A heart pacemaker is a small battery-operated device that detects and corrects slow, irregular heartbeats and delays in the normal flow of electrical impulses within the heart. According to a 1995 article in "Public Health Reports," approximately 2.6 in 1,000 adults have a pacemaker within their chests. The authors of this article also note that a higher prevalence of pacemaker implantation occurs in men compared to women.
Dislodgment
Lead dislodgment is a complication that can occur with pacemakers. Dislodgment of a pacemaker lead occurs in 2.5 percent of patients with pacemaker implants, according to a 2001 study by Dr. Stephen Pavia and Bruce Wilkoff in "Current Opinion in Cardiology." Lead dislodgment usually occurs 24 to 48 hours after the implantation procedure, but it can happen even 3 months after the operation. Doctors confirm this complication using a chest X-ray. Patients must have the dislodged pacemaker lead repositioned or replaced to solve the problem.
Malposition
Pacemaker lead malposition is another pacemaker lead complication. Malposition usually happens in patients with atrial or ventricular septal defects, which are congenital heart problems characterized by a defect in the heart walls that separate the chambers or compartments of the heart, according to Pavia and Wilkoff. Doctors diagnose this complication using an electrocardiogram, which displays an abnormal and misleading tracing when a lead is malpositioned. Malposition of a pacemaker lead can sometimes cause breathing discomfort to the patient as well. Doctors must reposition the lead to solve this problem.
Venous Thrombosis
Venous thrombosis---a blood clot within a vein---occurs in up to 40% of patients with a pacemaker, according to Pavia and Wilkoff. This complication is usually asymptomatic; however, 5 percent of patients will have symptoms including neck discomfort and swelling in the arms, face and head. Management of this problem depends on the severity and the cause.
Conductor Failure
Conductor failure, or discontinuity in the wire component of the lead, causes ineffective current delivery to the heart and inappropriate shocks or electric heartbeat stimulation. The University of Maryland Medical Center reports that this failure can lead to abnormal heartbeats. Lead replacement is the treatment of choice for this complication, state Pavia and Wilkoff.
Insulator Failure
Lead insulator failure usually occurs owing to an opening in the material surrounding the lead conductor. The opening results from wear over time, according to Pavia and Wilkoff. Lead insulator failure can increase a patient's defibrillation threshold---the minimum heart rate that stimulates action from the pacemaker---decreasing the effectiveness of the pacemaker. Pacemaker lead replacement is necessary to correct this complication.
References
- University of Maryland Medical Center: Heart Pacemaker---Overview
- "Public Health Reports"; The Epidemiology of Pacemaker Implantation in the United States; B. G. Silverman, et al.; 1995
- "Current Opinion in Cardiology"; The Management of Surgical Complications of Pacemaker and Implantable Cardioverter-Defibrillators; Stephen Pavia, M.D. and Bruce Wilkoff, M.D.; 2001
