From the Guidelines
The recommended management for a cardiac pacemaker with a low battery level is to replace the batteries or change the configuration to wall power. This approach is based on the guidelines provided by the American Heart Association, as stated in the 2017 scientific statement on the use of mechanical circulatory support 1. The key points to consider in managing a cardiac pacemaker with a low battery level include:
- Recording device parameters such as power, speed, flow, and pulsatility throughout the patient’s course
- Replacing the batteries or changing the configuration to wall power if the battery power is low
- Exchanging the controller for the backup controller if the power source is confirmed but there is a persistent device alarm
- Assessing for hemolysis, including lactate dehydrogenase, if thrombus is suspected In the context of real-life clinical medicine, it is crucial to prioritize the replacement of the batteries or adjustment of the power source to prevent sudden loss of pacing function, which can be life-threatening for pacemaker-dependent patients. The procedure for replacing the batteries or adjusting the power source is relatively straightforward and can be performed under local anesthesia as an outpatient procedure. Patients should be monitored more frequently once the battery reaches the elective replacement indicator stage, typically every 1-3 months, to ensure timely intervention and prevent complications.
From the Research
Cardiac Pacemaker Battery Management
- The management of a cardiac pacemaker with a low battery level is crucial to ensure the device functions properly and the patient's safety is maintained 2.
- Normal battery depletion is signified by the elective replacement indicator appearing >3 years after implant, and the majority of pulse generators are replaced for this reason 2.
- Severe and accelerated battery depletion, manufacturers' advisories, and electronic or connector defects account for a smaller percentage of pulse generator removals 2.
Replacement and Maintenance
- Replacement of a cardiac pacemaker system can be done under local anesthesia, allowing for MRI access, and can be performed without the use of special devices 3.
- The use of retractable screw-in leads with a cut-down of cephalic or external jugular veins can facilitate replacement procedures 3.
- Regular follow-up and monitoring of the pacemaker system can help identify impending lead failure and avoid major adverse clinical events 2.
Precautions and Considerations
- Certain precautions must be observed when a patient with a pacemaker undergoes a procedure, including a focused history/physical examination, interrogation of the pacemaker before and after the procedure, and monitoring of electrolyte and metabolic disturbance 4.
- The use of ionizing radiation and/or electromagnetic interferences can cause device failure, and measures should be taken to minimize the risk to patients, including the use of energy ≤6MV and not exceeding a total dose of 2 Gy to the pacemaker 5.
- A close collaboration between cardiologist, radiotherapist, and physicist is necessary to ensure patient safety when a patient with a cardiac pacemaker requires radiation treatment 5.