Pacemaker Malfunction Follow-up
- Author: Chakri Yarlagadda, MD, FACC, FASNC, FSCAI; Chief Editor: Jeffrey N Rottman, MD more...
Further Inpatient Care
- Device interrogation
- Chest radiograph for lead position and any complications such as pneumothorax
- Wound care after pulse generator change or lead implant
Further Outpatient Care
Most cases require only follow-up device interrogation and chest radiograph.
Complications
Complications during pulse generator change and lead insertion or extraction include the following:
- Vascular injury
- Venous thrombosis
- Cardiac tamponade
- Hemothorax
- Pneumothorax
- Perforation of heart
- Avulsion of RV
- Bleeding
- Infection: The rate of infection has been widely debated. Johansen et al studied the incidence of pacemaker infection and its associated risk factors and found the overall risk of infection after pacemaker implantation was low. However, the rate of infection is higher as more operations are performed, and this should be taken into consideration.[5]
Prognosis
- Prognosis depends on the underlying cause of pacemaker failure.
- Most of the pacing system malfunctions are benign and can be corrected with appropriate reprogramming.
Patient Education
- Patient education needed for optimal pacemaker function and early diagnosis of malfunction includes the following:
- Advise patients not to manipulate the pulse generator to prevent twiddler syndrome.
- Advise patients not to operate digital cellular phones close to the pulse generator to avoid inappropriate inhibition from oversensing.
- Advise patients to seek medical attention for any unusual symptoms, such as dizziness, palpitations, and syncope, and for any pain, swelling, or drainage from pacemaker area.
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Maisel WH. Pacemaker and ICD generator reliability: meta-analysis of device registries. JAMA. Apr 26 2006;295(16):1929-34. [Medline].
Hauser RG, Hayes DL, Kallinen LM, Cannom DS, Epstein AE, Almquist AK, et al. Clinical experience with pacemaker pulse generators and transvenous leads: an 8-year prospective multicenter study. Heart Rhythm. Feb 2007;4(2):154-60. [Medline].
Amin MS, Matchar DB, Wood MA, Ellenbogen KA. Management of recalled pacemakers and implantable cardioverter-defibrillators: a decision analysis model. JAMA. Jul 26 2006;296(4):412-20. [Medline].
Johansen JB, Jorgensen OD, Moller M, et al. Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. Eur Heart J. Apr 2011;32(8):991-8. [Medline]. [Full Text].
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Levine PA, Love CJ. Pacemaker diagnostics and evaluation of pacing system malfunction. In: Clinical Cardiac Pacing and Defibrillation. 2nd ed. Philadelphia, Pa: WB Saunders; 2000:827-875.
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Sweesy MW, Holland JL. Pseudomalfunction. In: Cardiac Device and Basic EP-Self Assessment. Simpsonville, SC: Cardiac Device Consultants, Inc; 2000:60-86.
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