Pacemaker Failure

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

  • Help increase your heart rate if it's too slow

  • Take care of problems with the electrical system in your heart that causes heart block

  • Improve heart failure when you have heart muscle damage and problems with the electrical system of your heart

  • Slow a fast, irregular heart rate that needed medicine for treatment

Each of the above problems typically causes you to feel symptoms. So if your pacemaker fails to work correctly, you may have symptoms caused by these problems. Or you may have symptoms from the pacemaker not working correctly. Symptoms of pacemaker failure or malfunction include:

  • Dizziness or lightheadedness

  • Fainting or loss of consciousness

  • Feeling like your heart is fluttering (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

If you have any of the symptoms above, call 911 or seek medical care right away. Your pacemaker may not be working correctly.

A complete failure of a modern pacemaker is rare. Most of the time, problems occur when the pacemaker is working correctly but needs 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:

  • Worn-out battery

  • Loose or broken wire between the pacemaker and the heart

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

  • Electrolyte problem, such as high potassium in the blood

  • Electromagnetic interference from certain devices. These include 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. Most modern-day pacemakers are not affected by MRIs. Talk with your healthcare provider to find out if you can safely have an MRI with your device or if you need to take any special precautions first.

Be careful when using cell phones and other electronic devices. Keep them at least 6 inches away from your pacemaker. It's safest to hold all cell phones to the ear farther from your pacemaker or use the speaker mode setting. Don’t carry your phone or electronic device in your chest pocket, over the pacemaker. Experts advise carrying your cell phone and other electronics in a pocket or bag below your waist. Most cell phones and electronic devices don't interfere with pacemakers. But some cell phones and electronic devices such as smart watches use powerful magnets for wireless charging. These may interfere with the normal function of your pacemaker. The magnet used for charging or other magnet accessories can also interfere with the normal function of your pacemaker. These devices should be kept away from your pacemaker when wirelessly charging or stored. Follow any other instructions given to you by your healthcare provider or from the maker of your pacemaker.

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 if it malfunctions.

  • Tell your healthcare providers and 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. This is to make sure your battery does not get worn out. The generator will need to be changed when the device has reached the elective replacement period just before the end of its battery life. This is about every 10 years, depending on the type of device you have and how much it's 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 send information to your healthcare provider over the internet. This is called remote monitoring. Ask your provider if this is an option for you.

Call 911

Call 911 if you have any of the following:

  • Trouble breathing

  • Fainting or loss of consciousness

  • Chest pain

  • Frequent or continued feeling that your heart is fluttering or beating fast or hard or irregularly (palpitations)

  • Slower than usual heart rate compared with your normal heart rate

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

  • Extreme drowsiness or confusion

It's important to keep in mind that these symptoms may be a result of a problem with your pacemaker. But 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 or lightheadedness

  • Pain, redness, swelling, or 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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