Procedure prep
Fasting Before a Pacemaker
A pacemaker or defibrillator is usually implanted under local anesthetic with light sedation, through a small cut below the collarbone. Preparation is straightforward — the main twist is that blood thinners are often handled differently from other surgery.
Fasting for this procedure
→ Get your exact fasting times with the calculator
Medicines to check
- Warfarin is often continued for pacemaker implants (stopping and bridging can cause more pocket bleeding) — but this is individual, so follow your team's specific instruction. See medications to stop.
- DOACs (Eliquis, Xarelto) and antiplatelets (clopidogrel, ticagrelor) — the plan varies; your cardiologist will tell you whether to pause or continue each.
- Diabetes medicines & insulin need a fasting-day plan. See diabetes tablets.
- Most heart and blood-pressure medicines are continued with a sip of water — confirm each one.
When this surgery may be delayed
- Fever or any active infection (a device infection is serious, so infections are cleared first)
- A skin infection or break near the collarbone area
- A new cough/cold or chest infection
- Very high blood pressure or blood sugar
- You ate or drank outside the instructions you were given
Reports & documents to carry
- Photo ID and your insurance or hospital paperwork
- A current list of all your medicines, doses, and allergies
- Recent blood tests (including your INR if you take warfarin), ECGs and heart scans
- Details of any previous pacemaker or heart procedures
- A loose, front-opening top and a ride home
What to ask your anesthesia team
- Should I keep taking my warfarin or other blood thinners, or pause them?
- Will I be awake, and what will I feel?
- How long must I limit lifting that arm above my shoulder afterward?
- When can I drive again?
- Which heart tablets do I take that morning?
Your prep checklist
Tick things off as you sort them — saved on this device only, nothing is sent anywhere.
A general guide — your hospital's own instructions always come first.
Frequently asked questions
Do I stop my blood thinners before a pacemaker?
Often not warfarin — for many pacemaker implants it's safer to continue it (at a stable level) than to stop and bridge with injections, which can cause more bleeding in the device pocket. DOACs and antiplatelets are handled case by case. The rule stands: don't change any blood thinner without your cardiologist's specific instruction.
Why can't I lift my arm after getting a pacemaker?
For the first few weeks you'll be asked not to raise the arm on the pacemaker side above shoulder height or lift heavy things, to let the leads settle and bed in. Gentle normal movement is encouraged — it's the big overhead reaches and heavy lifting that are restricted. Your team will tell you for how long.
Will I be asleep during the pacemaker procedure?
Usually you're awake but relaxed, with local anesthetic numbing the area and light sedation to keep you comfortable. You shouldn't feel pain, though you may be aware of pushing or pressure. Because of the sedation, arrange for someone to take you home.