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Cardiac Pacemakers, Emergency Medicine

Reviewed 06/2017



  • A device that uses electrical impulses to contract the heart muscles and provide an adequate pulse

  • Methods of cardiac pacing:

    • Transcutaneous pacing:

      • 2 pads are placed on the chest in th...


Signs and Symptoms

  • Pacemaker failure:

    • Bradycardia

    • Syncope

    • Hypotension, progressive to shock and hemodynamic collapse

    • Fatigue and weakness

    • Dyspnea on exertion or shortness of breath secondary to CH...



Record rhythm strips for analysis 

Initial Stabilization/Therapy

  • Oxygen administered via 100% nonrebreather

  • Intubation as needed

  • IV access

  • Advanced cardiac life support drugs as per u...



Admission Criteria

  • Permanent pacemaker failure or malfunction

  • Suspicion of infection involving pacemaker components

Discharge Criteria

  • Asymptomatic pacemaker malfunction

  • A cardiologist...

Pearls and Pitfalls

  • Always consider pacemaker failure in evaluation of cardiac decompensation, bradycardia, or syncope.

  • Utilize pacemaker magnet to evaluate function.

Additional Reading

  • Cardall  TY, Brady  WJ, Chan  TC, et al. Permanent cardiac pacemakers: Issues relevant to the emergency physician, parts I and II. J Emerg Med.  1999;17:479–489, 697–709.

  • Griffi...



  • V45.01 Cardiac pacemaker in situ

  • V53.31 Fitting and adjustment of cardiac pacemaker

  • 996.61 Infection and inflammatory reaction due to cardiac device, implant, and graft


  • T82.7XXA Infect/inf...

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