The Problems With Pacemakers
While pacemakers save the lives of millions of people by steadying and sustaining the heartbeat, thereby maintaining the life of the individual implanted with the device, they are not perfect. Like any device implanted in the human body, it can become infected, malfunction, or even completely fail. Personally, in my 30+ years of experience with this device, I have encountered all three of these scenarios and would definitely not recommend them. However, with the implant of the pacemaker, and the necessity of it by nature, it is a risk worth taking.
Infections for pacemakers are rather rare, but are very dangerous. According to the article, ‘The Diagnosis and Treatment of Pacemaker-Associated Infection,’ from the Deutsches Aerzteblatt Online Journal, “the incidence of device-associated infection is 1.7% (in six months) for implanted defibrillators and 9.5% (in two years) for resynchronization devices” (Döring, Richter and Hindricks, 2018). While the “associated in-hospital mortality” (Döring, Richter, and Hindricks, 2018) remains rare, “between 5–15% (Döring, Richter, and Hindricks, 2018), this illustrates a notable mortality rate in this instance. Therefore, this highlights the present danger of this particular complication.
When I was fifteen, my pacemaker rejected me and had to be removed. It was the worst pain of my life, but it didn’t start out that way. For weeks beforehand, I got jolts of pain from the area, and no one knew the cause until one day it became constant, and I could not take it anymore. At the hospital, they didn’t believe me until the problem was removed and its nature was revealed. Luckily, it didn’t progress further than that. While a rare case, pacemakers becoming infected or rejected by the biological body is not probable, but it is possible, as my experience proves.
Malfunctions are more common, but it is just part of the mechanical nature of the beast, and exist as a spectrum in terms of severity. According to the article, ‘Pacemaker Malfunction’ by StatPearls Publishing, “these pacemakers can often malfunction and produce a set of symptoms that require timely assessment and rectification” (Liaquat and Alzahrani, 2021). Therefore, as it can be dangerous when something goes wrong with the device, it is essential to understand how and why it functions and what to expect when it functions correctly. By doing this, and if you have a pacemaker, knowing the sensation when it functions properly, one can have a more timely reaction to potential pacemaker malfunctions.
This is because, at best, a malfunction can be a fluke in the system, which is quickly remedied by the pacemaker itself and can cause dizziness or potential temporary shortness of breath. For example, exposure to electromagnetic fields (EMF) can potentially cause electromagnetic interference (EMI) if someone with a pacemaker is exposed to them for too long. However, removing oneself from the source of the EMF usually remedies the symptoms. Given that pacemakers are mostly shielded, but can be susceptible to such interference, that itself counts as a generally easily remedied pacemaker malfunction.
On the other hand, in the worst-case scenario, a “pacemaker malfunction can lead to potentially life-threatening situations, including syncope and even cardiac arrest” (Liaquat and Alzahrani, 2021). This is a very real and perilous possibility if the malfunction is not addressed by the doctor or corrected by the device itself.
So, technically, if you have a pacemaker and still experience arrhythmia, feel that it's not working properly, suspect something is wrong, or the pacemaker is acting outside the parameters it was programmed to operate within, then that could indicate a malfunction. If it persists, consult your doctor. The real problem is when this malfunction leads to a pacemaker breaking.
A broken pacemaker is a serious medical issue, especially if it is caused by a lead fracture or a dislodgement of the wire. It also depends on the level of cardiac reliance the individual has on the pacemaker. If they are completely or fully reliant upon their pacemaker to keep their heart beating, then this can be genuinely life-threatening.
The article ‘Fracture of a Pacemaker Lead’ by the Canadian Medical Association Journal states that, “The incidence of lead fractures in pacemakers is about 1%–4%” (Chang, Tan and Lee, 2009). “Most fractures occur in the area just lateral to the subclavian venous entry site as a result of compression of the lead between the clavicle and the first rib or entrapment of the lead by soft tissue in the costoclavicular space. Fractures in pacemaker leads during weightlifting have been reported”(Chang, Tan and Lee, 2009). Therefore, these types of breaks in pacemakers can be caused by physical activity, but that does not mean avoiding physical exercise is necessary just because someone has a implanted pacemaker; instead, it means that one must excersise caution while participating in hardcorre sports and to avoid directly stirking or abusing the area surrounding the device.
This also leads to another problem with pacemakers, balancing what is necessary for one's quality of life and physical well-being with the needs of maintaining such a device.
For example, my pacemaker broke as a result of a cup of coffee with some friends. However, the intensely caffeinated beverage triggered my arrhythmia, which then led to my pacemaker breaking. However, with my experience with heart conditions at a young age, I recognized the feeling that something was very wrong. But I did nothing about it. I kept going about my normal daily routine while continuing to grow steadily weaker for no discernible reason. This was because, as I said, I was familiar with the sensation and was certain it would pass… until it didn’t.
Four months later, I brought my deteriorating condition to the attention of my doctor. There, I discovered that my pacemaker wire, the thing that is necessary for maintaining my life, was hanging by a thread. I had two weeks to live if it wasn’t fixed immediately. This process required two surgeries and a whole new device and system.
I survived by nothing short of a miracle. However, my point is that if you experience a malfunction for an extended period, consult your doctor. If you feel like something is cardiovascularly wrong and you have a pacemaker, don’t ignore it and discuss it with your doctor anyway. It may save you or help solve a problem before it becomes severe enough to require medical intervention.
As discussed in the previous article, pacemakers are essential for maintaining the lives of people of any age with an irregular heartbeat. However, this does not mean this angel of mercy is foolproof. These devices can become infected, malfunction, or even break. In my more than three decades of being fully paced by a pacemaker, I have experienced all three of these problems. I hope my advice helps others who have also required a pacemaker for an extended period, as well as those who are new to the experience. If you are new to pacemakers, it may require some lifestyle changes, but don’t let that stop you from living.
Have you experienced these problems with pacemakers? How was it resolved?
Reference list
Chang, S.-H., Tan, C.-K. and Lee, S.-H. (2009). Fracture of A Pacemaker Lead. CMAJ : Canadian Medical Association Journal, [online] 181(11), p.823. doi:https://doi.org/10.1503/cmaj.082092.
Döring, M., Richter, S. and Hindricks, G. (2018). The Diagnosis and Treatment of Pacemaker-Associated Infection. Deutsches Aerzteblatt Online. doi:https://doi.org/10.3238/arztebl.2018.0445.
Liaquat, M.T. and Alzahrani, T. (2021). Pacemaker Malfunction. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK553149/.
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