Pacemaker Failure

Pacemakers are reliable life-saving devices. But problems can occur., even though they are rare. It is important to understand why you have a pacemaker. This can also help you understand why it might "fail" and what effects might happen if it does fail. Some reasons you may have a pacemaker are to

  • Help increase your heart rate if it is too slow

  • Address problems with the electrical system within in the heart resulting in heart block

  • Improve heart failure when there is evidence of both heart muscle damage and problems with the electrical system of the heart.

  • Slow a fast, irregular heart rate that required medicine or procedures leading to a heart rate that is too slow

Each of the above problems typically causes you to feel symptoms. So, if your pacemaker fails to work properly, you may have symptoms due to the reason you have the pacemaker. Or you may have symptoms from the pacemaker not working properly. Signs and symptoms of pacemaker failure or malfunction include:

  • Dizziness, lightheadedness

  • Fainting or loss of consciousness

  • Palpitations

  • Hard time breathing

  • Slow or fast heart rate, or a combination of both

  • Constant twitching of muscles in the chest or abdomen

  • Frequent hiccups

A complete failure of a modern pacemaker is rare. Most of the time, problems occur when the pacemaker is working properly, but it may just need to be reprogrammed. Other times, there might be a true problem with the battery, a lead, or an electrode. These problems can sometimes be fixed with reprogramming of the pacemaker. Other times, they may require a procedure to fix the problem. This is often called a lead revision.

Causes for a pacemaker failure include:

  • Battery depletion

  • Loose or broken wire between the pacemaker and the heart

  • Electronic circuit failure resulting from a break in wire insulation or a fracture in the wire

  • Electrolyte abnormality (such as high potassium in the blood)

  • Electromagnetic interference from certain devices such as power generators, arc welders, and powerful magnets (found  in medical devices, heavy equipment, and motors)

  • A pacemaker lead getting pulled out of position

  • A change in your condition that needs pacemaker reprogramming

Common household devices, such as microwave ovens, TV remotes, heating pads, and electric blankets don't interfere with pacemakers. Cell phones in the U.S. do not interfere with pacemakers, but it is recommended that you keep a cell phone on the opposite side of the body from the pacemaker. Most modern day pacemakers are not affected by MRI. Talk , with your healthcare provider to know if you can safely have an MRI with your device and if you need to take any special precautions first.

Home care

The following are general care guidelines:

  • Don't push, pull, or twist the pulse generator unit placed under your skin.

  • Carry a wallet ID card with the name of your device and its maker, and the name of your cardiologist. This will help emergency personnel test your pacemaker in the event of a malfunction.

  • Tell your healthcare providers or dentist that you have a pacemaker before any procedures are done because medical and dental equipment can affect it. Routine X-rays will not affect a pacemaker.

Follow-up care

Follow up with your healthcare provider as advised.

Have your battery checked at least every 6 months, or as advised by your healthcare provider, to make sure your battery does not get worn out. The generator will need to be changed once the device has reached the elective replacement period just prior to the end of its' battery life. This is about every 10 years, depending on the type of device you have and how much it is used. Monitoring device function and battery strength can sometimes be done using a device connected to your phone line. Or you may be able to  transmit information to your healthcare provider over the internet. This is called remote monitoring. Ask your provider if this is an option for you.

When to seek emergent care

You may need to seek emergent care or call 911 if you have any of the following:

  • Trouble breathing

  • Fainting or loss of consciousness

  • Chest pain

  • Frequent or persistent palpitations (the sense that your heart is fluttering or beating fast or hard or irregularly)

  • Slower than usual heart rate compared to your normal

  • Chest pain with weakness, dizziness, fainting, heavy sweating, nausea, or vomiting

  • Extreme drowsiness, confusion

It is important to keep in mind that these symptoms may be a result of a problem with your pacemaker. However, they can also be unrelated to pacemaker function.

When to seek medical advice

Call your healthcare provider right away if any of the following occur:

  • New symptoms of weakness, dizziness, lightheadedness

  • Pain, redness, swelling, drainage from pacemaker implant site or other signs of infection

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Pacemaker generator feeling like it is loose or wiggling in the pocket under the skin

  • Muscle twitching in the muscles of your chest or abdomen

  • Hiccups that won't stop

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