Pacemaker Malfunction Follow-up

Updated: Sep 19, 2016
  • Author: Chakri Yarlagadda, MD, FACC, FSCAI, FASNC, CCDS; Chief Editor: Jeffrey N Rottman, MD  more...
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Further Outpatient Care

Most cases require only follow-up device interrogation and chest radiograph.


Further Inpatient Care

Additional inpatient care may include the following:

  • Device interrogation

  • Chest radiograph for lead position and any complications such as pneumothorax

  • Wound care after pulse generator change or lead implant



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. [9]



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.