We described two cases of pacemaker battery depletion. Case 1 was an year-old male manifesting chest pain and dyspnea. Automatic reprogramming after pacemaker battery depletion resulted in pacemaker syndrome. While case 2 was an year-old female with complete atrioventricular heart block and torsade de pointes, due to complete depletion of pacemaker battery. In addition, we introduce a method that can easily identify the depletion of the pacemaker battery, which has clinical promotion value of a certain degree.
Those cases emphasize that serious morbidity can arise from pacemaker battery depletion, even in the early stages. Therefore, early detection and diagnosis is especially important. Peer Review reports. Chest pain, dyspnea accompanied by changes of pacing mode and rate in patient with pacemaker suggest the possibility of battery depletion of pacemaker.
Torsade de pointes TdP tachycardia in patient with pacemaker suggests the possibility of pacemaker battery depletion, which causes bradycardia with QT interval prolongation. Pacemaker battery depletion is a gradual process, usually divided into two stages, ERI Elective replacement indication and EOL End of life [ 1 , 2 , 3 ]. At this stage, in order to extend battery life, the pacemaker will automatically reprogram, including turning off the rate response function, and changing in pacing mode and rate.
If the generator is not replaced during this period, it will progress to EOL status and the pacemaker will gradually stop working, causing varying degrees of symptoms and clinical events [ 4 , 5 , 6 ]. Meanwhile, due to lack of understanding of and attention to it, it is easy to be misdiagnosed and missed diagnosis in the Emergency Department ED. We present two cases related to pacemaker battery depletion in order to improve the understanding of this special clinical situation.
An year-old male was admitted to our ED due to angina pectoris and dyspnea. He had a past medical history of coronary heart disease and hypertension. He received a pacemaker due to sick sinus syndrome. Laboratory studies reported: troponin T 0.
Treatments such as anti-angina and diuretic therapy did not ease the symptoms. ECG a : at presentation b : after pacemaker exchange. An year-old woman was admitted to our ED with fever and syncope. She had a history of hypertension and was prescribed aspirin, amlodipine as regular oral medications. On arrival, the patient was generalized weakness. During monitorization and ECG examination Fig. Laboratory analysis showed blood potassium 5. Cardiac biomarkers, liver and renal function were normal.
An isoproterenol infusion and intravenous magnesium sulfate MgSO4 treatment was initiated. In order to find out the reason why the pacemaker was not working, pacemaker interrogation was performed immediately. However, the pacing system programmer could not interrogate the device, and the magnet check did not respond, indicating pacemaker battery depletion in the EOL status.
During the preparation for temporary pacing, ventricular fibrillation occurred and she died after rescue. ECG a and b : at presentation. The rhythm strip showed complete atrioventricular AV block. The QRS complexes were wide because of the presence of right bundle branch block and left posterior fascicular block, representing the AV block is infranodal.
The first PVC occurred on the downslope of the T wave, which induced a polymorphic ventricular tachycardia with changing QRS complex amplitudes, which was known as torsade de pointes TdP. The clinical effects of pacemaker battery depletion come from two aspects: 1. Sinha et al. The results showed that 83 patients Bradycardia: With the progress of pacemaker battery depletion, the symptoms will gradually worsen. Syncope and pre-syncope were reported to be the most frequent symptoms [ 4 , 6 ].
However, syncope in bradycardia is not always caused by asystole but may instead be caused by TdP. TdP is a fatal polymorphic ventricular tachycardia, which is caused by many conditions that prolonged QT interval, such as drug, electrolyte abnormalities, bradycardia, myocardial infarction, congestive heart failure et al.
In Case 2, no electrolyte abnormalities were found and she was not taking drugs that were known to prolong the QT interval. Cardiac biomarkers were negative and the evidence for the diagnosis of myocardial infarction was insufficient.
Although complicated with heart failure and fever, it could not fully explain the QT interval prolongation. Complete atrioventricular block was the main cause of prolongation of QT interval [ 8 ].
When associated with premature ventricular contractions, it was very easy to induce TdP. You might have chest pain, difficulty breathing, dizziness, or lightheadedness. If your pacemaker fails, you are at increased risk of stroke and heart failure. The risk of stroke for patients with atrial fibrillation AFib increases by five times. The risk of death-related to cardiac problems doubles. Therefore, it is important to seek help as soon as possible. You can take care of your health and your pacemaker by making sure not to pull, twist, or push the generator.
You can also inform doctors and dentists before undergoing any procedures that you have a pacemaker. If you think it is failing, you should contact your cardiologist or electrophysiologist also known as an EP doctor. If you have concerns about your pacemaker, set up an appointment with Heart Rhythm Consultants in the Sarasota and Tampa Bay area.
Our experienced team is ready to help you and answer any questions about your heart health. Speak with a care coordinator today. The experienced electrophysiologists of Heart Rhythm Consultants, P. Our specialty cardiologists, or EP doctors, help patients manage their abnormal heart rhythm conditions, whether they suffer from arrhythmias like atrial fibrillation AFib , or other irregular heartbeats.
Dilip J. Mathew, Dr. Antonio Moretta, and Dr. Rajesh Malik perform arrhythmia treatments like cardiac ablation, cryoablation, and implanting pacemakers or defibrillators. My pacemakers last about five years. I go "on and on" like the Energizer Bunny until the battery starts to wind down and I shift into slow-motion mode and when all is as it should be, it is replaced before it stops completely. When I get a new battery, I am fully charged, enthused with new energy and feel like a superwoman who can move at the speed of the superhero Flash.
Needless to say, a new pacemaker is a cause for celebration. Technology advances so rapidly that each time I get a new pacemaker, the function is significantly improved and the surgery is relatively minor.
My next pacemaker was a fancy dual-chamber pacemaker. It required the surgical implant of a second wire or lead as they are called , allowing pacing in both my heart's atrium and ventricle. I was walking upright. I was not cognizant until then that I had previously walked with my body bent to the side because my atrium and ventricle were marching to different drummers. I try not to get myself worked up over pacemaker complications.
I have experienced a number of interferences from motion sensors, dental equipment, power wires, old microwaves and various electronic tools that have zapped me, messing up my settings so that I fall to the ground or start to run.
A new kind of interference is always lurking around the corner. Pacemakers continue to improve and get more sophisticated. My latest — I have lost count, but I believe it's my eighth — is like a little computer, responds according to my own level of activity and weighs less than an ounce.
How wonderful is this? I have to say that it is a bit unnerving when your time on this Earth is up but you are given a machine that takes over the functioning of your heart.
Indeed, I am what doctors call "pacemaker-dependent. In the end, what's not to like about having a machine in my body, akin to a Ferrari engine, that motors me through life?
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