Pacemakers are very common. Over a million people worldwide receive one each year, and the number keeps climbing as populations age and heart rhythm problems are caught earlier. In the United States alone, roughly 200,000 to 300,000 pacemakers are implanted annually, making it one of the most frequently performed cardiac procedures.
How Many People Have Pacemakers
Pacemaker implantation rates have risen steadily for decades. Back in the late 1980s, around 115,000 to 130,000 devices were sold per year in the U.S. That number has more than doubled since then, driven by an aging population and better screening for heart rhythm disorders. Globally, the cardiac rhythm management device market was valued at nearly $21 billion in 2024 and is projected to reach $36 billion by 2033, reflecting just how widespread these devices have become.
Several forces are pushing those numbers higher. Cardiovascular disease remains the leading cause of death in most developed countries, and conditions like atrial fibrillation are becoming more prevalent. The CDC estimates that around 12.1 million Americans will have atrial fibrillation by 2030. Government screening programs, greater public awareness of heart symptoms, and advances in device technology all contribute to more people being diagnosed and treated earlier than in previous generations.
Who Gets a Pacemaker
The typical pacemaker recipient is older, though people of any age can need one. Roughly 70 to 80 percent of all permanent pacemakers go to patients 65 or older, and the share of recipients aged 75 and up has been growing. In population studies, that proportion rose from 54 percent in the late 1990s to 62 percent in the years that followed. This tracks with the reality that the electrical system of the heart tends to slow down with age, making rhythm problems more likely the older you get.
Men receive pacemakers at nearly twice the rate of women. A large Australian study covering more than 7 million people over a decade found that the age-adjusted annual implantation rate was about 126 per 100,000 men compared to 63 per 100,000 women. That gap actually widened over the study period, and researchers noted it wasn’t explained by age differences alone. Whether this reflects genuine differences in how heart rhythm disorders develop between sexes, or whether women are underdiagnosed, remains an open question.
Why People Need One
The most common reason for a pacemaker is a heart that beats too slowly, a condition called bradycardia. When your heart’s natural electrical signals become unreliable, it can’t pump enough blood to keep up with your body’s needs. That can cause dizziness, fatigue, fainting spells, or shortness of breath, especially during physical activity.
Beyond a slow heartbeat, pacemakers are used for several other rhythm problems:
- Heart block: The electrical signals between your heart’s upper and lower chambers are delayed or completely interrupted, causing skipped or irregular beats.
- Heart failure with poor synchronization: In some patients, the left and right sides of the heart don’t contract in sync, reducing pumping efficiency. A specialized pacemaker (sometimes called a biventricular device) coordinates those contractions.
- Certain fast or irregular rhythms: Some pacemakers can detect and correct a heartbeat that speeds up abnormally or becomes chaotic.
Most people don’t know they have a rhythm problem until symptoms become disruptive enough to prompt a visit to the doctor. Fainting without a clear cause is one of the most common triggers for evaluation.
What the Procedure Involves
Pacemaker implantation is considered minor surgery. A surgeon makes a small incision near your collarbone, threads thin wires (called leads) through a vein into your heart, and connects them to a small generator placed just under the skin of your upper chest. The whole process typically takes one to two hours, and most people go home the same day or the next morning.
Newer leadless pacemakers skip the wires entirely. These are tiny capsule-shaped devices inserted through a vein in the leg and anchored directly inside the heart. They’re a single self-contained unit, roughly the size of a large vitamin, and leave no visible bump under the skin.
Complication Rates
Pacemaker implantation has a strong safety record, though no surgical procedure is risk-free. In clinical studies, the short-term complication rate within the first 30 days is around 5 percent. After three years, the overall complication rate (including minor issues) sits around 7.5 percent.
The most frequent complications are relatively minor. Pocket bleeding, which is bruising or swelling at the implant site, occurs in about 5 percent of patients. Collapsed lung (pneumothorax) from the insertion process happens in roughly 3 percent of cases and usually resolves on its own or with a brief intervention. Lead problems, where a wire shifts out of position or loses its connection, occur in about 5 percent of patients, mostly within the first 30 days. Infection is rare, occurring in less than 1 percent of procedures.
Reoperation within three years is needed for about 5 percent of patients, most often to reposition a lead or address a device malfunction.
How Long Pacemakers Last
Traditional pacemakers with leads have batteries that last anywhere from 7 to 15 years depending on how much pacing your heart requires. Newer leadless models are showing impressive longevity. Recent data from a leadless pacemaker family projects a median battery life of 12 to nearly 17 years depending on the model, with the newest versions expected to last long enough that 80 to 91 percent of patients will only ever need one device in their lifetime.
When a traditional pacemaker’s battery runs low, replacing it is a simpler procedure than the original implant. The surgeon opens the same pocket under your skin, swaps the generator, and typically reuses the existing leads. Recovery is quicker the second time around.
Cost in the United States
For patients on Medicare, the total approved cost for pacemaker implantation averages about $8,200 at an ambulatory surgical center and $11,100 at a hospital outpatient department. The patient’s share comes to roughly $1,600 to $1,800 on average. Private insurance coverage varies, but most plans cover the procedure when it’s medically indicated, leaving patients responsible for deductibles and copays. Without insurance, the total cost can run significantly higher, often $30,000 to $50,000 or more when the device, surgeon fees, and facility charges are combined.
Long-Term Outlook With a Pacemaker
People with pacemakers generally live long, active lives. The device doesn’t cure the underlying heart condition, but it effectively manages the rhythm problem that caused symptoms. Large studies following patients for decades show that survival rates for pacemaker recipients closely track those of similar patients without pacemakers. In one long-term study, survival at 10 years was 53 percent in the pacemaker group compared to 58 percent in a matched group without pacemakers, a modest difference largely explained by the fact that pacemaker patients tend to have more underlying heart disease to begin with.
Day-to-day life with a pacemaker is largely unrestricted. Most people return to normal activities within a few weeks. You’ll need to avoid strong magnetic fields (like MRI machines, unless your device is MRI-compatible) and keep certain electronics a few inches from your chest. Your cardiologist will check the device periodically, often remotely through a home monitor that transmits data while you sleep. These check-ins track battery life, lead function, and your heart’s activity, catching potential issues before they cause symptoms.