The number of pacemaker implants is growing because of newer indications. There are a few million pacemaker patients worldwide with hundreds of thousands of new implants yearly. Knowledge of different modes, timing cycles, and event markers, as well as newer algorithms, is necessary for accurate diagnosis of pacing system malfunction.
Although true pulse generator failure is very rare, pacing system malfunction occurs occasionally. Pacing system malfunction can be due to malfunction of lead, electrode-tissue interface, or pulse generator. Most of these malfunctions can be corrected by simple reprogramming of the device. The majority of malfunctions in fact are due to normal programmed pacemaker function. Thorough understanding of the cause of malfunction is extremely important for accurate diagnosis and management.
Maisel reported pacemaker generator failure rate of 0.46% based on US FDA reports and 1.3 malfunctions per 1000 person-years based on device registries. [1, 2] Actual incidence of pacemaker malfunction, however, would be higher since these numbers are exclusive of lead failure. Hauser et al reported a 2% device electronic failure rate at their center. 
Actual incidence of pacemaker malfunction is unknown.
Overall morbidity and mortality depend on the underlying cause of malfunction as well as the patient's dependency on the pacemaker. Most pacing system malfunctions are benign, although conditions such as cross-talk inhibition or runaway pacemaker can be life threatening. Maisel reported a 1 in 75,000 death rate among pacer implants. 
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