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

We report the case of a 77-year-old man who underwent single-chamber pacemaker implantation 16 years prior. The patient, who did not utilize remote monitoring, was lost to follow-up 14 years after the implantation, leading to profound battery depletion. 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.

This 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.