Can a Pacemaker Malfunction?

Hi everyone, I have done some work(!)

I have prepared a long document on Can a Pacemaker Malfunction, which I have placed in our FAQs if you go to Learn, then FAQs, then press the down or up arrow at Club Information, then scroll down to The Pacemaker/Defibrillator, then press Choose Category, where you will find the document in three parts.  I have provided a List of Contents for Parts 2-3, so you can scroll down to any section you might be interested in.  It is, quite frankly, a vast subject and I therefore apologise for the length of this document or for any omissions during my attempts to keep it as short as possible. I hope nonetheless it will be helpful to have one place where we can go to start to look for this sort of information.  If you need any further help, I have kept some important research links.

Fortunately pacemakers are very reliable today and complete failure is rare but pacemakers can malfunction due to a number of reasons and I have attempted to set these out in the document.  This is in response to ongoing questions about “how can we have a meaningful conversation with our doctors regarding symptoms which we believe are due to a pacing or sensing problem, when our doctors keep telling us our pacemakers are functioning normally?”

You will see Pacemaker-mediated arrhythmias (Part 3) are an important part of this document, since pacemakers can be directly involved in initiating and sustaining multiple different forms of arrhythmia which could result in symptoms requiring prompt treatment and settings adjustments.  The most common form of this complication is pacemaker-mediated tachycardia.  Although these might be considered “functional” pacemaker system malfunctions, the resulting arrhythmia could be deleterious to the patient if not stopped quickly, although the device is often said to be functioning normally and in accordance with its programmed settings.

Of course most of us will never experience long term difficulties with our pacemakers, especially if we have regular clinic follow ups, a caring team and if we report any unusual symptoms promptly.  I hope therefore that you will not have to consult this FAQ any time soon, but if your symptoms do not resolve, I hope you will find the document of some help.  I think you might be surprised to learn about the sheer number of possible rhythm disorders that can be induced by a pacemaker.

16 Comments

Great Job

by Good Dog - 2024-03-02 16:17:56

I've already read through most of it (with the exception of arrhythmias) and found it very informative. A lot of relevant info for anyone with a PM. It is a great asset for the Club!

Great Job Gemita!

Thank you,

Dave

i echo Good Dogs comments

by new to pace.... - 2024-03-02 17:55:36

Very impressive Gemita and the time that you have taken to write in such a manner that everyone can understand.  

new to pace

Outstanding

by Repero - 2024-03-02 18:04:32

Thanks Gemita for that comprehensive explanation: a very impressive piece of work. Your contribution to this club is already magnificent, and these articles go over and above. As you say, we may not have frequent need to dip into this account, but it is great to know that it is there.Thanks again.

Good Dog, New to Pace, Repero

by Gemita - 2024-03-02 19:19:07

Thank you my friends.  

I have enjoyed putting it all together over a period of time and learning a lot along the way.  I won’t pretend it wasn’t a challenge, especially when I was trying to use information from several different research papers on the same subject and come up with a final version that I could actually understand.  Now I hope this FAQ won't be lost in any future upgrade of the site, although I have kept a copy just in case!

Wow 🤩

by Lavender - 2024-03-02 20:29:48

Girl you have been burnin the midnight oil! You are amazing with such dedication to this site! Your work will help so many folks along the way.  Thanks too for the reminder to check out the learn faqs! There's a ton of information in there!

🙌🏼💐

 

Timely Information

by Flo - 2024-03-02 21:02:31

I look forward to reading the document again and thank you for the work you have put into this.  My new EP has found I have Inappropriate mode switching due to noise from a lead.  

Lavender and Flo

by Gemita - 2024-03-03 04:29:47

Lavender, thank you.  Yes there is a ton of information in FAQs as a whole, but I do sometimes wonder how many members go there looking for answers?  We all have numerous questions to ask following our implants, questions that our consultants perhaps would never have time to completely cover during all too brief follow up appointments, so a good FAQs section is really important. 

If you have anything you want included in the FAQs, I hope you will send them in, Lavender.  FAQs are only as good as we make them, so don’t be afraid to request changes, updates, additions, deletions to anything you read in our FAQs.  They are our FAQs after all 

Flo, thank you.  I was interested to read about your inappropriate mode switching due to noise from a lead rather than from an atrial tachyarrhythmia.  This is exactly the purpose of the new FAQ, to identify potential causes of pacemaker malfunction from a variety of different sources.  Have they pinpointed what the cause of the noise is?  I hope it is not coming from a faulty lead but from a source that can be corrected by sensitivity settings changes.  I hope this can be sorted for you and that you are not too adversely affected symptom wise from these inappropriate mode switches.

They have made my atrial lead more sensitive to pick up true AF episodes since my ectopic beats which were coming in fast, have been frequent triggers for inappropriate mode switch.  I am though still getting "appropriate" mode switching from AF high rate episodes (above 171 bpm).  

Been busy

by piglet22 - 2024-03-03 06:26:01

Great piece of work Gemita.

We must never underestimate the complexity of our built-in pump, the way it works and how all these electrical signals have evolved.

It would be a difficult task to simulate the heart at an advanced engineering level, let alone with muscles and cells.

First comes the understanding then the means of correcting the many things that can go wrong.

well done!

by Selwyn - 2024-03-03 08:52:03

Well done  Gemita. A very useful piece of work bringing together pacemaker technology in a readable form.  I have never been on the LEARN section before. FAQ is clearly of great value to everyone. We are in your debt for putting this together. 

 

Piglet and Selwyn

by Gemita - 2024-03-03 17:29:40

Thank you both for your kind words.

I would never underestimate the complexity of my natural pacemaker, nor of my pacemaker device, and I certainly struggle to understand both of them most of the time. 

Working through what could go wrong with my pacemaker has been of immense help to me too, so I have to declare a personal interest in doing the work.  

I had no idea for example that skeletal muscle activity could actually be tracked by a pacemaker, particularly with unipolar leads, and even falsely interpreted as a depolarisation.  There is indeed a lot to learn and to respect.

I am glad you found the FAQs of value.  There is a wealth of information there already, but I hope we can make further improvements in the future and that everyone will have easier access to what is available on this site

Great Job

by Grateful Heart - 2024-03-03 23:05:18

Great addition to FAQs Gemita!   This will be very helpful to all.

Grateful Heart 

Dedication and Kindness

by SeenBetterDays - 2024-03-04 12:48:58

Thanks Gemita for investing such a lot of time and effort into this piece of work.  It will be an excellent addition to the resources available on this site.  Your hard work in trying to help us to decipher often complex and involved topics is so much valued and appreciated.  I wish I had half your brain power!

Much love

Rebecca x

Good Heavens!

by Gotrhythm - 2024-03-04 14:28:23

I'm amazed. Amazed is a much overused word, but in this case I mean it exactly. To render so much technical information so that it is intelligible to the layperson...!

Gemita, you are truly a gift to all of us.

Being a person who was dealing with RNRVAS and would never have known to ask about it were it not for this group, I am particularly sensitive to just how useful the information you have provided really is. It is what we need to know to be able to ask intelligent questions.

For all the people who now will be able to get a quick explanation of PMT and the ways it can show up, I say "thank you, thank you!"

Grateful Heart, SeenBetterDays, Gotrhythm

by Gemita - 2024-03-05 06:23:24

Thank you all for your warm hearted support.  Most of the time I feel I have more in the way of brain fog than brain power so your comments were particularly nice to receive.   

When I started preparing the FAQ document, I wasn’t expecting to find so many possible causes for pacemaker malfunction and it was difficult to decide what to include and what to leave out.  I think it has largely worked, but I have repeated myself quite a lot although hopefully we all learn from “repetition”.  

Retrograde ventriculo-atrial conduction in pacemaker mediated arrhythmias was a difficult subject to tackle.  It was only when I found the statement:  "Retrograde conduction is the backwards conduction phenomena in the heart, where the conduction comes from the ventricles or from the AV node and travels “upwards” into the atria", that things started to fall into place.  

I suppose we can never afford to give up trying to understand how our hearts and devices work if we want to help ourselves when things sometimes go mysteriously wrong with a normal functioning pacemaker

Very Helpful

by Penguin - 2024-03-06 12:00:30

Thank you for this Gemita.  I bet that took some time to put together and a huge effort. I am very grateful for the reference material all in one place.  You deserve a medal! 

 

Penguin

by Gemita - 2024-03-07 03:51:32

Penguin, thank you, although both you and Gotrhythm really deserve the prize since you first asked the question about a rhythm disturbance called RNRVAS (repetitive non-reentrant ventriculo-atrial synchrony) and then poor Gotrhythm had the unfortunate experience of suffering from it!  This first started our journey of wanting to explore other causes of pacemaker induced unexpected rhythms and clearly there are several, and then finding other triggers/causes along the way. 

It has been difficult to put something together from so many different sources, but I hope this has enriched the paper.  I hope too I have broken down some of the medical jargon to improve readability, medical jargon that I struggled with at times.

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