Pacemaker Malfunction Treatment & Management
- Author: Chakri Yarlagadda, MD, FACC, FASNC, FSCAI; Chief Editor: Jeffrey N Rottman, MD more...
Medical Care
Medical therapy has a limited role in pacemaker malfunction.
- Correction of electrolyte and metabolic abnormalities
- Apply transcutaneous pacing pads if external pacing is necessary.
- Intravenous fluids and inotropic support if symptomatic hypotension
- Adjust the dose or withhold the medication.
- Pulse generator reprogramming based on underlying pacing malfunction.
Surgical Care
Surgical care depends on underlying cause for pacing malfunction.
- Exploration of pacemaker pocket, lead, connectors, and set-screws
- Repair, reposition, extraction, or replacement of lead
- Removal of air from dry-pocket
- Upgrading single chamber to dual chamber generator in pacemaker syndrome
- Tightening of loose set-screws
- Replacement of pulse generator
- Uncoiling the lead, new lead implant, or repositioning of the pulse generator in twiddler syndrome
Consultations
- Cardiologist - To reprogram the pacemaker to prevent, eliminate, or minimize the pacing system malfunction; for pulse generator change or lead insertion or extraction
- Cardiovascular surgeon - If thoracotomy is needed
Activity
To minimize risk of lead dislodgement, advise patient not to raise ipsilateral arm over and above the shoulder for approximately 2 weeks after lead implant.
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