What are the potential complications of a pacemaker?

Updated: Oct 11, 2019
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
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Pacemaker complications include malfunction due to mechanical factors such as pneumothorax, pericarditis, infection, skin erosion, hematoma, lead dislodgment, and venous thrombosis. Treatment depends on the etiology. Pneumothoraces may require medical observation, needle aspiration, or even chest tube placement.

Erosion of the pacer through the skin, while rare, requires device replacement and systemic antibiotics. Hematomas may be treated with direct pressure and observation, rarely requiring surgical drainage.

Lead dislodgment generally occurs within 2 days of device implantation pacer and may be seen on chest radiography. Alternatively, fluctuating impedance may be a subtle clue, as the patient may have normal impedance when the lead is in contact with the endocardium, but infinite (or very high) impedance when the lead is dislodged.

Free-floating ventricular leads may trigger malignant arrhythmias. Device-associated venous thrombosis is rare but generally presents as unilateral arm edema. Treatment includes extremity elevation and anticoagulation.

Advanced life support protocols, including defibrillation, may safely be performed for patients with pacemakers in place. Sternal paddles are placed at a safe distance (10 cm) from the pulse generator. Temporary pacing may become necessary in cases of myocardial infarction, as the current pacemaker discharge settings may be insufficient to stimulate ventricular contraction.

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