Pacemaker failure to capture skin#
Pacemaker failure to capture code#

Asymptomatic pacemaker syndrome is probably common and the true incidence of pacemaker syndrome much higher. The incidence of pacemaker syndrome has been estimated to range from 5% (symptoms severe enough to warrant pacemaker revision) to 80% (mild to moderately severe symptoms).

Absence of rate response to physiological need.

In 1994 Furman redefined pacemaker syndrome as : But not all patients exhibit a rise in blood pressure and indeed some will have a drop in their blood pressure. The result is decreased cardiac output in response to which the total peripheral resistance will increase. Pacemaker syndrome refers to the occurrence of symptoms relating to the loss of AV synchrony in patients with a pacemaker, ie the atria contract at the same time as paced ventricular contractions.

To evaluate lead fracture - fluoroscopy is the gold standard, but ultrasound may be used if unavailable.

As devices become more reliable and battery life increases, monitoring by telephone is becoming increasingly rare.

Usually useful in the early post-implant period can reveal loss of capture.

This will result in asynchronous pacing mode and can reveal loss of capture and battery depletion.

Some brands may have stored electrocardiograms.

Review triggering thresholds, lead impedance, and battery function.

Echocardiogram: to assess for lead position, pericardial effusion or tamponade, or lead fracture.

Pacemaker failure to capture code#

A CXR can be used to identify the pacemaker model, as most pacemakers have an X-ray code which is visible on a standard CXR. CXR: evaluate lead position and look for lead fracture.12-lead ECG - any sign of myocardial ischaemia, arrhythmias or abnormal sensing.Blood tests: electrolytes, coagulation screen, digoxin levels if appropriate, myocardial injury markers - eg, troponins (may indicate recent myocardial infarction but may also indicate perforation).Wrong position requiring repositioning.Septicaemia (especially staphylococcal infection).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).

Pacemaker failure to capture skin#

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.