• Implant related Troubleshooting
• Lead related Troubleshooting
• Pacemaker malfunction
Early complications of pacemaker
– SVT, VT/ Cardiac arrest
– Lead dislodgement/Lead perforation
• Absence of lung markings over the lung
field ipsilateral to the pacemaker pocket
assessed from the fluoroscopy or pre-
• Non-puncture related, might occur at
• 0.66% (190/28,860 patients) in Danish Pacemaker
– more often in women [OR 1.9],
– age >80 years [OR 1.4],
– prior history of chronic obstructive pulmonary disease
– implantation of a dual-chamber PM [OR 1.5]
– venous access with subclavian vein puncture [OR 7.8]
– venous access with both subclavian vein puncture and
cephalic vein cut-down [OR 5.7]
– implantation in a non-university center [OR 2.1].
Old lady, kyphoscoliosis,
chronic obstructive pulmonary disease
How to avoid pneumothorax
• The cephalic vein cut-down technique
should be applied whenever possible to
avoid this complication.
Pneumothorax nursing care
• Administer oxygen as prescribed.
• Position the client in high fowler’s position.
• Prepare for chest tube placement until the lung
has expanded fully.
• Monitor chest tube drainage system.
Hematoma formation at pulse
generator / due to
• Warfarin was temporarily discontinued before device
implantation when possible to achieve an INR value
of < 1.7
• Administration of LMWH was stopped 24 h before the
• Antiplatelet therapy with ASA or clopidogrel was
allowed to continue
• Treatment with warfarin was resumed after 24 h and
with LMWH after 12–24 h
– changes in the morphology of
– changes in dipole of the
– changes in the lead position
identified on a chest
– surgical intervention to reposition the lead
• an adequate heel on the intracardiac portion of the lead
• look for a 2 to 3mV current of injury pattern
• electrical and mechanical stability of the lead may be
– Twiddler’s syndrome
• the portion of the lead within the pocket should be
• If damage to the conductor coil or insulation is noted, the
lead should not be reused.
Order a Chest X-ray
The chest x-ray revealed a dislodged lead