Ventricular tachycardia or fibrillation.Venous thrombosis - rare and usually presents as unilateral arm oedema.Lead dislodgement - usually occurs within two days following implantation of a permanent pacer and may be seen on chest radiography (if the lead is floating freely in the ventricle, malignant arrhythmias may develop).Erosion of the pacer through the skin (rare - requires pacer replacement and systemic antibiotics).Pneumothorax (may require chest drain).Replacement with a dual chamber is required. Pacemaker syndrome is associated with atrial cannon waves caused by simultaneous atrial and ventricular contractions. Pacemaker syndrome: some patients with VVI pacemakers, especially with sinoatrial (SA) rather than atrioventricular (AV) disease, will show retrograde ventriculoatrial (VA) conduction during ventricular pacing which can cause fatigue, dizziness and hypotension.This may be due to poor lead positioning, lead dislodgment, magnet application, low battery states, or myocardial infarction. Undersensing: pacer incorrectly misses intrinsic depolarisation and paces despite intrinsic activity.This may be due to muscular activity, particularly oversensing of the diaphragm or pectoralis muscles, electromagnetic interference, or lead insulation breakage. Oversensing: pacer incorrectly senses electrical activity and is inhibited from correctly pacing.This may be due to lead fracture, lead dislodgement, a break in lead insulation, an elevated pacing threshold, myocardial infarction at the lead tip, certain drugs (eg, flecainide), metabolic abnormalities (eg, hyperkalaemia, acidosis, alkalosis), cardiac perforation, poor lead connection at the take off from the generator, and improper amplitude or pulse width settings. Failure to capture: pacing spike is not followed by either an atrial or a ventricular complex.

This may be due to battery failure, lead fracture, a break in lead insulation, oversensing (inhibiting pacer output), poor lead connection at the take off from the pacer, and 'cross-talk' (ie a phenomenon seen when atrial output is sensed by a ventricular lead in a dual-chamber pacer). Failure to output: no pacing spike is present despite an indication to pace.Complications arising from cardiac implantable electrophysiological devices: review of epidemiology, pathogenesis and prevention for the clinician. HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDs): description of techniques, indications, personnel, frequency and ethical considerations. Wilkoff BL, Auricchio A, Brugada J, et al.

Actions elicited during scheduled and unscheduled in-hospital follow-up of cardiac devices: results of the ATHENS multicenter registry. Mascioli G, Curnis A, Landolina M, et al. Pacemaker and ICD generator malfunctions analysis of Food and Drug Administration Annual Reports. Maisel WH, Moynahan M, Zuckerman BD, et al. A knowledge of these factors is essential for health care providers, given the morbidity and mortality that can potentially be associated with device-related issues, especially in patients who are dependent on the included pacing function.Ĭardiac implantable electronic devices implantable cardioverter-defibrillator malfunction loss of capture noncapture pacemaker malfunction.Ĭopyright: © 2020 Innovations in Cardiac Rhythm Management. Further, there are also potential noncardiac causes, such as medications, electrolyte imbalance, and acidemia. Loss of capture can also occur from external electrical stimuli and inappropriate pacemaker or ICD settings. This change can be due to a cardiomyopathy, fibrosis medications, metabolic imbalance, lead fracture, or an exit block. In comparison, an increase in the required threshold promoting a loss of capture can happen after months to years of insertion of the pacemaker or ICD.

The most common acute cause just after the insertion procedure is lead dislodgement or malposition. There are many causes for a loss of capture, with the timing of the implant having a high correlation with certain causes over others. Loss of capture can be an emergent presentation for an unstable patient and can be encountered intermittently in hospitalized patients. As more pacemakers and implantable cardioverter-defibrillators (ICDs) are being placed, a basic understanding of some troubleshooting for devices is becoming essential. The number of patients with implantable electronic cardiac devices is continuously increasing.

Failure to sense vs failure to capture