Living with a pacemaker gives you something priceless: a heart that keeps its rhythm, day after day. For many Americans, this small device means the difference between living a full, active life or facing risks and surprises.
But what should you do if something doesn't feel right? Depending on your heart condition and health, these feelings may be normal. However, they could also mean your pacemaker isn't working correctly.
Keep reading to learn more about your pacemaker, how to tell if it might be having problems and what steps to take.
How does a pacemaker work?
A pacemaker is a small device, about the size of a silver dollar, that is placed under the skin, usually near the collarbone. It sends tiny electrical signals to your heart to help it beat at the right pace. Most people have a pacemaker because their heart beats too slowly, skips beats or has an irregular rhythm.
Traditional pacemakers have two main parts:
- A pulse generator, which contains the battery and a small computer
- Wires (called leads) that connect the generator to the heart
Some people may be candidates for a leadless pacemaker. These newer systems combine the functions of the pulse generator and leads into a single, self-contained device that is placed directly inside the heart.
“Pacemakers are designed to work all the time and include many safety features,” said Jake Martinez, DO, an electrophysiologist and cardiologist with Banner Health. “They are checked regularly with follow-up visits and can also be monitored remotely."
What are the signs my pacemaker may not be working?
Many symptoms that people associate with a pacemaker problem can have other causes. Still, certain symptoms may suggest a device issue and should be checked out by your provider.
- Dizziness or lightheadedness
- Fainting or near-fainting
- Heart palpitations (fluttering, racing or skipping beats)
- Fatigue or unusual tiredness
- A pulse that feels unusually slow
- A pulse that feels unusually fast
- Chest pain or pressure
- Hiccups that will not stop
- Muscle twitching in your stomach or chest
“Symptoms like occasional tiredness, mild shortness of breath with exertion or chest pain are not specific to the pacemaker,” Dr. Martinez said. “Chest pain is especially important to take seriously because it may be caused by a heart attack or another serious condition that is unrelated to the device.”
Symptoms can occur because of other heart conditions, medication changes, dehydration, infection or other illnesses. Because symptoms can have many causes, it’s important to see your health care provider.
What causes a pacemaker to stop working properly?
Several issues can affect how a pacemaker functions. Fortunately, most can be identified and treated.
Pacemaker battery depletion
One common concern is the pacemaker battery. Pacemaker batteries typically last many years. According to Dr. Martinez, how long they last depends on several things:
- What type of pacemaker it is
- How often it needs to work
- The settings on the device
- Your individual heart rhythm needs
Most of the time, the battery doesn’t just stop working without warning. During regular check-ups, which happen every six to 12 months, your health care provider can see if the battery is getting low.
When it’s time, the pulse generator is replaced. Most of the time, the leads don’t need to be replaced but this will be decided during device checks before the procedure.
Pacemaker lead displacement
Pacemaker lead displacement occurs when a lead moves out of its proper position. This often happens soon after the device is implanted, before scar tissue fully secures the lead in place. A displaced lead may affect how well the pacemaker works with the heart and may cause symptoms like dizziness, tiredness or palpitations.
Lead damage or fracture
Sometimes, a lead can get broken or damaged. This can cause problems with the electrical signals between the pacemaker and the heart. Doctors can usually find these issues when they check the pacemaker.
Programming issues
Sometimes the pacemaker hardware works correctly but the settings need to be changed. You might need different settings if your heart rhythm changes or if you start to have symptoms. These changes can usually be made during an office visit without surgery.
Infection
A pacemaker infection can happen at the place where the device was put under the skin (implanted), along the wires that go into the heart or directly on the device itself. Several things can increase your chance of getting an infection. These include:
- Diabetes
- Heart failure
- Renal insufficiency (kidney failure)
- Immunocompromised
If you notice redness, swelling, warmth or discharge near your pacemaker site along with other symptoms of a malfunction, contact your health care provider or cardiologist right away.
Twiddler’s syndrome (very rare)
Twiddler’s syndrome is a rare complication that can affect how your pacemaker works.
“Twiddler’s syndrome happens when the pacemaker generator rotates in its pocket, usually because it is frequently rubbed, twisted or manipulated,” Dr. Martinez said. “This can pull the leads out of place and cause the device to stop working properly.”
When the leads move, the pacemaker might not work properly. You may need another procedure to move or replace the lead.
To help prevent it:
- Avoid pressing on the device
- Do not twist or rub the device under the skin
- Avoid repeatedly checking or manipulating the pacemaker
- Follow your provider’s activity restrictions after implantation
How is your pacemaker monitored?
A pacemaker check, also called pacemaker interrogation, is one of the most important tools for detecting device problems. During this procedure, your care team reviews the:
- Battery status
- Lead performance
- Heart rhythm recordings
- Device settings
- Pacing activities
You’ll typically have in-office visits every six to 12 months, although many interrogations can be performed remotely. Modern pacemakers often feature wireless technology that transmits data to your care team through remote monitoring. This allows any issues to be identified early, sometimes even before you notice symptoms.
If your health care team detects potential problems, they may recommend an in-person visit for a pacemaker interrogation, electrocardiogram or chest X-ray to evaluate your heart's electrical activity and check for lead-related changes.
[Also read: Habits to Keep Your Arteries Clear and Heart Strong.]
When should you call your cardiologist?
Contact your cardiologist or care team if you experience:
- Dizziness
- New, unexplained tiredness
- Palpitations
- Mild shortness of breath with activity or exercise
- A pulse that seems too slow
- A pulse that seems too fast
- Redness, swelling or warmth near the pacemaker site
- Pain near the pacemaker site
- Drainage from the pacemaker site
- A wound that was previously healed that has now opened
- A feeling that the device has shifted position
You should also contact your care team if you recently had an MRI, surgery or another procedure that could affect device settings.
When should you seek emergency care?
Some symptoms require immediate medical attention.
Call 911 or go to the nearest ER if you experience:
- Loss of consciousness
- Severe chest pain
- Severe shortness of breath
- Confusion
- Symptoms that suddenly feel severe or dangerous
"A simple way to think about it is this: mild or developing symptoms should go to the cardiology team but passing out, severe shortness of breath or intense chest pain should go straight to emergency care," Dr. Martinez said.
Takeaway
Pacemakers are reliable devices that help millions of people maintain healthy heart rhythms. While device issues can occur, most are identified through routine monitoring before they become serious.
Concerned about your pacemaker? Banner Health cardiologists and electrophysiologists can check your device, review your symptoms and help keep your heart rhythm safely managed.
Frequently asked questions about pacemaker problems
How do I know if my pacemaker is not working?
Possible signs include dizziness, fainting, shortness of breath, unusual fatigue, swelling, palpitations or chronic hiccups. These symptoms can have other causes, so call your cardiologist or health care provider for guidance.
Can a pacemaker suddenly stop working?
It is uncommon for a pacemaker to suddenly stop working. Batteries are monitored during routine checks and most problems are found before they become emergencies. New or severe symptoms should still be evaluated right away.
What happens when a pacemaker battery gets low?
Your device clinic usually detects battery changes during regular monitoring. When the battery is low, the pacemaker generator is typically replaced during a planned procedure.
Can hiccups mean my pacemaker is not working?
Persistent hiccups after pacemaker placement can sometimes mean a lead or setting is stimulating the diaphragm. It is not common but you should call your cardiologist if hiccups do not stop.
Can sleeping on my side damage my pacemaker?
Sleeping on your side usually does not damage a pacemaker after you have healed. Follow your post-surgery instructions and ask your care team when it is safe to sleep comfortably on the implant side.
Can I touch my pacemaker through my skin?
Light touching is usually not a problem. Avoid repeatedly pushing, twisting or playing with the device under the skin, especially in the weeks after surgery.
What is Twiddler’s syndrome?
Twiddler’s syndrome is a rare problem where repeated twisting or manipulation of the pacemaker under the skin causes the leads to move or coil. This can affect how the device works.
Who checks my pacemaker?
Pacemakers are checked by a cardiology team, often including an electrophysiologist, device clinic staff or heart rhythm specialist.
