For most of your life, your heart’s electrical system works without ever asking for your attention. Then something shifts: you come over faint in a queue, or your GP notices your pulse is slower than it should be. For thousands of people in Ireland, the answer is a small device implanted below the collarbone, quietly correcting a rhythm that has stopped correcting itself. Being told you need one can feel like a line has been drawn between the person you were and the patient you are now. It rarely turns out that way.
TL;DR
- Pacemakers treat a heart that beats too slowly; ICDs stop a dangerously fast rhythm. CRT devices resynchronise the pumping chambers in some people with heart failure.
- Implantation is done under local anaesthetic with sedation, takes about an hour, and is often a day case.
- The key recovery rule is arm care: nothing above shoulder height on the device side for four to six weeks, while still moving the shoulder daily.
- Irish driving rules differ by device. Under Sláinte agus Tiomáint, a pacemaker generally means one week off driving; ICDs mean one or six months depending on why it was fitted.
- Everyday electronics are mostly fine. Keep phones and magnets about 15cm away, stand back from induction hobs, and always tell radiography staff before an MRI.
Why heart rhythm changes with age
The heart has its own wiring, and over decades that conducting tissue accumulates fibrosis. The signal can slow, stutter or drop altogether, showing up as sick sinus syndrome or as heart block. The symptoms are easy to mistake for ordinary ageing: fatigue that rest does not fix, breathlessness on mild exertion, light-headedness on standing, or blackouts with no warning.
Research from The Irish Longitudinal Study on Ageing (TILDA) has repeatedly highlighted how often falls and faints in older adults have an unrecognised cardiovascular cause. An unexplained blackout deserves a proper cardiac assessment, not a shrug and a bruise.
The devices, plainly explained
Pacemakers watch the heart and deliver a tiny impulse whenever the rate drops below a set threshold. The pulses are painless and you will not feel the device working.
ICDs do all of that, but also watch for dangerously fast rhythms from the lower chambers, trying painless rapid pacing first and a shock only if that fails. They are fitted either after someone has survived a life-threatening arrhythmia (secondary prevention) or because a weakened heart muscle puts them at high risk (primary prevention). That distinction matters enormously for driving.
The day itself, and the first six weeks
Implantation is a procedure rather than open surgery. You are usually awake but sedated, with local anaesthetic below the collarbone. The leads are threaded through a vein to the heart under X-ray guidance and the generator sits in a pocket under the skin. You will go home with a device identification card. Carry it: airport staff, radiographers and any emergency team will want to see it.
Keep the wound clean and dry. Device infection is uncommon but serious, so spreading redness, swelling, discharge or a temperature means ringing your clinic the same day.
The arm advice trips people up because it pulls in two directions. Avoid raising the arm on the device side above shoulder height, and avoid heavy lifting, for four to six weeks so the leads can settle. At the same time, keep moving the shoulder gently every day. Protect it too rigidly and you can end up with a frozen shoulder, which takes far longer to fix than the implant did.
Driving: know which rules apply to you
Ireland’s medical fitness to drive standards are set out in Sláinte agus Tiomáint, published by the Road Safety Authority with the National Office for Traffic Medicine, and the responsibility to comply sits with you. For car licences, a new pacemaker generally means one week off driving. For an ICD fitted as primary prevention it is a month; fitted after a cardiac arrest or a dangerous rhythm, or following a shock, it is usually six months. Bus and truck standards are stricter, and an ICD is a permanent bar. These rules are revised periodically, so confirm the current position with your cardiologist before driving again, and check whether your insurer needs telling.
The everyday questions
Phones, gadgets and the kitchen. Smartphones, wireless chargers and magnetic phone accessories contain magnets strong enough to switch a device temporarily into a test mode. Keep them roughly 15cm away and never carry a phone in a breast pocket over the generator. Ordinary appliances are fine, but stand back from an induction hob rather than leaning over it.
Airports, shops and scans. Show your device card, walk through security archways at a normal pace without stopping, and ask for a hand search rather than a wand passed over the device. Most devices fitted in recent years are MR-conditional, meaning an MRI can be done safely with the right protocol, but never assume it. Tell the radiographer every time.
Exercise and intimacy. Once the wound has healed and the arm restriction has passed, walking, swimming, cycling and gardening are all encouraged. Sexual activity is safe, and worrying that it is not causes far more harm than the activity ever will.
Check-ups, batteries and shocks
You will be followed at a hospital device clinic, increasingly with remote monitoring that sends readings to your team overnight. Pacemaker batteries typically last seven to fifteen years, ICD batteries less. Nothing runs out suddenly: the clinic sees the decline months ahead and schedules a generator change.
An ICD shock is startling, often described as a sudden thump in the chest. One shock with no other symptoms means ringing your device clinic that day. More than one shock, or feeling unwell, breathless or faint, means calling 112 or 999. Tell the people you live with that if they are touching you during a shock they may feel a mild tingle, and it will not harm them.
The part that gets least attention
Adjusting emotionally is a real part of this. A significant minority report anxiety after an ICD in particular, sometimes avoiding exercise or intimacy in case it triggers a shock. That reaction is common and treatable, and cardiac rehabilitation through HSE hospitals, the Irish Heart Foundation and Croí is built for exactly this: supervised exercise where you rebuild confidence with monitoring in place.
One further conversation is worth having while you are well. An ICD’s shock function can be deactivated if someone is approaching the end of life, so it does not fire repeatedly during a natural death, while pacing support continues. This is a routine, dignified part of good cardiac care, and it can be recorded through an advance healthcare directive under the Assisted Decision-Making (Capacity) Act.
Where to find support in Ireland
Your device clinic handles anything device-related; your GP coordinates the rest. If you hold a medical card or GP visit card and have a qualifying condition such as heart failure or atrial fibrillation, the HSE Chronic Disease Management Programme provides structured reviews twice a year at no cost. The Irish Heart Foundation runs a nurse support line and Croí offers heart health programmes. If you are waiting on cardiology, ask your GP about National Treatment Purchase Fund options.
A pacemaker or ICD is not a marker of decline. It gives back the reliability your own wiring lost, and for most people the result is more ordinary life, not less. At Críonna Health, we believe understanding what is happening in your own body is the difference between living cautiously and living well.
This article is general information, not individual medical advice. Always follow the guidance of your cardiologist, device clinic and GP.
📷 Photo by Thulfiqar Ali on Unsplash
