Runaway Pacemaker Research Articles

Life-Threatening Pacemaker Dysfunction Associated with Therapeutic Radiation: A Case Report

Reports about pacemaker (PM) dysfunction during irradiation (IR) are very rare, which is because of the extensive protective mechanisms that exist in these devices against electromagnetic interference (EMI). We report a case in which one of the most clinically relevant type of PM malfunctions, a runaway PM, occurred during radiation in a 76-year-old woman who was treated for inoperable esophageal cancer with a course of photon IR. The estimated IR dose of 0.11 Gy was the lowest in vivo dose ever reported. So a direct radiation effect as cause for this malfunction appears to be improbable. It could be concluded that the PM dysfunction was most likely induced by EMI during radiotherapy. The real reason of the device's software failure remains unclear.

Endoscopy in patients with implanted electronic devices

Endoscopy in patients with implanted electronic devices

A Rare Case of “Runaway” Pacemaker in a Modern CPU‐Controlled Pacemaker

"Runaway" pacemaker is a rare entity that occurs when a malfunctioning artificial cardiac pacemaker abruptly accelerates its pacing rate above the set upper rate limit. This can result in life-threatening dysrhythmia. Runaway pacemaker used to occur more frequently in older model pacemakers, but now with newer pacemaker generators, runaway pacemaker is a rare entity. We report the case of a runaway pacemaker in a modern CPU-controlled pacemaker in a 79-year-old man presenting with lightheadedness and review the literature regarding this rare entity.

Runaway Pacemakers in Ventricular Fibrillation

Arunaway pacemaker is a malfunctioning pacemaker that paces the heart at rapid rates. A report from Australia 30 years ago1 described a patient with runaway pacemaker that paced the ventricles at 280 bpm. The patient survived only because one of the coauthors alertly cut the pacemaker wires to disconnect the high-frequency focal source from the myocardium. In this issue of Circulation , Thomas et al2 report that they occasionally detected sustained high-frequency sources during ventricular fibrillation (VF) in sheep with myocardial infarction (MI). Specifically, in 3 of 12 hearts, they detected periodic high-frequency activations at 1.3% of the intramural electrodes sampled. The authors propose that these findings support the hypothesis3 that a relatively stable periodic source (“mother rotor”), with fibrillatory conduction block occurring in the remainder of the ventricle, may be the mechanism of VF in this model. This mother rotor mechanism of fibrillation contrasts with the multiple wavelet mechanism, in which all rotors are unstable and wavebreak is the engine driving fibrillation. Both mechanisms of fibrillation have been documented in various settings,4 but controversy exists over which is the most common in and clinically relevant to diseased human hearts. This issue has therapeutic implications because it has been suggested that ablation of the mother rotor may be a strategy to abolish VF. At the same time, ablation of the mother rotor may just allow the next-fastest daughter rotor to take its place because fibrillatory wavebreaks act as niduses for new rotors. In any case, however, to even test this intriguing therapeutic strategy, it is first necessary to identify the location of the mother rotor, which has been elusive to date, especially in large animals.5 The findings of the present study, in a large-animal diseased heart model, are therefore significant. They also raise important questions. …

Practice Advisory for the Perioperative Management of Patients with Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter–Defibrillators

Practice Advisory for the Perioperative Management of Patients with Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter–Defibrillators

Runaway Pacemaker Due to Software‐Based Programming Error

Pacing and Clinical ElectrophysiologyVolume 27, Issue 12 p. 1689-1690 Runaway Pacemaker Due to Software-Based Programming Error JEROEN V. LEVERT, JEROEN V. LEVERT Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Zwolle, the NetherlandsSearch for more papers by this authorJAN C.A. HOORNTJE, JAN C.A. HOORNTJE Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Zwolle, the NetherlandsSearch for more papers by this author JEROEN V. LEVERT, JEROEN V. LEVERT Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Zwolle, the NetherlandsSearch for more papers by this authorJAN C.A. HOORNTJE, JAN C.A. HOORNTJE Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Zwolle, the NetherlandsSearch for more papers by this author First published: 10 December 2004 https://doi.org/10.1111/j.1540-8159.2004.00705.xCitations: 1 Address for reprints: J.C.A. Hoorntje, M.D., Isala Klinieken, Locatie Weezenlanden, Dept. of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands. Fax: 31-38-4243222; e-mail: v.r.c.derks@isala.nl Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume27, Issue12December 2004Pages 1689-1690 RelatedInformation

Runaway Pulse Generator Malfunction Resulting from Undetected Battery Depletion

Runaway pacemaker is an uncommon, potentially lethal circuit malfunction characterized by sudden onset of erratic pacing at rapid nonphysiological rates. Two patients with a single chamber pacemaker (Medtronic ST 8331 and 8419) presented with episodic dizziness. ECG revealed recurrent decrescendo amplitude episodes of runaway stimuli at 2,400 and 2,600 ppm, approximately 3 seconds in duration, separated by pacing at 62.5 and 65 ppm, respectively. Fortunately the runaway stimuli were subthreshold and did not result in capture of the ventricle. Emergency pulse generator replacement was uneventful. Both leads were normal and both pulse generators had low battery voltages at 1.488 and 1.78 V, respectively.

Runaway pacemaker: A case report and review

We describe a case of runaway pacemaker. The differential diagnosis is discussed and a review of the literature is included for the diagnosis and treatment of pacemaker mediated tachycardia and runaway pacemaker.

The Shaw Hemostatic Scalpel as an Alternative to Electrocautery in Patients with Pacemakers

David Amar, M.D.; David H. Fogel, M.D.; Department of Anesthesiology and Critical Care Medicine.Jatin P. Shah, M.D.; Chief, Head and Neck Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; 1275 York Avenue; New York, New York 10021.To the Editor:--It is well known that intraoperative use of electrocautery can potentially affect implanted pulse generators in one of several ways. [1]Inappropriate inhibition or triggering of pacer output during cautery commonly occurs as a result of sensing electromagnetic interference, and is most troublesome in pacemaker-dependent patients. Cautery also may induce transient asynchronous pacing because of reversion to the "noise mode," or reprogramming to the "back-up mode," which necessitates resetting the device. Destruction of pacemaker circuitry with loss of pacemaker function, conduction of electrical impulses with resultant increases in pacing thresholds, myocardial thermal burns or initiation of ventricular fibrillation, [2]and the induction of a "runaway pacemaker" [3]all were reported. We would like to alert anesthesiologists to another available device used to promote surgical hemostasis and to prevent such interference.A 65-yr-old woman with a right thyroid nodule was scheduled for a right thyroid lobectomy at our institution. The patient had a permanent pacemaker inserted 6 months before this admission for bradydysrhythmia and near syncope. The pacemaker was a dual chamber Pacesetter 2028L generator (Sylmar, CA), with bipolar leads in the right atrium and ventricle. Because of the proximity of the surgical field to the pacemaker (< 6 in), we were concerned about electrocautery interference. The manufacturer was contacted for technical advice on this particular device and advised us not to apply a magnet during electrocautery use.In addition, the surgeon was ready to use bipolar cautery and suggested that the surgery could be accomplished with the aid of the Shaw Hemostatic Scalpel (Hemostatix Medical Devices, Cherry Hill, New Jersey (Figure 1). At our request, on the morning of surgery, a representative of the Pacesetter company was available, with a device-specific program systems analyzer at our operating room, to help, in case electrocautery was used and the pacemaker required reprogramming. The planned procedure was carried out successfully with the Shaw Scalpel, without difficulty or interference with pacemaker function, and no further follow-up was required.The successful use of the Shaw Scalpel was described in adults and children undergoing a variety of operative procedures. [4-6]The Shaw Scalpel was particularly useful in patients with pacemakers that required replacement of pacemaker batteries. [7]This scalpel works by thermally transferring heat to the tissue, and is electrically insulated from the patient by a Teflon coating (Figure 1). This is an obvious advantage of the Shaw Scalpel over conventional electrocautery in patients with pacemakers. We believe that anesthesiologists aware of this option can prevent serious intraoperative pacemaker malfunction due to electrocautery in select cases where the Shaw Scalpel is available and the surgical site is in close proximity to the pulse generator.David Amar, M.D.; David H. Fogel, M.D.; Department of Anesthesiology and Critical Care MedicineJatin P. Shah, M.D.; Chief, Head and Neck Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; 1275 York Avenue; New York, New York 10021(Accepted for publication April 8, 1996.)

Runaway Pacemaker During High-Energy Neutron Radiation Therapy

Runaway pacemaker occurred in a patient undergoing high-energy neutron radiation therapy despite adherence to published safety guidelines. The very low estimated dose of 0.9 Gy received by the pacemaker demonstrates the extreme sensitivity of integrated circuits to this new modality of radiation therapy.

Electrocardiographic artifact with a transcutaneous electrical nerve stimulation unit

We describe an unusual electrocardiographic artifact in a patient with a transcutaneous electrical nerve stimulation unit. The artifact, consisting of low amplitude high frequency deflections, can be misinterpreted as a runaway pacemaker.

Surgical Electrocautery and the Runaway Pacemaker Syndrome

A case of a unipolar surgical electrocautery-induced runaway pacemaker is described. The single chamber ventricular pacemaker began firing at 140 beats/min with intermittent capture and the abnormal rhythm persisted after cessation of the electrocautery. Emergent explanation of the pulse generator was required.

Radiation induced failures of complementary metal oxide semiconductor containing pacemakers: A potentially lethal complication

New mufti-programmable pacemakers frequently employ complementary metal oxide semiconductors (CMOS). This circuitry appears more sensitive to the effects of ionizing radiation when compared to the semiconductor circuits used in older pacemakers. A case of radiation induced runaway pacemaker in a CMOS device is described. Because of this and other recent reports of radiation therapy-induced CMOS type pacemaker failure, these pacemakers should not be irradiated. If necessary, the pacemaker can be shielded or moved to a site which can be shielded before institution of radiation therapy. This is done to prevent damage to the CMOS circuit and the life threatening arrythmins which may result from such damage.

Runaway Pacemaker Inhibited by External Overdrive Stimulation: A Case Report

A case is described of runaway pacemaker ( Stimulith ) which could be inhibited by external chest-wall overdrive. This pulse generator had been implanted for four years before runaway occurred; the runaway rate was 140/min with capture of the ventricles. Using external chest-wall stimulation at a rate of 170/min, we were able to achieve almost complete inhibition of the faulty generator, while preparing for emergency replacement.

Pseudo-Runaway Pacemaker

To the Editor. —Malfunction of a permanent cardiac pacemaker is most often manifested by intermittent or absolute cessation of function or by a reduction from the chronic stable pacing rate. On rare occasions, however, pacemaker tachycardia occurs with rate acceleration up to 100 beats per minute, ie, runaway pacemaker. In this report, pseudo-runaway pacemaker, a previously unrecognized phenomenon, will be presented. Report of Cases.—Case 1. —A 46-year-old woman had a R-wave inhibited demand pacemaker inserted for episodic Stokes-Adams attacks with verified high-degree atrioventricular block. The pacing rate was 72 beats per minute (Figure, A). A routine ECG, taken three months later during an emergency room visit for noncardiac chest pain, showed 100% pacemaker capture at 90 beats per minute (Figure, B). Although the pulse generator was implanted only three months earlier, component failure was suspected, and the unit was replaced. Case 2. —A 70-year-old man had a demand

Runaway Pacemaker

The runaway pacemaker is an uncommon but very serious complication of permanent artificial pacemakers. Although the runaway pacemaker has been most frequently encountered in older (fixed rate) pacemakers, this problem has also been reported in various types of newer models manufactured by different companies. The most striking finding in our case is that the pacemaker was reported by a reliable pacemaker follow-up service to be working normally only one week before the development of the malfunction. The extremely rapid pacing rate (750 beats per minute) was a manifestation of a far-advanced runaway pacemaker. The manufacturer believes that this is the first reported incident of a runaway pacemaker in this model. This indicates that the runaway pacemaker is still a potential problem, even in newer pacemakers, and reemphasizes the unpredictable and serious nature of this medical emergency.

Ventricular Ectopic Rhythms due to Rapid Runaway Pacemaker

A patient initially had syncope due to a runaway pacemaker firing at an unusually rapid rate (30 impulses per second). The ventricular arrhythmia was characterized by numerous ectopic beats, with coupling intervals related to the length of the preceding cycle and runs of ventricular tachycardia with slight variations in the intervals between beats. This case demonstrates the clinical characteristics of a very rapidly firing, low-intensity, ventricular parasystolic focus.

Interference with cardiac pacemaker function.

A survey is given of the factors affecting cardiac pacemaker function. Whereas it was earlier considered that external interference was a frequent cause of a pacemaker failure, more recent studies indicate that this is of minor importance. It would appear that failure of pacemaker function due to changes in the QRS-complex, i.e. voltage change, intraventricular conduction defects and frequency changes, intraventricular conduction defects and frequency changes, are more important. A lesser known cause of failure in demand function is the inhibition which arises from skeletal muscle postentials. This appears to be a major problem in some types of pacemaker. Manufacturing defects are unavoidable, and it can still be assumed that electronic component defects may develop in 1 of 1000 pulse generators. Cases with the problem of early run-away pacemaker are still being reported and two such cases are discussed. In one of the patients the run-away phenomenon was intermittent, and was accompanied by a variation in run-away frequency. This possibility should thus always be taken into consideration in a pacemaker patient presenting with snycope. In a patient with a QRS-inhibited pacemaker a double stimulation phenomanen has been observed.

Runaway pacemaker in seven patients: A persisting problem

Runaway pacemaker has been encountered in 7 patients during the past 7 years at the Texas Heart Institute. In this series, 4 patients with fixed-rate pacemakers experienced pacemaker arrhythmias because of battery depletion, and 3 had arrhythmias because of component failure. Battery deterioration was heralded by an increase in cardiac rate. Ventricular tachycardia, rapidly followed by ventricular fibrillation, occurred in 2 patients. Prompt surgical exteriorization of the failing pulse generator and connection to an external pacemaker resulted in prompt recovery in all patients. Elective generator change should be performed routinely after 24 to 30 months unless reliable serial observations of ventricular rates can be attained. This at least will reduce the lethal complications attributed to battery exhaustion. Increasing developments in the design of generators and sources of power, as well as data from pacemaker clinic follow-up and telephone pulse transmittal, are expected to decrease the frequency of this complication.

Treatment of sinoatrial syndrome with permanent cardiac pacing in 90 patients.

Out of a pacemaker population of 392 patients, 90 (23%) have been found to have sinoatrial syndrome. Their ages ranged from 22 to 86 years, and averaged 66 for men and 70 for women. The male-to-female ratio was 1:1.6. Before pacemaker implantation, syncopal attacks had occurred in 54%, dizziness without syncope in 31% and tachyarrhythmias in 57%. Atrial or paroxysmal supraventricular tachycardia had been recorded in 33%, atrial fibrillation or flutter in 28%, and ventricular tachycardia in 11%. First and/or second degree AV block was found in 36%. Coronary heart disease was present in 61% and 20% had had myocardial infarction. Cardiomyopathy and previous carditis were other associated heart diseases. Sinoatrial syndrome was the only manifestation of heart disease in 20%. Follow-up time after pacemaker implantation ranged from 3 months to 7 years, mean 23 months. Syncopal attacks were stopped in 48 of 49 patients, dizziness was relieved in all 28 patients and tachyarrhythmias were controlled by combined drug treatment in 43 of 51 patients. Nineteen patients died during the follow-up, most of them of cerebrovascular events or myocardial infarction. Associated coronary heart disease was especially frequent in this group. The death of one patient was caused by a run-away pacemaker. Other pacing failures were due to electrode movement or premature battery exhaustion. There was no mortality associated with pacemaker implantations or replacements. These results strongly support the view that pacemaker treatment most effectively controls symptoms of sinoatrial syndrome when drug treatment fails.