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A pacemaker produces electrical impulses or stimuli to regulate the heartbeat when the heart’s natural pacemaker ( SA/ AV node) fails to coordinate with our heart. An artificial pacemaker is a wireless device that needs to be implanted in the patient’s body so that heart can keep pace with the regular functionalities of our system. Pacemaker malfunction is quite a severe issue as its failure involves life and death. The significant problems are failure to pace the appropriate cardiac chamber, the problem with detecting intracardiac signals, pseudomalfunction, etc. It can be further subdivided into more issues as per the fishbone below. Refer to the fishbone template below to list the vital causes of a pacemaker malfunction.

Pacemaker Malfunction
Pacing output failure

•         Lead fracture
•         Lead displacement
•         Generator failure
•         Battery failure
•         Crosstalk inhibition
•         Oversensing

  Pacing capture failure

•         Lead or pacer failure
  • Elevated myocardial pacing thresholds
  • Low pacing voltage
  • Fracture
  • Fibrosis
•       Lead maturation
•       Low output
•       Lead dislodgment

  Intra-cardiac signal undersensing

•         Lead or pacer failure
  • Fracture
  • Fibrosis
•         Electrolyte abnormality
•         Insufficient myocardial voltage signal
•         Improper sensing threshold

Intra-cardiac signal oversensing

•         Lead insulation break
•         Lead fracture
•         Myopotential signals like electromagnetic interference
•         Physiologic signals like T waves

Pseudomalfunction

•         Crosstalk with resultant safety pacing
•         Pacemaker-mediated tachycardia
•         Sensor-induced tachycardia
•         Runaway pacemaker
•         Lead-displacement dysrhythmia
•         Twiddler syndrome

Our objective is to adopt an organized approach to arrange the potential causes of any incident or problem. We have made an effort to show the likely issues leading to a pacemaker malfunction. We have designed a simple fishbone and made the cause analysis procedure visually accessible to make it easy for everyone to understand the most like issues and causes.

Who should use the Pacemaker Malfunction template?

• This template is a suitable example of incident analysis. It aims at people who want to do a root cause analysis/ incident analysis of a pacemaker malfunction. We would be glad to inspire anyone to work with our templates.

Why use this template?

• It contains lists of the essential factors that affect the performance of a pacemaker and are responsible for its failure.
• Completes incident analysis riveting with its uniqueness and shares knowledge about it.
• Create and alter your template or apply this with some alteration for your own problem-solving.

Curated from community experience​​​​​​ and public sources:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067035