Concierge cardiology · UK
Pacemakers + defibrillators - two jobs, five devices, one right answer.
A pacemaker stops the heart going too slowly; a defibrillator stops it going dangerously fast; CRT re-synchronises a failing pump. We help you land on the right device - pacemaker, ICD, S-ICD, CRT-P or CRT-D - with a consultant electrophysiologist and proper risk stratification.
Why patients choose us
- 01
The pacemaker-or-ICD question, answered properly
Slow rhythms need pacing; dangerous fast rhythms need a defibrillator; some hearts need both. A consultant electrophysiologist works out which camp you are in before any device is chosen.
- 02
Risk scores, not guesswork
ICD decisions rest on ejection fraction, genetics and arrhythmia history - formal risk stratification, echo and sometimes cardiac MRI, all arranged before you consent.
- 03
Independent, and free
We are paid by no hospital or device company, so whether the answer is a pacemaker, an ICD, a CRT device or no device at all, the advice is impartial and costs you nothing.
Indicative pricing
What private cardiac devices cost in the UK.
Indicative all-in ranges across the device spectrum at our partner cardiac units. Send the details and we quote firm figures across two or three options, with cover checked.
In short
The spectrum in our network: pacemakers from £7,000, ICDs from £20,000, CRT-D to £45,000 all-in.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Electrophysiology consultation + ECG | £275–£475 | 30–45 min | Same visit |
| Pacemaker system (single or dual, all-in) | £7,000–£15,000 | 45–90 min | Day-case or 1 night |
| Transvenous ICD (all-in) | £20,000–£35,000 | 90–150 min | 1 night |
| Subcutaneous ICD (S-ICD, all-in) | £25,000–£40,000 | 90–150 min | 1 night |
| CRT-P (resynchronisation pacemaker, all-in) | £18,000–£30,000 | 2–3 hours | 1–2 nights |
| CRT-D (resynchronisation defibrillator, all-in) | £28,000–£45,000 | 2–3 hours | 1–2 nights |
| Cardiac MRI (scar assessment) | £600–£1,200 | 45–60 min | Report in days |
The hardware drives the spread - a defibrillator generator costs several times a pacemaker, and CRT adds a third lead and longer lab time. Insurers usually cover clinically indicated devices with pre-authorisation. We come back with a firm all-in quote within one working day.
The problem
The right device family - decided by risk, not by habit.
Device medicine goes wrong at the decision, not the implant - ICDs offered without proper risk scores, CRT missed in wide-QRS heart failure, and the no-device option never voiced. We fix the decision first.
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Slow versus fast is the first fork
Bradycardia needs pacing. Sudden-death risk needs defibrillation. Muddling the two leads to the wrong hardware in the wrong chest.
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ICDs are a risk calculation
Ejection fraction, scar on MRI, genetics, arrhythmia history - a primary-prevention ICD should follow a formal risk assessment, and we arrange one.
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Do not miss the CRT window
Heart failure with left bundle branch block can be transformed by resynchronisation - an opportunity too often lost to routine follow-up.
The journey
From enquiry to recovery - what happens, in order.
One team from first message through risk stratification, the implant and every device clinic check after it.
Phase 1 · Before your device
Risk stratification and device choice
Phase 2 · On the day
Implant and programming
Phase 3 · After
Device clinic, shocks reviewed, battery plan
- 01
Before
You tell us what is going on
A short, confidential form. Blackouts or cardiac arrests survived, heart failure history, family history of sudden death, and any ECGs, echos or genetic results.
- 02
Before
We come back with a recommendation
Within one working day: which device family fits your situation - pacemaker, ICD, CRT-P or CRT-D - the right electrophysiologist, and an indicative price.
- 03
Before
Risk stratification
Echocardiogram for ejection fraction, cardiac MRI for scar where needed, ambulatory monitoring, and genetic or inherited-condition assessment when family history demands it.
- 04
Before
The device decision, with you in the room
Pacing need, shock protection, resynchronisation, transvenous versus subcutaneous - the trade-offs laid out plainly, including the option of no device.
- 05
On the day
Implantation
Pacemakers and transvenous ICDs go in under local anaesthetic with sedation in 60–150 minutes; subcutaneous ICDs and CRT devices take longer. Most patients stay one night.
- 06
On the day
Programming and testing
The device is programmed to treat your specific rhythm risk - pacing rates, detection zones and shock thresholds - before you go home with remote monitoring enrolled.
- 07
After
Device clinic for life
Checks at 4–6 weeks then at least annually, remote transmissions in between, therapy reviews after any shock, and planned generator changes years down the line.
Typical end-to-end: 2–3 weeks from enquiry to implant including risk work-up. Device clinic follow-up: for the life of the device.
When it helps
Which situations point to which device.
The presentations we see most across the pacing–defibrillation spectrum, plus the one red flag that means urgent family screening.
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Slow rhythms: the pacemaker camp
Heart block, sick sinus syndrome, AF with pauses - pacing territory, covered in depth on our pacemaker pages.
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Survived cardiac arrest
Ventricular fibrillation or sustained VT survived is the clearest secondary-prevention ICD indication there is.
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Heart failure with a weak pump
An ejection fraction persistently at or below 35 percent despite three months of good medical therapy puts a primary-prevention ICD on the table.
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Inherited arrhythmia syndromes
Long QT, Brugada, hypertrophic and arrhythmogenic cardiomyopathy - device decisions guided by genetics and specialist risk scores.
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Heart failure with a wide QRS
Left bundle branch block and a struggling ventricle - resynchronisation (CRT-P or CRT-D) can transform symptoms, not just insure against them.
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Unexplained syncope with a scarred heart
Blackouts plus prior infarction or cardiomyopathy need electrophysiological assessment - sometimes an ICD, sometimes reassurance.
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ICD generator change or system revision
Existing devices reaching end of battery, recalled leads, or upgrades from pacemaker to CRT - all arranged with the same rigour.
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Red flag: family history of sudden death under 40
A first-degree relative dying suddenly young means inherited-cardiac-conditions assessment for the family - urgently arranged, never left on a list.
Procedure options
The device spectrum, compared honestly.
What each device family does, who it suits, and the trade-offs - including the wearable bridge and the legitimate choice of no device at all.
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Pacemaker - the rhythm floor
Prevents the heart beating too slowly. Small, implanted under local anaesthetic, battery 8–15 years. It cannot treat dangerous fast rhythms.
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ICD - the safety net
Does everything a pacemaker does, plus detects ventricular tachycardia and fibrillation - and terminates them with rapid pacing or a shock. For those at real risk of sudden cardiac death.
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Subcutaneous ICD (S-ICD)
The lead sits under the skin beside the breastbone, never inside the heart - no vascular lead to fracture or infect. Ideal for younger patients; the trade-off is no long-term pacing capability.
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CRT-P - resynchronisation pacemaker
Three leads pace both ventricles back into step, improving symptoms and survival in heart failure with a wide QRS - without shock capability.
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CRT-D - resynchronisation plus defibrillation
The full toolkit: biventricular pacing and a built-in defibrillator, for heart failure patients who need both resynchronisation and sudden-death protection.
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Anti-tachycardia pacing (ATP)
The quiet hero inside every ICD - bursts of rapid pacing that terminate most ventricular tachycardias painlessly, so many patients never feel a shock at all.
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Wearable defibrillator (LifeVest)
A vest worn while risk is being assessed or the heart given time to recover - a bridge, not a destination.
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No device - a legitimate answer
Some risk profiles do not justify hardware. When the evidence says medication and surveillance, we say so plainly.
Our vetted UK network
A small panel of electrophysiologists, we picked them.
Consultant electrophysiologists and inherited-cardiac-conditions specialists across London and the major UK cities. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every device centre in our network.
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Consultant electrophysiologists implanting the full spectrum - pacemakers, ICDs, S-ICD and CRT
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Inherited cardiac conditions clinics with genetic counselling for family syndromes
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Cardiac MRI on site for scar-based risk stratification before ICD decisions
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Psychological support pathways for patients living with shock therapy
Safety and recovery
What to expect afterwards - honestly.
Pacemakers and defibrillators carry different risks and very different daily-life implications. Here is the honest version of both.
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Two different risk conversations
A pacemaker decision is about symptoms; an ICD decision is about statistical risk of sudden death. The second is harder, more personal - and deserves unhurried time, which is what we build in.
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Shocks: effective, and worth preparing for
An appropriate ICD shock is a life saved - and still a jolt often described as a kick in the chest. Around a quarter of ICD patients receive one within five years; anti-tachycardia pacing silently handles many episodes first.
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Inappropriate shocks are the main ICD downside
Fast AF or lead noise can trigger shocks that were not needed - affecting roughly 5–10 percent of patients over several years. Modern programming and remote monitoring have cut this substantially.
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Implant risks scale with complexity
A simple pacemaker carries around 3–5 percent overall complication risk; ICD and CRT implants sit somewhat higher, mostly from lead placement. Operator volume is protective, and we vet for it.
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Driving rules differ sharply by device
Pacemaker: typically one week off driving. ICD: one month after a primary-prevention implant, six months after a shock or secondary-prevention implant - and bus/lorry licences are usually lost with an ICD. We make sure this is discussed before you consent.
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Red flags with any device
A shock (call the device clinic same day; A&E if more than one, or if you feel unwell), fainting, a hot or swollen device site, or beeping alerts - never wait for the next routine check.
Reading your device report
Your device report in four parts. Read the last one first.
Whether you carry a pacemaker, an ICD or a CRT system, the report from your device clinic keeps to the same shape.
A quiet reminder
Detection zones, therapy counters, shock logs - dense reading. We translate it for you.
If you would like us to talk you through your interrogation report - especially after a shock - just ask.
- 01 Header
Device family and indication
Which device you have - pacemaker, ICD, S-ICD, CRT-P or CRT-D - and whether it was implanted for symptoms, primary prevention or secondary prevention.
- 02 Technique
System details and thresholds
Generator and lead models, positions, and the electrical measurements - plus defibrillation testing results where performed.
- 03 Findings
Therapies delivered
What the device has actually done: pacing burden, arrhythmia episodes detected, anti-tachycardia pacing delivered, and any shocks - appropriate or not.
- 04 Impression
Programming, driving and the plan
Read this first: detection zones and settings, your current DVLA driving status, battery outlook, and exactly when the next check falls.
Recognised by major UK insurers
Pacemakers, ICDs and CRT devices are usually covered when clinically indicated, always with pre-authorisation for the hardware. Ongoing device clinic care is often claimable as outpatient follow-up. We confirm cover before booking.
Frequently asked
Everything we get asked about pacemakers and defibrillators.
Quick answers on the pacemaker–ICD difference, who needs which, shocks, CRT, driving and costs.
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What is the difference between a pacemaker and a defibrillator?
A pacemaker stops the heart going too slowly, using tiny impulses you never feel. An implantable defibrillator (ICD) additionally watches for dangerously fast ventricular rhythms and terminates them - first with painless rapid pacing, and if needed with a shock. Every ICD can pace; no ordinary pacemaker can defibrillate.
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Who needs an ICD rather than a pacemaker?
ICDs are for people at meaningful risk of sudden cardiac death: survivors of cardiac arrest or sustained VT (secondary prevention), and those with a persistently weak heart - broadly an ejection fraction of 35 percent or less despite three months of optimal medication - or high-risk inherited conditions (primary prevention). Slow-rhythm problems alone need only a pacemaker.
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What is CRT, and what do CRT-P and CRT-D mean?
Cardiac resynchronisation therapy uses a third lead to pace both ventricles back into step in heart failure with a wide QRS, improving symptoms and survival. CRT-P is resynchronisation with pacemaker function only; CRT-D adds a built-in defibrillator. The choice between them depends on age, cause of heart failure and overall sudden-death risk.
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What does an ICD shock feel like - and how likely is one?
Patients describe it as a sudden thump or kick in the chest, over in an instant. Roughly a quarter of ICD patients receive an appropriate shock within five years, though anti-tachycardia pacing silently terminates many episodes first. One shock, feeling well afterwards: call your device clinic the same day. Multiple shocks or feeling unwell: 999.
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How much do these devices cost privately in the UK?
All-in: pacemakers £7,000–£15,000; transvenous ICDs £20,000–£35,000; subcutaneous ICDs £25,000–£40,000; CRT-P £18,000–£30,000; CRT-D £28,000–£45,000. The hardware drives the difference. Insurers usually cover devices that are clinically indicated, with pre-authorisation. We confirm firm figures within one working day.
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Can I drive with a pacemaker or ICD?
With a pacemaker, private driving usually resumes a week after implant. ICDs are stricter: one month off after a primary-prevention implant, six months after a secondary-prevention implant or after any shock - and Group 2 (bus/lorry) licences are generally lost permanently with an ICD. Your cardiologist confirms your position with the DVLA criteria in writing.
Related treatments
Looking for something else?
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Pacemaker implantation
The implant procedure itself, step by step.
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Pacemakers
The pacing devices in detail.
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Conduction system pacing
His-bundle and left-bundle pacing.
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Atrial fibrillation
Fast rhythms that are not ICD territory.
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Cardiac treatments
Every cardiac service we arrange.
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All tests & procedures
Every test and procedure we arrange.
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