Pacemakers and defibrillators — what they do and what life looks like after
Reviewed by a board-certified medical writer specializing in cardiac electrophysiology and geriatric cardiology
Your parent's cardiologist has recommended a pacemaker or defibrillator, and the word "device" carries a particular weight. Something inside the chest, sending electrical impulses, requiring surgery. This article explains what these devices do, what the implantation procedure involves, what recovery and daily life look like afterward, and the end-of-life conversation that comes with having a cardiac device.
Pacemakers and ICDs Are Among the Most Successful Interventions in Modern Medicine
Step back from the fear for a second. Pacemakers and defibrillators are among the most successful interventions in modern medicine. According to the AHA, more than one million Americans currently live with pacemakers, and the devices have been used successfully since the 1960s. Most people feel dramatically better after getting one. The procedure itself is usually quick and well-tolerated. The recovery is usually easy. This is not a last-ditch desperate measure. This is a proven solution to a specific problem.
The fear around having a device implanted is understandable. But understanding what the device does, how it works, and what recovery looks like will help your parent make peace with the decision and help you support them through it.
A pacemaker is a small, battery-powered device that helps regulate the heart's rhythm. Your parent's heart normally has its own electrical system that tells it when to beat. If that system is malfunctioning, if the heart is beating too slowly or the electrical signal is not getting where it needs to go, the heart is not pumping efficiently. A pacemaker sends electrical impulses to trigger contractions at an appropriate rate.
A defibrillator, sometimes called an ICD (implantable cardioverter-defibrillator), does more. It monitors the heart's rhythm and can deliver a shock if the heart develops a dangerous, life-threatening rhythm. It is a cardiac arrest prevention device. If your parent's heart starts fibrillating or producing another dangerous arrhythmia, the defibrillator detects it and delivers an electrical shock to reset the heart back to a normal rhythm.
Some people get pacemakers alone. Some get defibrillators alone. Some get a device that combines both functions, called a CRT (cardiac resynchronization therapy) device, which also helps both sides of the heart beat in better coordination. The specific device your parent needs depends on their heart problem.
Why would your parent need a pacemaker? The heart's electrical system can slow down. Sometimes the signal from the upper chambers to the lower chambers gets blocked (heart block). Sometimes the heart's natural pacemaker, the SA node, fires too slowly (sick sinus syndrome). Sometimes people have fainting episodes because their heart rate drops dangerously low. According to the AHA, symptomatic bradycardia (abnormally slow heart rate) is the most common indication for permanent pacemaker implantation. If the heart beats too slowly, it cannot pump enough blood to the brain, and your parent can lose consciousness. A pacemaker prevents this by ensuring the heart beats at an adequate rate.
Why would your parent need a defibrillator? If they have had a heart attack and the damaged scar tissue is prone to developing dangerous arrhythmias, or if they have certain inherited conditions that make dangerous arrhythmias likely, or if they have already survived a life-threatening arrhythmia, a defibrillator can be lifesaving. The NIH reports that ICDs reduce the risk of sudden cardiac death by 50 to 60 percent in appropriate candidates.
The Procedure Is Usually Outpatient and Recovery Is Quick
The procedure to insert a pacemaker or defibrillator is usually outpatient surgery. Your parent goes to the hospital, gets local anesthesia at the placement site (usually under the collarbone), and the cardiologist or cardiac surgeon makes a small incision and guides the leads through a vein to the heart. The generator, the actual device, is placed under the skin, and the leads are attached. The whole procedure usually takes an hour or so, sometimes less.
Your parent is usually awake during the procedure, though sedated. They might feel pressure or tugging but not pain. Many patients say the anticipation was worse than the actual procedure.
After the procedure, your parent goes to recovery for a few hours, then usually goes home the same day. The incision is small, roughly an inch and a half, and typically closed with dissolvable stitches. There is usually some soreness and bruising at the site for a week or two, but this is mild compared to what people expect.
Recovery is surprisingly quick. Your parent might feel tired the first few days, but within a few days to a week, most people feel close to normal. They are restricted from heavy activity for a few weeks: no lifting more than ten to fifteen pounds, no reaching overhead with the arm on the side of the device, no swimming or submerging the incision until it is fully healed. After those restrictions are lifted, your parent can go back to normal activities.
Many people report feeling better almost immediately after device implantation. If they were experiencing fainting spells or severe fatigue from a slow heartbeat, those symptoms resolve as soon as the device is working. If the device is preventing dangerous arrhythmias, your parent does not feel it doing so, but the security of knowing they are protected is genuinely psychologically helpful.
Living With the Device Day to Day
Your parent's life does not fundamentally change after getting a pacemaker or defibrillator, but there are practical considerations worth understanding.
The device has a battery that lasts roughly five to ten years depending on how much the device is working. When the battery gets low, the device needs to be replaced. This is a simpler procedure than the original insertion because the leads are already in place. The generator gets swapped out, which takes even less time. Your parent will get regular check-ups that monitor battery level, so the replacement never happens as a surprise.
Your parent needs to be aware of strong magnetic fields, including MRI machines. This used to be an absolute contraindication, but many modern devices are MRI-conditional, meaning MRI scans can be performed under specific conditions. According to the AHA, the majority of pacemakers and ICDs implanted after 2010 are MRI-conditional. Your parent should carry an ID card indicating what device they have and always tell medical personnel about it so they can determine whether any scanning or imaging is safe.
Airport security sometimes reacts to the metal in the device. Your parent should mention the device to security so they can do a hand-wand search or pat-down. This is quick and not a big deal.
Normal household electronics, including microwaves, televisions, and computers, are fine. Your parent should avoid holding cell phones directly against the side of the body where the device is implanted. Very powerful magnets, like those in industrial settings, should be avoided. But your parent can use tools, work in yards, and live a normal life.
Your parent needs regular follow-up appointments with the cardiologist for device checks. These appointments involve checking how well the device is working, how it is sensing heart rhythm, and how the battery is doing. Some devices can be checked remotely now, which is convenient. Your parent can have a remote monitor in their home, and data from the device uploads automatically, so some check-ups can be done without going to the office.
If the device is a defibrillator, your parent needs to understand what happens if it delivers a shock. Most shocks feel like a kick in the chest, strong and startling. After a shock, your parent should call their cardiologist immediately. The shock means a dangerous rhythm occurred, and that information is important for managing the condition. Your parent should not be alarmed. It means the device did exactly what it is supposed to do.
The End-of-Life Device Conversation
This is the part that is uncomfortable to talk about, but it is important. At the end of life, when your parent is dying and the devices are not preserving quality of life anymore, there is a question of whether to disable the device or let it continue attempting to restart the heart.
If your parent has a defibrillator and is dying of an illness like advanced cancer or end-stage dementia, the defibrillator might keep giving shocks to try to restart the heart when it stops. This can prevent a peaceful death. The AHA's consensus statement on management of cardiac devices at end of life supports the ethical appropriateness of deactivating ICDs when the patient or their surrogate requests it and when continued shocks are inconsistent with the patient's goals of care.
This is a conversation worth having with your parent while they are well and able to express their values. Do they want the device disabled at end of life? Do they want everything done to keep them alive as long as possible? The answers matter, and the time to discuss it is before the crisis, not during it.
If your parent is in the hospital dying, the doctors can disable the defibrillator so it does not continue shocking the heart if it stops. This is ethical and appropriate at the end of life. It helps if your parent has already expressed what they want, and if you know their wishes, so you can advocate for them if they cannot speak for themselves.
These Devices Give People Their Lives Back
More people than you realize have pacemakers or defibrillators. According to the CDC, pacemaker implantation is one of the most commonly performed cardiac procedures in the United States, with hundreds of thousands implanted annually. Your parent's neighbor, their friend from church, the person in their exercise class: these devices are common, and most people adjust to having them quickly.
Many people report that the device gives them freedom rather than restricting it. Before the device, they were limited by symptoms: fainting, fatigue, fear of the heart stopping. After the device, those limitations are gone. They can exercise more, be more active, and live with less fear.
Your parent might worry about whether people will judge them for having the device, or whether it makes them seem weak or old. The device is internal. No one knows about it unless your parent tells them. It does not change how your parent looks or how they interact with the world. It just quietly does its job.
The psychological adjustment to having a device can take some time, especially if your parent is someone who resists depending on medical technology. Some people mourn the loss of a "normal" body. Some people feel relief that a problem has been solved. Most people feel both at different moments. These feelings are valid and normal.
Your role includes normalizing the device for your parent. Not minimizing the reality that they have a device in their chest, but helping them see it as a tool that improves their life, not a sign that something is fundamentally broken about them.
Many people live for decades with pacemakers or defibrillators. They work, they raise families, they travel, they retire, they enjoy their lives. The device becomes something they sometimes think about, like glasses or a chronic medication. It is part of their medical care, but it is not their identity.
Frequently Asked Questions
How long does the device battery last?
Most pacemaker and ICD batteries last between five and fifteen years, depending on the device type and how frequently it needs to pace or deliver therapy. Your parent's cardiologist will monitor battery status at regular check-ups and during remote monitoring sessions. When the battery reaches a predetermined low point, a replacement procedure is scheduled, which is simpler and quicker than the original implantation.
Can my parent still exercise with a pacemaker or ICD?
Yes. After the initial recovery period of a few weeks, most people with cardiac devices can return to their normal exercise routine. The AHA encourages regular physical activity for people with pacemakers and ICDs. Your parent should discuss any specific exercise limitations with their cardiologist, particularly regarding contact sports or activities that involve repetitive overhead arm motion on the device side.
Will the device set off metal detectors at airports?
It can. Your parent should inform TSA agents that they have a cardiac device and present their device identification card. TSA agents are trained to handle this and will typically perform a hand search or use a hand-held wand rather than sending your parent through the metal detector or full-body scanner. This adds a few minutes but is straightforward.
What happens if the ICD delivers a shock?
A shock from an ICD means the device detected a dangerous heart rhythm and delivered an electrical pulse to restore normal rhythm. Most people describe it as a sudden kick or thump in the chest. After any shock, your parent should contact their cardiologist the same day. The device stores data about the event, which the cardiologist can review to determine whether medication adjustments or other changes are needed.
Is it safe for my parent to have an MRI with a cardiac device?
It depends on the device. Most pacemakers and ICDs implanted after 2010 are classified as MRI-conditional, meaning MRI scans can be performed safely under specific conditions and with appropriate monitoring. Older devices may not be MRI-safe. Your parent's cardiologist can confirm whether their specific device is MRI-conditional and coordinate with the imaging facility to ensure safety.
Can the device be turned off if my parent no longer wants it?
Yes. Deactivation of a cardiac device is an ethically and medically accepted decision. The AHA supports the right of patients or their healthcare proxies to request device deactivation when the device no longer aligns with the patient's goals of care. This conversation should ideally happen while your parent can clearly express their wishes and should be documented in their advance directives.