From the Guidelines
Yes, a permanent artificial cardiac pacemaker can switch modes due to low battery, a feature known as "elective replacement indicator" (ERI) mode or "end-of-life" (EOL) mode, which extends battery life while maintaining essential pacing functions. This mode switch is a safety feature designed to conserve battery power by simplifying pacing functions, typically switching to a fixed-rate mode such as VOO or VVI with reduced functionality 1. When the battery voltage drops below a certain threshold, the pacemaker automatically switches to this mode, providing basic cardiac support while minimizing power consumption. Patients may experience symptoms like fatigue, dizziness, or shortness of breath when this occurs.
Key Considerations
- Modern pacemakers provide advance warning of battery depletion during routine device checks, allowing for scheduled replacement before emergency intervention is needed 1.
- The typical pacemaker battery lasts 5-15 years, depending on the model, settings, and pacing frequency 1.
- Regular follow-up appointments (every 3-12 months) are crucial for monitoring battery status and ensuring timely replacement before critical depletion occurs.
Clinical Implications
- Physicians should be aware of the ERI mode and its implications for patient care, including the potential need for more frequent follow-up appointments as the battery approaches end of life 1.
- Patients should be educated on the symptoms of low battery and the importance of regular follow-up appointments to prevent complications 1.
- The decision to replace a pacemaker should be based on individual patient needs and the risk of complications, rather than solely on battery life 1.
From the Research
Pacemaker Mode Switching Due to Low Battery
- Pacemakers are powered by primary batteries, and device replacement due to battery depletion may cause complications and is costly 2.
- There is no direct evidence to suggest that a pacemaker can switch modes due to low battery.
- However, pacemakers can switch modes in response to certain conditions, such as atrial fibrillation detection, to avoid pacemaker-mediated rapid ventricular pacing and allow for dual-chamber pacing during phases of sinus rhythm 3.
- Low battery levels can lead to unexpected battery depletion, which may require explantation of the pacemaker 4.
- The power source for pacemakers has evolved over time, with lithium-anode batteries becoming the dominant power source for low-voltage, microampere current, single- and dual-chamber pacemakers 5.
Battery Life and Pacemaker Performance
- The average battery longevity for dual-chamber pacemakers is around 6.8 years, with some variations depending on the device and usage 6.
- Reused pacemakers have been shown to be safe and feasible, with similar performance to new devices, although with expected shorter battery life 4.
- Advances in pacemaker technology have necessitated the development of power sources that can provide higher current delivery, such as lithium-carbon monofluoride and lithium-manganese dioxide batteries 5.