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EP News: Case Reports

  • T. Jared Bunch
    Correspondence
    Address reprint requests and correspondence: Dr T. Jared Bunch, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Room 4A100, Salt Lake City, UT 84132.
    Affiliations
    Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Published:November 04, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.11.004
      In the setting of a general transition to remote management of cardiac implantable devices, manufacturers are increasingly using this form of monitoring for device advisories. Recently, Abbott Medical (Lake Forest, IL) issued a safety notification for a subset of their pacemakers because of the potential of premature battery depletion and a higher risk of rapid transition from elective replacement indicated status to end of life (EOL) that could compromise device function. Melman et al (https://doi.org/10.1016/j.hrcr.2021.09.013) shared the cases of 2 patients with rapid pacemaker generator dysfunction that occurred before remote communication. The first patient had intermittent second-degree heart block and presented after his pacemaker abrupted transitioned to a VVI backup mode. By recommendation, the original parameters were restored. Ten days later the device function degenerated to EOL without remote communication and the patient presented with symptomatic bradycardia and presyncope. A second patient with complete heart block was contacted after his routine remote transmission failed. The prior transmission estimated approximately 10 years of battery longevity. In the clinic his device was found to be EOL and his underlying rhythm was a junctional rhythm at 40 beats/min. Both patients underwent urgent pacemaker generator replacement. In review of the records from Intermountain Medical Center, there were 46 of 169 patients who received a pacemaker generator affected by this advisory. Of these patients, 3 who were pacemaker dependent died of sudden cardiac death. The cause of death of these 3 patients may or may not have been associated with rapid device failure, however the aggregate findings of the patients presented, and additional institutional experience should prompt concern regarding use of remote management to safely manage pacemaker-dependent patients at risk of premature battery failure.
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