Managing pacemaker-related complications and malfunctions in the emergency department

The use of implanted pacemaker devices is increasing worldwide, owing to technological advances, new indications, and an aging population. Despite greater experience in implantation and improved device sophistication, patients continue to face complications associated with hardware implantation and device malfunction. This review summarizes current indications for permanent pacing, reviews epidemiologic data relevant to implant complications, and describes a clinical approach to the patient with potential pacing malfunction. The electrocardiographic diagnosis of hyperkalemia and acute myocardial infarction in paced rhythms is also discussed. Potential sources of electromagnetic interference and special considerations pertaining to the cardiac resuscitation of patients with implanted cardiac devices are reviewed. Finally, a basic approach to implanted cardioverter-defibrillator devices (which often accompany pacemaker devices) is presented.