Pacemaker failure is the inability of an implanted artificial pacemaker to perform its intended function of regulating the beating of the heart. A pacemaker uses electrical impulses delivered by electrodes in order to contract the heart muscles. Failure of a pacemaker is defined by the requirement of repeat surgical pacemaker-related procedures after the initial implantation. Most implanted pacemakers are dual chambered and have two leads, causing the implantation time to take longer because of this more complicated pacemaker system. These factors can contribute to an increased rate of complications which can lead to pacemaker failure.
Approximately 2.25 million pacemakers were implanted in the United States between 1990 and 2002, and of those pacemakers, about 8,834 were removed from patients because of device malfunction most commonly connected to generator abnormalities. In the 1970s, results of an Oregon study indicated that 10% of implanted pacemakers failed within the first month. Another study found that more than half of pacemaker complications occurred during the first 3 months after implantation. Causes of pacemaker failure include lead related failure, unit malfunction, problems at the insertion site, failures related to exposure to high voltage electricity or high intensity microwaves, and a miscellaneous category (one patient had ventricular tachycardia when using his electric razor and another patient had persistent pacing of the diaphragm muscle). Pacemaker malfunction has the ability to cause serious injury or death, but if detected early enough, patients can continue with their needed therapy once complications are resolved.
Symptoms
Moderate dizziness or lightheadedness
Syncope
Slow or fast heart rate
Discomfort in chest area
Palpitations
Hiccups
Causes
Direct factors
Lead dislodgement
A Macro-dislodgement is radiographically visible. A Micro-dislodgement is a minimal displacement in the lead that is not visible in a chest X-ray, but has the ability to increase the capture threshold and eventually cause a loss of capture. Lead dislodgement can cause sensing failure, which occurs when proper atrial or ventricular sensing is not achieved by the programming of the pacemaker. Ventricular lead dislodgement is less common compared to atrial lead dislodgement. Causes Twiddler's Syndrome The patient's constant manipulation of the pulse generator within its skin pocket can lead to a dislodgement of the device. The generator is rotated on its longitudinal axis, which causes traction and results in a lead dislodgement. Reel's Syndrome Like Twiddler's Syndrome, it is the manipulation of the pulse generator, but instead the generator is rotated on its transverse axis, which rolls the lead around the generator, creating dislodgement. Direct trauma over the system. Lead fracture Unit malfunction Battery failure, component malfunction, or generator failure Problems at the insertion site Infection of the insertion site can cause local inflammation or the formation of an abscess in the pulse generator pocket. Infection can cause the erosion of part of the pacing system that is in the skin. Failures related to exposure to high voltage electricity or high intensity microwaves