make arrangements to have someone at home with you (overnight) on the day of your discharge in the rare event that you need assistance or support.

You can read more about your discharge care in our patient guides: Day of my procedure and After my visit.

What if I have questions or concerns?

If you have any questions about your forthcoming procedure, please contact your referring cardiologist or Eastern Heart Clinic on tel: 02 9382 0700.

What will happen before, during and after my procedure?

For a detailed overview of how to prepare for your procedure and what to expect before, during and after your visit to Eastern Heart Clinic, please read the following patient guides:


Before my visit


Day of my procedure


After my visit