How is a pacemaker replaced?

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1. 1

   Preventing complications in cardiac pacemaker therapy: a lifecycle-based risk management framework.

   Frontiers in cardiovascular medicine (Li et al.)Published Jun 1, 2026Checked Oct 11, 2026

   “These events may arise from procedural factors, lead or device dysfunction, device-associated infection, or subsequent structural and functional alterations of the heart. This review proposes a structured lifecycle-based risk management framework that integrates complication prevention across the entire continuum of pacemaker therapy. This approach highlights the dynamic nature of complication risk across different phases of device therapy. Within this lifecycle risk-management paradigm, complication prevention should extend beyond isolated perioperative measures and encompass structured preprocedural assessments, standardized intraoperative techniques, and longitudinal postprocedural surveillance. By synthesizing current evidence regarding the underlying mechanisms and clinical manifestations of pacemaker-related complications and contemporary prevention and management strategies for these complications, this work provides a comprehensive overview. This framework-based approach offers a practical strategy to enhance risk stratification, guide procedural decision-making, and improve long-term outcomes in patients undergoing pacemaker therapy.”

2. 2

   Prevalence and incidence of left ventricular systolic dysfunction and adverse outcomes in patients receiving de novo and replacement pacemaker therapy for bradycardia.

   European heart journal open (Abdul et al.)Published Apr 27, 2026Checked Oct 11, 2026

   “We investigated the prevalence and predictors of LVSD and adverse HF outcomes in patients undergoing de novo or replacement RVP for bradycardia.Methods and resultsProspective data were collected from 1024 patients receiving de novo (2014-2017, n = 514) or generator replacement (2008-2011, n = 510) RVP at a UK tertiary centre. Logistic regression models were used to identify predictors of LVSD, defined as left ventricular ejection fraction (LVEF) De novo patients were more often male (66% vs. 56%) and more likely to have ischaemic heart disease (IHD; 31% vs. 14%) and diabetes (24% vs. 6%), but less likely to have atrial fibrillation (AF; 25% vs. 33%) than replacement patients (all P de novo than replacement cases (20% vs. 17%, P 80% (OR = 2.13, CI: 1.29-3.52). Over a median 30 (IQR: 16-42) months, 341 (33%) experienced HFH or death, more commonly after replacement than de novo RVP (25% vs. 8%, P ConclusionLVSD is common in RVP recipients and largely driven by comorbidities rather than pacing burden. Screening and targeted therapy in high-risk patients may improve outcomes and optimize resource use.”

3. 3

   Pacing cessation just before generator replacement - A life-threatening consequence of pacemaker battery depletion: A case report.

   Journal of cardiology cases (Mitsumizo et al.)Published May 7, 2026Checked Oct 11, 2026

   “This lack of surveillance resulted in a critical reduction of the pacing rate to 14 ppm, culminating in the complete cessation of pacing immediately before generator replacement. Despite the Abbott device's specified End-of-Life (EOL) safety mechanism, pacing function failed entirely-a rare but life-threatening complication. Uniquely, this case provides serial electrocardiographic documentation capturing the full progression of severe battery depletion. These findings underscore that continuous follow-up and remote monitoring, as emphasized in recent guidelines, are pivotal for preventing such critical outcomes.Learning objectiveThis case highlights the potential for profound pacemaker rate reduction and complete pacing cessation beyond manufacturer-defined End-of-Life settings in the setting of extreme battery depletion. It emphasizes the importance of regular device follow-up, timely generator replacement, and the use of remote monitoring to detect critical battery status changes and prevent life-threatening complications during pacemaker management.”

4. 4

   Pacemaker (Wikipedia)

   WikipediaPublished Sep 30, 2026Checked Oct 11, 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.”