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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. Landing on the right device - pacemaker, ICD, S-ICD, CRT-P or CRT-D - takes a consultant electrophysiologist and proper risk stratification.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private cardiac devices cost in the UK.

Indicative all-in ranges across the device spectrum at UK private cardiac units.

In short

£7,000, ICDs from £20,000, CRT-D to £45,000 all-in.

Procedure Indicative range
Electrophysiology consultation + ECG £275–£475
Pacemaker system (single or dual, all-in) £7,000–£15,000
Transvenous ICD (all-in) £20,000–£35,000
Subcutaneous ICD (S-ICD, all-in) £25,000–£40,000
CRT-P (resynchronisation pacemaker, all-in) £18,000–£30,000
CRT-D (resynchronisation defibrillator, all-in) £28,000–£45,000
Cardiac MRI (scar assessment) £600–£1,200

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.

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. The decision comes before the device.

  • 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.

  • ICDs are a risk calculation

  • 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.

When it helps

Which situations point to which device.

The presentations seen most often across the pacing–defibrillation spectrum, plus the one red flag that means urgent family screening.

  • Slow rhythms: the pacemaker camp

    Heart block, sick sinus syndrome, AF with pauses - pacing territory, covered in depth on the pacemaker pages.

  • Survived cardiac arrest

    Ventricular fibrillation or sustained VT survived is the clearest secondary-prevention ICD indication there is.

  • 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.

  • Inherited arrhythmia syndromes

    Long QT, Brugada, hypertrophic and arrhythmogenic cardiomyopathy - device decisions guided by genetics and specialist risk scores.

  • 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.

  • Unexplained syncope with a scarred heart

    Blackouts plus prior infarction or cardiomyopathy need electrophysiological assessment - sometimes an ICD, sometimes reassurance.

  • ICD generator change or system revision

    Existing devices reaching end of battery, recalled leads, or upgrades from pacemaker to CRT - all deserve the same rigour.

  • Red flag: family history of sudden death under 40

    A first-degree relative dying suddenly young means inherited-cardiac-conditions assessment for the family - which should be urgent, 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • Wearable defibrillator (LifeVest)

    A vest worn while risk is being assessed or the heart given time to recover - a bridge, not a destination.

  • No device - a legitimate answer

    Some risk profiles do not justify hardware. When the evidence says medication and surveillance, that is the honest answer.

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.

  • 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.

  • 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.

  • 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.

  • 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, so it is worth asking about.

  • 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. This should be discussed before you consent.

  • 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 UK electrophysiologist reviewing a patient’s ICD interrogation report

A quiet reminder

Detection zones, therapy counters, shock logs - dense reading, so ask for it to be put in plain English.

If you would like your interrogation report talked through - especially after a shock - just ask your device clinic.

  1. 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.

  2. 02 Technique

    System details and thresholds

    Generator and lead models, positions, and the electrical measurements - plus defibrillation testing results where performed.

  3. 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.

  4. 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

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

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.

Frequently asked

Everything patients commonly ask about pacemakers and defibrillators.

Quick answers on the pacemaker–ICD difference, who needs which, shocks, CRT, driving and costs.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

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