Some situations may need to be managed on an urgent basis, either because of new-onset symptoms or because of CIEDs-related issues.
Pacemaker
The sudden occurrence of symptoms may be related to the implanted pacemaker in the event of loss of function. This latter may occur because of an increase of the current needed to stimulate the heart despite a normally functioning implanted system, or because of a lead integrity issue, lastly and extremely rarely because of pulse generator failure. Battery end of life is indeed usually managed by timely device replacement.
Syncope (transient loss of consciousness) or near-syncope is the harbinger of such situations.
How to suspect a pending pacemaker loss of function?
- syncope or near syncope is usually recurring in a few minutes, 2-4 in an hour
- heart rate measured by the arterial pulse is usually lower than the programmed pacemaker rate ( < 35 bpm). Pauses, 2 to 5 seconds duration, may be detected.
About symptoms: syncope can occur because of several medical conditions that range from benign fainting to severe illnesses. Syncope after gastrointestinal symptoms (vomiting, diarrhea), after fasting or huge meals, after prolonged standing, on a heat wave or on blood sight, micturition syncope, portend a situation that is not related to the pacemaker, usually have a favourable outcome and do not need medical intervention unless recurrent. Recurrent syncope or near syncope in a short period (hours) should prompt pacemaker recipients to seek urgent medical intervention regardless of the measured heart rate.
Other symptoms such as shortness of breath, fatigue, palpitation, chest pain are only rarely reported in the event of pacemaker malfunction: these symptoms can be effectively evaluated by the general practitioner, who can properly assess the need for further investigation.
Patients with a cardiac resynchronization device (CRT-P, also termed biventricular pacemaker) should pay particular attention to Heart Failure symptoms (shortness of breath, fatigue, foot oedema, weight gain, palpitation), that might foretell loss of left ventricular stimulation (Lead dislodgement, increased pacing threshold), need for pacemaker reprogramming, or onset of atrial arrhythmias.
