eMedicine Specialties > Cardiology > Electrophysiology Procedures

Pacemaker Malfunction: Multimedia

Author: Chakri Yarlagadda, MD, FACC, FASNC, Consulting Cardiologist, St Elizabeth Hospital, Youngstown, OH
Contributor Information and Disclosures

Updated: Feb 18, 2009

Multimedia

Atrial undersensing. Rhythm strip showing an atri...Media file 1: Atrial undersensing. Rhythm strip showing an atrial pacing artifact after the intrinsic P wave.
Atrial undersensing. Rhythm strip showing an atri...

Atrial undersensing. Rhythm strip showing an atrial pacing artifact after the intrinsic P wave.

Ventricular undersensing. Rhythm strip showing ve...Media file 2: Ventricular undersensing. Rhythm strip showing ventricular pacing artifacts despite normal underlying ventricular activity.
Ventricular undersensing. Rhythm strip showing ve...

Ventricular undersensing. Rhythm strip showing ventricular pacing artifacts despite normal underlying ventricular activity.

Atrial lead dislodgement. Chest radiograph film d...Media file 3: Atrial lead dislodgement. Chest radiograph film detail showing dislodged atrial lead with tip in the right ventricular cavity.
Atrial lead dislodgement. Chest radiograph film d...

Atrial lead dislodgement. Chest radiograph film detail showing dislodged atrial lead with tip in the right ventricular cavity.

Ventricular noncapture. Rhythm strip showing atri...Media file 4: Ventricular noncapture. Rhythm strip showing atrial (P wave) sensing followed by ventricular spike, which failed to capture the ventricle.
Ventricular noncapture. Rhythm strip showing atri...

Ventricular noncapture. Rhythm strip showing atrial (P wave) sensing followed by ventricular spike, which failed to capture the ventricle.

Loss of atrial capture. Rhythm strip showing inte...Media file 5: Loss of atrial capture. Rhythm strip showing intermittent loss of atrial capture.
Loss of atrial capture. Rhythm strip showing inte...

Loss of atrial capture. Rhythm strip showing intermittent loss of atrial capture.

Pacemaker-mediated tachycardia. Rhythm strip show...Media file 6: Pacemaker-mediated tachycardia. Rhythm strip showing ventricular pacing at 110 beats per minute (programmed maximal track rate).
Pacemaker-mediated tachycardia. Rhythm strip show...

Pacemaker-mediated tachycardia. Rhythm strip showing ventricular pacing at 110 beats per minute (programmed maximal track rate).

Termination of pacemaker-mediated tachycardia. Au...Media file 7: Termination of pacemaker-mediated tachycardia. Automatic postventricular atrial refractory period (PVARP) extension terminated the PMT.
Termination of pacemaker-mediated tachycardia. Au...

Termination of pacemaker-mediated tachycardia. Automatic postventricular atrial refractory period (PVARP) extension terminated the PMT.

This is an artifact due to monitor malfunction or...Media file 8: This is an artifact due to monitor malfunction or loose limb lead connection. An abrupt loss of a portion of the QRS complex followed by a flat line can be observed. If R-R intervals are matched, 2 QRS complexes are missing during the pause. If it is due to a dislodged lead, a pacing artifact with no capture should be observed.
This is an artifact due to monitor malfunction or...

This is an artifact due to monitor malfunction or loose limb lead connection. An abrupt loss of a portion of the QRS complex followed by a flat line can be observed. If R-R intervals are matched, 2 QRS complexes are missing during the pause. If it is due to a dislodged lead, a pacing artifact with no capture should be observed.

This is a typical example of ventricular oversens...Media file 9: This is a typical example of ventricular oversensing with inhibition of ventricular pacing. In ventricular noncapture, a ventricular pacing artifact should be present after the third P wave.
This is a typical example of ventricular oversens...

This is a typical example of ventricular oversensing with inhibition of ventricular pacing. In ventricular noncapture, a ventricular pacing artifact should be present after the third P wave.

More on Pacemaker Malfunction

Overview: Pacemaker Malfunction
Differential Diagnoses & Workup: Pacemaker Malfunction
Treatment & Medication: Pacemaker Malfunction
Follow-up: Pacemaker Malfunction
Multimedia: Pacemaker Malfunction
References

References

  1. Maisel WH, Moynahan M, Zuckerman BD, Gross TP, Tovar OH, Tillman DB. Pacemaker and ICD generator malfunctions: analysis of Food and Drug Administration annual reports. JAMA. Apr 26 2006;295(16):1901-6. [Medline].

  2. Maisel WH. Pacemaker and ICD generator reliability: meta-analysis of device registries. JAMA. Apr 26 2006;295(16):1929-34. [Medline].

  3. 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].

  4. 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].

  5. Erickson S, Sweesy M, Forney R. Complications and Corrections in Pacing systems. Pacing Clin Electrophysiol. 1995;18:99-1004.

  6. Földesi C, Hegedüs Z, Simon J, Pap I, Rudas L. [Pacemaker syndrome without a pacemaker]. Orv Hetil. Aug 30 1998;139(35):2081-2. [Medline].

  7. Goldman DS, Levine PA. Pacemaker-mediated polymorphic ventricular tachycardia. Pacing Clin Electrophysiol. Oct 1998;21(10):1993-5. [Medline].

  8. Heldman D, Mulvihill D, Nguyen H, Messenger JC, Rylaarsdam A, Evans K. True incidence of pacemaker syndrome. Pacing Clin Electrophysiol. Dec 1990;13(12 Pt 2):1742-50. [Medline].

  9. 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.

  10. Pinski SL, Trohman RG. Interference with cardiac pacing. Cardiol Clin. Feb 2000;18(1):219-39, x. [Medline].

  11. Sweesy MW, Holland JL. Pseudomalfunction. In: Cardiac Device and Basic EP-Self Assessment. Simpsonville, SC: Cardiac Device Consultants, Inc; 2000:60-86.

Further Reading

Keywords

pacemaker malfunction, pacing system malfunction, heart pacing malfunction, pacemaker complication, pacemaker syndrome, pacemaker-mediated tachycardia, twiddler's syndrome, cardiac pacing, heart pacing, broken pacemaker, failed pacemaker, malfunctioning pacemaker, runaway pacemaker

Contributor Information and Disclosures

Author

Chakri Yarlagadda, MD, FACC, FASNC, Consulting Cardiologist, St Elizabeth Hospital, Youngstown, OH
Chakri Yarlagadda, MD, FACC, FASNC is a member of the following medical societies: American College of Cardiology, American Society of Echocardiography, American Society of Nuclear Cardiology, and Heart Rhythm Society
Disclosure: Nothing to disclose.

Medical Editor

Hanumant Deshmukh, MD †, Former Chief of Cardiology, Veterans Affairs Medical Center; Former Associate Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Brian Olshansky, MD, Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine
Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences
Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Reliant Grant/research funds Other; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

J Paul Mounsey, MD, PhD, MRCP, Professor of Medicine, Director, Cardiac Electrophysiology Service, Division of Cardiology, University of North Carolina at Chapel Hill School of Medicine
J Paul Mounsey, MD, PhD, MRCP is a member of the following medical societies: American College of Cardiology, American Heart Association, Heart Rhythm Society, and Royal College of Physicians of the United Kingdom
Disclosure: Medtronic Honoraria Speaking and teaching; St Jude Honoraria Speaking and teaching; Boston Scientific Honoraria Speaking and teaching

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