How is a pacemaker powered, and what happens when its battery runs out?

Numbers match the citations in the article. A working link isn't proof that a page supports a claim; check the quoted passage and date.

1. 1

   Pacemaker (Wikipedia)

   WikipediaPublished Oct 15, 2026Checked Oct 17, 2026

   “A pacemaker, also known as an artificial cardiac pacemaker, is an implanted medical device that generates electrical pulses delivered by electrodes to one or more of the chambers of the heart. Each pulse causes the targeted chamber(s) to contract and pump blood, thus regulating the function of the electrical conduction system of the heart. The primary purpose of a pacemaker is to maintain an even heart rate, either because the heart's natural cardiac pacemaker provides an inadequate or irregular heartbeat, or because there is a block in the heart's electrical conduction system. Modern pacemakers are externally programmable and allow a cardiologist to select the optimal pacing modes for individual patients. Most pacemakers are on demand, in which the stimulation of the heart is based on the dynamic demand of the circulatory system. Others send out a fixed rate of impulses. A specific type of pacemaker, called an implantable cardioverter-defibrillator, combines pacemaker and defibrillator functions in a single implantable device.”

2. 2

   Preferences of Patients and Cardiologists Regarding Pacemaker Characteristics in Spain: A Discrete Choice Experiment.

   Patient preference and adherence (García et al.)Published Feb 20, 2026Checked Oct 17, 2026

   “For both patients (P) and cardiologists (C), the most important characteristics of pacemakers (higher relative importance, RI) are MRI compatibility (P: 28.1%; C: 25.1%) and battery longevity (P: 22.6%; C: 23.8%). The type of follow-up is more highly valued by cardiologists than by patients (P: 10.2%; C: 21.1%), whereas pacemaker size is prioritized by patients (P: 19.1%; C: 7.7%). From the cardiologists' perspective, safety (12-month post-implantation infection rate: 19.39%) and technical aspects such as conduction system pacing (CSP) (15.14%), algorithms for minimizing unnecessary right ventricular stimulation (9.43%), and programming modes (9.11%) are also important decision drivers.ConclusionMRI compatibility and battery longevity are key factors for both patients and cardiologists in decision-making. Patients also prioritize generator size and replacement processes, while cardiologists additionally focus on safety (infection rates) and technical aspects (CSP and algorithms to reduce unnecessary right ventricular stimulation).”

3. 3

   Case Report: Sequential leadless pacing after battery depletion in a patient with recurrent device-related infection.

   Frontiers in cardiovascular medicine (Chinybayeva et al.)Published Jul 21, 2026Checked Oct 17, 2026

   “implanted 2017, left in situ at the right ventricular septum) to an AV-synchronous leadless pacemaker (Micra AV, implanted 2025 because of battery depletion of the prior device, not infection) using a leave-in-situ approach.ResultsSequential implantation was successfully performed in 2025, with the new device implanted at the right ventricular mid-septum while the previously implanted device was left in situ. Acute electrical parameters were satisfactory (pacing threshold 0.63 V, R-wave amplitude 9.8 mV, impedance 720 Ω), with no evidence of inappropriate sensing. At follow-up, electrical parameters remained stable (pacing threshold 0.50 V, impedance 670-650 Ω), with atrioventricular synchrony of 80% at 1 month and 84-85% at 3-6 months. No clinical or device-telemetry evidence of mechanical interaction or electrical interference between the devices was observed during follow-up. No device-related complications occurred during follow-up.ConclusionA sequential leadless-only pacing strategy, including a leave-in-situ approach, may represent a feasible and safe long-term option in selected high-risk patients with device-related infections and a history of transvenous system extraction.”

4. 4

   Expert Consensus Statement: Committee on Implantable Devices and Committee on Social Issues, Japanese Heart Rhythm Society (JHRS) Statement on Remote Monitoring of Cardiac Implantable Electronic Devices.

   Journal of arrhythmia (Watanabe et al.)Published Sep 1, 2026Checked Oct 17, 2026

   “Remote monitoring (RM) has been established as a standard tool for the management of patients with cardiac implantable electronic devices (CIEDs), offering advantages such as early event detection, fewer routine outpatient visits, and reduced mortality. As RM becomes more common, its appropriate implementation and the need for safe, efficient management have become increasingly important. This statement of the Japanese Heart Rhythm Society (JHRS) provides comprehensive guidance for medical professionals and device manufacturers involved in RM. Specifically, it outlines recommendations on personnel placement, workflow optimization, patient and caregiver education, alert notification settings, physiological parameter monitoring, and insurance claims. It also addresses the responsibilities of device manufacturers, the use of third-party resources, and strategies for reducing workload based on alert notifications. Recommendation classes and evidence levels were determined by the consensus of the writing team, and the proposed recommendations were reviewed and peer-reviewed by the JHRS' Committee on Implantable Devices.”

5. 5

   Cost-Effectiveness of Atrioventricular Synchronous Leadless Pacing in Patients With Atrioventricular Block: Results and Implications From an Exploratory Analysis for Japan.

   Circulation reports (Satomi et al.)Published May 27, 2026Checked Oct 17, 2026

   “In this study we assessed the potential cost-effectiveness of TC-PM in Japan and methodological implications for future global cost-effectiveness analyses.Methods and resultsA decision-analytic Markov model captured strategy-specific complication rates, device replacements, and health-related quality of life. Parameter inputs were derived from systematic literature search, clinical studies, and claims data. The discounted lifetime incremental cost-effectiveness ratio (ICER, in JPY per quality-adjusted life-year (QALY) gained) was evaluated against a 5 million JPY per QALY willingness-to-pay threshold. Extensive scenario and sensitivity analyses were conducted. TC-PM was associated with lower complication rates (3.8% vs. 9.8% at 36 months, hazard ratio 0.39; PConclusionsAV-synchronous pacing with a TC-PM is associated with lower complication rates and some improvement in projected quality-adjusted survival that can render it a cost-effective intervention in the Japanese healthcare system as long as some of the observed short-term quality-of-life benefit is maintained.”