Heart and vascular surgery · Saint Petersburg
Pacemaker Implantation
A modern treatment for bradycardia and cardiac conduction disorders
Free under CHI and federal quotas
when indicated and with a referral
Text reviewed by Anton Sheremet, arrhythmologist, cardiac surgeon
What a pacemaker is and who needs one
Pacemaker implantation is a minor operation: a pacemaker is placed under the skin or muscle below the collarbone, and its leads are passed through a vein into the heart. A pacemaker is implanted in patients with certain types of bradycardia and disorders of electrical impulse conduction in the heart. The most common indications are sinus node dysfunction and atrioventricular block. The decision takes into account the type of conduction disorder, symptoms, ECG results and other tests. At Pirogov Clinic in Saint Petersburg it is done under local anesthesia.
A pacemaker is a small device that helps the heart beat correctly when its natural rhythm is too slow. If symptoms are caused by bradycardia, pacing can prevent the fainting it causes and reduce dizziness, weakness, shortness of breath and other effects of a slow rhythm.
The main goal of pacemaker implantation is to maintain the required heart rate in bradycardia and conduction disorders. Today millions of people around the world live with pacemakers, maintaining good health and physical activity.
Pacemaker implantation in numbers
- operation time
- ~1 hour
- anesthesia
- Local
- in hospital
- 3–4 days
- device check-ups
- 3, 6, 12 months
When a pacemaker is needed
A pacemaker is recommended for bradycardia — a slow pulse that can manifest as:
- Constant fatigue and weakness
- Dizziness or near-fainting episodes
- Fainting
- Shortness of breath even with minimal exertion
Symptomatic bradycardia can be caused by sinus node dysfunction, atrioventricular block and other disorders of impulse formation or conduction. In some conditions what matters is whether the slow rhythm or pauses are linked to the patient’s symptoms; in certain types of AV block a pacemaker may be needed even without marked complaints. An arrhythmologist determines the indications after reviewing the ECG and test results.
Tests and preparation before pacemaker implantation
To confirm the diagnosis, the patient undergoes:
- Electrocardiography (ECG)
- 24-hour Holter ECG monitoring
The scope of testing depends on the rhythm disorder and the clinical situation. Once bradycardia is documented on an ECG or with Holter monitoring, the physician looks for reversible causes, including the effect of medications and certain metabolic disorders, and only then decides on implantation and chooses the type of device.
How pacemaker implantation is performed
The procedure is done under local anesthesia and takes about one hour.
A small incision under the collarbone
Under local anesthesia a small incision is made in the right or left subclavian area.
Placing the leads in the heart
One, two or three leads, depending on the type of pacemaker, are passed through a vein into the heart under X-ray guidance.
Connecting the pacemaker
The lead is positioned in the selected area of the heart and its parameters are checked. The number and position of the leads depend on the type of device and the clinical goal. The leads are connected to the pacemaker, which is placed under the skin or muscle.
Adjustment and testing
The device is adjusted and its function is tested.
At our clinic the operations are performed by experienced specialists — top-category physicians, candidates and doctors of medical sciences, trained at leading medical centers in Europe and Asia.
Recovery and life with a pacemaker
- The patient usually stays in hospital for 3–4 days
- Before discharge, doctors recheck and fine-tune the device
- For 4–6 weeks it is important to limit strain on the arm on the pacemaker side
- Regular follow-up visits are required — after 3, 6 and 12 months
Each patient receives personalized recommendations, a device card and passport, and the opportunity for long-term observation and support.
A pacemaker allows patients to return to their normal lives — walking, exercising (with a doctor’s approval), traveling and driving. For most people it is a reliable way to maintain heart health and well-being for many years.
Your physician gives individual advice on physical activity and the device check-up schedule.
Doctors who perform pacemaker implantation
Free under CHI and federal quotas
At Pirogov Clinic pacemaker implantation is performed free of charge under the CHI policy and federal quotas for high-tech medical care, when indicated and with a referral. Our administrators will help you arrange the quota and prepare the documents.
Questions about pacemaker implantation
A pacemaker is implanted for certain types of bradycardia and disorders of electrical impulse conduction in the heart, most often sinus node dysfunction and atrioventricular block. An arrhythmologist decides based on the type of disorder, symptoms, ECG results and other tests. In certain types of AV block a pacemaker may be needed even without marked complaints.
The operation is done under local anesthesia and takes about an hour. A small incision is made under the collarbone, the leads are passed through a vein into the heart under X-ray guidance, connected to the pacemaker, and the device is placed under the skin or muscle. Finally, it is adjusted and tested.
The incision area is numbed with local anesthesia during the operation. For a few days afterwards there may be moderate discomfort around the incision, which goes away on its own.
Patients usually stay in hospital for 3–4 days. Before discharge, doctors recheck and fine-tune the device.
There are different types of pacing systems. They differ in the number and position of leads, the pacing mode and additional functions. In some situations cardiac resynchronization therapy devices, conduction system pacing or devices with a defibrillation function are used. The physician chooses the best option based on the rhythm disorder, the condition of the heart and the patient’s individual characteristics.
The battery usually lasts several years, on average 7–10, depending on the model and how often the pacemaker works. When it runs down, the device itself is replaced. The pacemaker is checked at scheduled visits, so the time for replacement is known in advance.
When the battery runs down, the pacemaker body is replaced. Working leads are kept if they can stay. The physician decides on the scope and timing of the procedure after checking the device.
For the first 4–6 weeks, limit strain on the arm on the pacemaker side: do not lift heavy objects or raise the arm sharply above the head. Do not hold phones or magnets right against the device, and keep to the check-up schedule. Your physician will give other recommendations.
Whether an MRI is possible depends on the entire implanted system — the pacemaker and the leads. Many modern systems allow MRI under certain conditions. Before the scan, the device must be checked and set up accordingly.
Yes. Show your pacemaker patient card at security. Hold the phone to the ear on the opposite side and do not carry it in a breast pocket over the device.
Most patients return to their normal lives: they walk, travel, drive and exercise. Agree on the type and intensity of exercise with your physician.
Check-ups are usually 3, 6 and 12 months after the operation, then on the physician’s schedule. The battery charge and lead function are checked and the settings are adjusted if needed.
Yes. At Pirogov Clinic implantation is performed free of charge under CHI and federal quotas when indicated and with a referral. The step-by-step route is described in How to get care at the Center.
Conditions it treats
- Sick sinus syndromeThe sinus node sends impulses too rarely, at intervals that are too long or irregular.
- Atrioventricular blockA failure of electrical signal conduction in the heart from the atria to the ventricles.
- BradycardiaA pulse that is too slow, causing weakness, dizziness, shortness of breath or fainting.
Related procedures and diagnostics
Patient reviews
Patients tell about their treatment at our center — reviews that mention “Pacemaker implantation”: 8 reviews. The latest are below.
I was admitted to the department as planned for pacemaker replacement. Cardiologist Nikita Sergeyevich Remizov was assigned as my attending physician. From the first days of my stay in the department, the doctor made a very good impression. Nikita Sergeyevich was attentive to my condition, regularly asked how I was feeling, and explained in detail every stage of the treatment and the upcoming procedure. I would especially like to note how calmly and clearly he explains everything. He answers questions, does not rush, and makes sure that the patient truly understands what is being done and why. Before my pacemaker replacement, it was especially important for me to feel calm and confident. Thanks to the doctor’s attentive approach, I did not experience unnecessary anxiety and understood that I was under the care of a competent specialist. My treatment fully met my expectations. The procedure went well, and I am feeling well after the treatment. I am very grateful to Nikita Sergeyevich for his professionalism, attentiveness, patience, and humane attitude. Among his strengths, I would especially note his competence, responsibility, kindness, and ability to communicate with patients. I did not notice any shortcomings in the doctor’s work. Many thanks to Nikita Sergeyevich for his work and care! I wish him professional success, good health, and many grateful patients. It is very reassuring when your attending physician inspires trust and confidence.
Anonymous
Review of the doctorNikita RemizovCardiologistI came to Pirogov Clinic for a pacemaker implantation and was treated by Dr. Anton Andreevich Sheremet, who also performed my surgery. Dr. Sheremet was patient, thorough, and provided exceptional care. I highly recommend both the clinic and him! A huge thank you to the entire team for their support, especially Dr. Sheremet.
Anonymous
Review of the doctorAnton SheremetArrhythmologist, Cardiac SurgeonOn January 21 and 24, 2025, I underwent heart surgery in the Center of Cardiac Surgery. Many and warm thanks to my attending physician, Ilshat Asadullin Shamilevich. He is a highly professional in his field and a wonderful soul person. A calm, patient doctor. Initially, a completely different treatment was planned. During the operation, he decided to change the type of surgery and performed it brilliantly. Having correctly assessed my condition, a pacemaker was additionally installed. From the first to the last step in the department, I felt his care and desire to help. He visited me many times a day in the intensive care unit and ward, told me what was happening to me. He considered it necessary to call my son to me, for which I would like to thank him very much. He didn't discharge me until he was sure I was able to move on. Upon discharge, he gave many explanations and recommendations. He explained which medications and how I should take them in the future. He gave good advice for the future, and allowed me to contact him in case of problems. There just aren't enough words to express all my feelings. Thank you many, many times! I can't help but thank Maxim Sergeevich Kamenskikh, head of the department, and Anton Andreevich Sheremet, doctor, and all the staff of the Center of Cardiac Surgery and Intensive Care for their excellent work, responsiveness, participation, care and kindness!
Anonymous
Review of the doctorIlschat AsadullinCardiovascular SurgeonI, Vladimir V. Filimonov, have a bunch of heart diseases, I have been admitted to the Pirogov clinic more than once for the step-by-step treatment of the identified disease manifestations, and I have once again been admitted for a previously planned RF operation, which was successful. Before that, there was stenting, bypass surgery, an EX was installed, and Maria V. Starosotskaya was the attending physician every admission.
Vladimir F.
Review of the doctorMaria StarosotskayaCardiologistBased on the results of the tests, I was sent to Anton A. Sheremet, who programmed the pacemaker he had installed earlier. At the same time, as in previous receptions, he was as correct as possible, gave full information on emerging issues, clarified identified health problems, and promptly responded to all the wishes and complaints of the patient.
Anonymous
Review of the doctorAnton SheremetArrhythmologist, Cardiac SurgeonHow to get care at the Center
- Free under CHI and quotasStep-by-step guide: which documents you need and how to get treatment free of charge.Learn more
- Choose your surgeonSupport program: your operation is performed by the cardiac surgeon you choose.Learn more
- Online expert opinionAn online talk with a cardiologist about your documents — for patients from other cities.Learn more
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