Pacemaker Malfunction Clinical Presentation

Updated: Jun 21, 2022
  • Author: Priyanka Ghosh, DO; Chief Editor: Jose M Dizon, MD  more...
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History and Physical Examination


Clinical symptoms of pacemaker malfunction are variable and include syncope, dizziness, palpitations, and slow or fast heart rate. Extracardiac stimulation or hiccup may be present. Obtain as much information as possible regarding the pulse generator, leads, and programmed values. Information on time of initial device placement, indication for pacemaker implant, special programming features particular to that model or patient, any recent surgeries, and knowledge of any manufacturer recalls or alerts on pacing systems may provide clues to the underlying malfunction.

Physical examination

Look for the following signs in patients with pacing system malfunction:

  • Pocket stimulation

  • Erosion of pocket

  • Diaphragmatic stimulation

  • Cannon A waves during atrioventricular dyssynchrony

  • Bradycardia

  • Tachycardia

  • Hypotension