Sick Sinus Syndrome
Also called sinus node dysfunction — the heart’s natural pacemaker fires too slowly, pauses, or alternates between slow and fast rhythms (tachy-brady syndrome).
Medically Reviewed By: Dr Paul Lim – MBBS, M.Med (Int Med), MRCP (UK), FAMS (Cardiology)
Heart Rhythm Treatment
Pacemaker Implantation in Singapore
A pacemaker — also known as a heart pacemaker or 心脏起搏器 (xīnzàng qǐbó qì) — is a small, battery-powered device implanted under the skin near the collarbone to treat a slow or unreliable heartbeat. It delivers small, painless electrical impulses to keep the heart beating at a safe, steady rate.
Dr Paul Lim Chun Yih
Senior Consultant Cardiologist & Electrophysiologist
Performed by Heart Rhythm Specialist
1,000+ Ablation & Device Procedures
Home The Next Day
22+
Years of
Clinical Experience
Clinical Experience
Your Specialist
Procedure Performed by Dr Paul Lim
Senior Consultant Cardiologist & Cardiac Electrophysiologist
Dr Paul Lim subspecialises in heart rhythm disorders, performing pacemaker, defibrillator, and catheter ablation procedures for arrhythmia patients. He completed advanced fellowship training at Barts Heart Centre, London — one of Europe’s largest heart rhythm centres — under Singapore’s HMDP award.
UK & SG
Fellowship Training
10,000+
Patient Consultations
1,000+
Ablation & Device Procedures
The Device Explained
What Is a Pacemaker?
A pacemaker is a small electronic device that helps the heart beat at a normal rate when its own electrical system is too slow or unreliable. The healthy heart has a natural pacemaker — the sinus node — that sets the heart rate. When this natural pacemaker, or the electrical “wiring” that carries its signal, is not working properly, the heart can beat too slowly. This may cause tiredness, dizziness, breathlessness, or blackouts. A pacemaker restores a reliable rhythm.
A pacemaker has two parts:
- The generator — a small sealed metal box, about the size of a large coin, containing the battery and the electronic circuitry.
- The leads — one to three thin, insulated wires that carry the electrical impulses between the generator and the heart muscle. (A leadless pacemaker, described below, has no separate wires.)
The device works on demand: it constantly senses the heart’s own beats and only delivers an impulse when the heart rate falls below the programmed minimum. The impulses are very small and are not felt by most patients. A pacemaker treats a slow heartbeat — it does not treat blocked arteries and does not prevent a heart attack.
When It’s Needed
When Is a Pacemaker Needed?
A pacemaker is recommended mainly for slow or unreliable heart rhythms (bradyarrhythmias), particularly when they cause symptoms such as fatigue, dizziness, fainting, or breathlessness. A specialist assessment with an ECG, and often a Holter (prolonged ECG) monitor, is needed to confirm the diagnosis. Common indications include:
Heart Block (AV Block)
The electrical signal between the upper and lower chambers is delayed or blocked. Complete (third-degree) heart block and certain second-degree blocks usually require a pacemaker.
Atrial Fibrillation with a Slow Rate
When atrial fibrillation results in a heart rate that is too slow, or when rate-controlling medication causes excessive slowing.
Symptomatic Bradycardia
A persistently slow heart rate causing tiredness, dizziness, or fainting, where no reversible cause can be corrected.
After AV Node Ablation
When ablation of the AV node is used to control a fast, irregular rhythm, a pacemaker is implanted to maintain the heart rate.
Recurrent Fainting
Carotid sinus hypersensitivity and certain other causes of recurrent fainting (syncope), in selected patients.
Been told you may need a pacemaker? Discuss your options with Dr Paul Lim.
Device Options
Types of Pacemakers
The right type of pacemaker depends on your heart condition and is decided with your electrophysiologist.
| Single-chamber | Dual-chamber | Biventricular (CRT-P) | Leadless (e.g. Micra) | |
|---|---|---|---|---|
| Leads | One lead (usually right ventricle, sometimes right atrium) | Two leads (right atrium + right ventricle) | Three leads (right atrium, right ventricle, left ventricle) | None — a self-contained capsule placed inside the heart |
| Typically used for | Atrial fibrillation with a slow rate; some isolated sinus node disease | Heart block and sick sinus syndrome (keeps the chambers coordinated) | Heart failure with an electrical conduction delay (cardiac resynchronisation therapy) | Selected patients suitable for single-chamber pacing who would benefit from avoiding leads |
| How it’s placed | Vein near the collarbone | Vein near the collarbone | Vein near the collarbone | Through a vein in the leg, directly into the heart |
| Note | Simplest configuration | Most common for AV block | Improves coordination of the pumping chambers | No chest incision or visible bump; newer technology, suitability assessed individually |
Suitability
Am I a Candidate for a Pacemaker?
Your suitability is determined during a consultation based on your symptoms, ECG and monitor findings, and overall health.
A pacemaker may help if…
- You have a documented slow or pausing heart rhythm causing symptoms (dizziness, fainting, fatigue, breathlessness)
- You have complete or advanced heart block, even without symptoms, where guidelines support pacing
- A necessary medication for another heart condition slows your heart rate too much
- You have sick sinus syndrome or symptomatic bradycardia
A pacemaker may not be needed if…
- Your slow heart rate is occasional, harmless, and causes no symptoms (for example, the slow resting rate often seen in fit, athletic people)
- A reversible cause can be corrected first (for example, an underactive thyroid or a medication that can be adjusted)
- An active infection is present — this must be treated before any device is implanted
Step by Step
How Pacemaker Implantation Is Performed
Pacemaker implantation is a minimally invasive procedure carried out in a cardiac catheterisation or electrophysiology laboratory. It is not open-heart surgery, and most implants take about 1 to 2 hours.
Before the procedure: You will usually be admitted on the day of the procedure after fasting for about 6 hours. Blood thinners such as warfarin may need to be stopped a few days beforehand on your specialist’s advice, and a blood test may be taken to confirm clotting is safe. Antibiotics are given through a drip to reduce the risk of infection.
-
1
Preparation and anaesthesia
You lie on a table with monitoring attached. A local anaesthetic numbs the skin below the collarbone, and sedation is given so you are relaxed and drowsy but usually awake.
-
2
Small incision
A small incision (about 5 cm) is made in the upper chest, usually on the left side, to create a pocket under the skin for the device.
-
3
Lead placement
One to three leads are guided through a vein into the correct chambers of the heart under X-ray guidance. A leadless pacemaker is instead delivered through a vein in the leg and fixed directly inside the heart.
-
4
Connecting and testing
The leads are connected to the generator, which is placed in the pocket. The device is tested to confirm it senses and paces the heart correctly.
-
5
Closure
The incision is closed with sutures, usually dissolvable, and a dressing is applied. A chest X-ray confirms the position of the device and leads.
-
6
Recovery in the ward
You rest and are monitored, typically staying overnight and going home the next day. The device is checked again before discharge.
What to Expect Afterwards
Pacemaker Recovery Timeline
Most patients recover quickly. Here is a typical recovery schedule after an uncomplicated pacemaker implantation.
-
1Day 0 — Procedure day
Rest in the ward
You rest with a dressing over the site. Mild soreness or bruising at the implant site is normal.
-
2Day 1 — Discharge
Home the next day
Most patients go home the day after the procedure once the device check and X-ray are satisfactory.
-
3Week 1
Return to desk work
Keep the wound clean and dry. Most people return to desk-based work within about a week. Simple pain relief such as paracetamol is usually enough.
-
4Weeks 2–3
Easing back to activity
Gentle, normal use of the arm is encouraged early — prolonged strict immobilisation is no longer routinely advised. Your specialist will guide you on activity, generally suggesting you avoid heavy lifting and very vigorous overhead movements in the first weeks while the device settles.
-
5Weeks 4–6
First device check
A follow-up check confirms the device settings are correct and the wound has healed.
-
6Long term
Ongoing monitoring
Regular device checks (in clinic or by remote monitoring) continue for the life of the device.
Honest Expectations
Pacemaker Risks and Complications
Pacemaker implantation is a well-established procedure with a strong safety record, and most complications are minor. Serious complications requiring intervention occur in approximately 1–3% of cases, while the overall complication rate (including minor issues such as bruising or a small haematoma) is around 5–10% in the first month. Possible risks include:
- Bruising or bleeding at the device pocket (most common; usually minor)
- Pocket haematoma — a collection of blood under the skin that occasionally needs attention
- Infection of the device or pocket, which in serious cases may require the system to be removed
- Pneumothorax — a small air leak around the lung where the vein is accessed
- Lead displacement — a lead moving out of position in the first weeks, sometimes needing repositioning
- Cardiac perforation — a rare injury to the heart wall
- Reaction to the anaesthetic or contrast, or rarely, a blood clot in the vein
Dr Lim will discuss your individual risks and obtain written informed consent before the procedure.
Have questions about pacemaker surgery? Dr Paul Lim is happy to help.
How It Compares
Pacemaker vs Defibrillator (ICD), CRT and Other Treatments
Patients with heart rhythm problems are sometimes offered more than one type of device. Here is how a pacemaker compares with the main alternatives.
| Device / treatment | What it does | When it is used | How it differs from a standard pacemaker |
|---|---|---|---|
| Pacemaker | Sends impulses to prevent the heart beating too slowly | Slow or blocked rhythms (bradycardia, heart block, sick sinus syndrome) | The baseline device for slow heart rhythms |
| ICD (implantable cardioverter defibrillator) | Watches for dangerous fast rhythms and delivers a shock if needed — and can also pace a slow heartbeat | People at risk of life-threatening fast rhythms: those who have survived a cardiac arrest, and those at high risk of one (for example, a significantly weakened heart muscle or certain inherited heart conditions) | An ICD treats fast, dangerous rhythms with a shock; a pacemaker only supports slow rhythms. Most ICDs can also pace. |
| CRT-P (biventricular pacemaker) | Coordinates the heart’s pumping chambers to ease heart-failure symptoms and improve survival | Heart failure with a weakened heart pump and an electrical delay between the chambers, despite optimal medication | A specialised pacemaker with an extra lead on the left side of the heart to resynchronise the pumping action |
| CRT-D | CRT plus a defibrillator | Heart-failure patients who also need defibrillator protection | Combines resynchronisation with shock therapy |
| Leadless pacemaker (e.g. Micra) | Paces the heart without any leads | Selected patients suitable for single-chamber pacing who would benefit from avoiding leads (for example, a higher infection risk or difficult vein access) | A self-contained capsule placed directly inside the heart through a vein in the leg — no chest incision or visible bump |
| Catheter ablation | Neutralises the small area of tissue causing an abnormal rhythm | Fast or irregular rhythms (AFib, atrial flutter, SVT, VT). Sometimes combined with a pacemaker — for example, AV node ablation to control the rate in AFib | Treats the cause of a fast rhythm rather than supporting a slow one; it does not treat a slow heartbeat. (See our catheter ablation page.) |
The right option depends on your specific rhythm problem, heart function, and overall health. Dr Paul Lim will discuss which device is most appropriate for you.
Paying for Your Procedure
Pacemaker Cost & Insurance in Singapore
MOH surgeon fee benchmark (TOSP SD815H, single-chamber)
S$3,379 – 6,104
Published by Singapore’s Ministry of Health for a single-chamber
permanent pacemaker, inclusive of GST. This covers the surgeon’s professional fee only
— hospital facility charges, anaesthesia, and the pacemaker device itself are billed
separately, and the total varies with case complexity. Device cost in particular varies by type:
dual-chamber, biventricular (CRT-P), and leadless devices generally cost more than a
single-chamber device. View MOH benchmark →
- MediSave claimable Pacemaker implantation falls under MOH-approved surgical procedure limits.
- Integrated Shield Plans (IP) Generally covered by IP riders from Great Eastern, AIA, NTUC Income, Prudential, Raffles and others, subject to plan terms. We can help verify your coverage before admission.
- Pre-authorisation support Our clinic team can assist with insurance pre-authorisation and required paperwork, and provide an itemised estimate before your procedure.
Common Questions
Pacemaker FAQ
Answers to the questions patients ask most often about pacemakers, the implantation procedure, and living with the device.
What is a pacemaker?
A pacemaker is a small, battery-powered device implanted under the skin near the collarbone that sends gentle electrical impulses to keep the heart beating at a safe rate. It treats a slow or unreliable heartbeat.
What is a pacemaker used for, and when is one needed?
A pacemaker is used to treat a slow heart rhythm (bradycardia), including sick sinus syndrome and heart block, particularly when these cause symptoms such as dizziness, fainting, fatigue, or breathlessness.
How is a pacemaker fitted?
Through a small incision (about 5 cm) below the collarbone, under local anaesthetic with sedation. One or more leads are guided into the heart through a vein, connected to the device, and the pocket is closed. It usually takes 1–2 hours, with an overnight stay.
Is pacemaker surgery painful?
The area is numbed with local anaesthetic and sedation is given, so the procedure is not usually painful. Some soreness or bruising at the site for a few days afterwards is normal and is well controlled with simple pain relief.
How long does a pacemaker battery last?
Most pacemaker batteries last about 8–12 years, depending on the device and how often it is used. The leads usually last much longer.
What happens when the battery runs low?
The battery does not stop suddenly. It is checked at every follow-up and gives several months’ warning, so a generator change can be planned. During replacement the existing leads are usually kept and reused, so it is generally simpler than the first operation.
How long can you live with a pacemaker?
A pacemaker does not limit life expectancy. People with pacemakers can generally expect to live a normal, active life; longevity depends on overall heart health and other conditions.
When can I lift my arm after pacemaker surgery?
Gentle, normal use of the arm is encouraged from early on. The older advice to keep the arm strictly still or below shoulder level for weeks is no longer routinely recommended — recent studies suggest prolonged immobilisation offers little benefit and can cause stiffness. Your specialist will advise you, but most people are simply guided to avoid heavy lifting and very vigorous overhead movements for the first few weeks while the device settles.
What are the restrictions after a pacemaker — what should I avoid?
In the first few weeks, follow your specialist’s advice on activity — generally avoiding heavy lifting and very vigorous use of the arm on the implant side, while gentle everyday movement is encouraged. Long term, keep mobile phones a short distance from the device, take care around strong magnetic or industrial fields, avoid heavy contact sports, and always tell medical staff you have a pacemaker. Most daily activities are unaffected.
Can I have an MRI scan with a pacemaker?
Many modern pacemakers are “MRI-conditional” and allow MRI under specific safeguards. Older devices may not be MRI-safe. Always tell the radiology team about your pacemaker so they can check the device first. Ultrasound, X-ray, and CT scans are not affected.
Can I go through airport security with a pacemaker?
Yes. Walking through the gate is safe, though the metal may set off the alarm. Carry your pacemaker identification card, tell security staff, and do not linger by the gate.
Can an AED be used on someone with a pacemaker?
Yes. An AED can be used in an emergency; the pads are placed a few centimetres away from the device.
Can I have a heart attack with a pacemaker?
Yes. A pacemaker controls the heart’s rhythm, not its blood supply, so it does not prevent a heart attack. Seek urgent help for chest pain as you normally would.
What is the difference between a pacemaker and a defibrillator (ICD)?
A pacemaker treats a slow heartbeat by gently pacing it. An ICD watches for dangerous fast rhythms and can deliver a shock to restore a normal rhythm; most ICDs can also pace. They treat opposite problems.
What is the difference between a single-chamber and a dual-chamber pacemaker?
A single-chamber pacemaker uses one lead; a dual-chamber pacemaker uses two (one in the upper chamber and one in the lower), keeping the chambers coordinated. The choice depends on your rhythm problem.
How much does a pacemaker cost in Singapore?
The MOH surgeon fee benchmark for a single-chamber pacemaker (TOSP SD815H) is S$3,379 – S$6,104 with GST. The device, hospital facility fees, and anaesthesia are billed separately, and device cost varies by type. Pacemaker implantation is MediSave claimable and usually covered by Integrated Shield Plans. View MOH benchmark →
How safe is pacemaker surgery?
It is a well-established procedure and most complications are minor. Serious complications requiring intervention occur in about 1–3% of cases, with an overall complication rate (including minor issues like bruising) of around 5–10% in the first month. Most patients have no significant problems and go home the next day.