Risk in pm battery replacement procedure


I have approximately 2 years left on my dual lead pm. My Electrophysiologist cannot say with certainty that the replacement surgery will go perfectly well, but that they have the technology to keep my heart beating during the procedure. My natural heart rate is quite low (30-50bpm). Is there anyone who cares to share their knowledge on this topic?  Thank you. 


pm replacement

by Julros - 2023-11-11 11:57:51

A lot can change in 2 years, and technology will likely change between now and then. Several members here have had multiple device changes without issue. I have one and it went quite smoothly. 

My underlying heart rate is about 30. Before my first pacer and ablation it was 40, and I walked around with that for about 6 months. So its doable, but not pleasant. You could probably tolerate a heart rate of 30 while lying down. 

During the procedure, you are only briefly disconnected from your device, so back up pacing may not be necessary, but they can attach external pads to pace through your chest wall, or they can thread in temporary pacer wires through your vein, just in case. In my case, they threaded in temporary wires, because they were also doing a lead extraction and were prepared to handle a torn vein or heart muscle. 

Battery Replacement

by Good Dog - 2023-11-11 12:22:13

I am happy to advise you that there is almost zero risk with battery replacement other than a post surgical infection. There is no surgical procedure that has zero risk, but this is among one of the most routine your EP or surgeon will perform. You should be completely comfortable during the entire procedure. Your new generator will be preset, checked and double-checked, and the transition from detaching and reattaching the leads to the new generator is fairly quick depending upon misc circumstances. However, here is the thing, they will have a temporary external pacemaker ready to use as well as paddles and will be well prepared for any emergency. I am pacemaker dependent, but as Julros indicated in his post, when in complete block most of us have an underlying rhythm commonly called an escape rhythm (usually between 25 bpm and 35 bpm) that will keep us safe (alive) if something goes wrong. I lived with that for 24 hours preceding my fist pacemaker implant. They will test you for your escape rhythm before they do anything else in the O.R.  

My point is; Not to worry! A generator change is a piece-of-cake! You will go home the same day with a shiny new generator. Just keep the incision clean and dry and you'll be back to normal when you arrive home later in the day (except for healing of the incision)! 

I wish you the very best!



Normal replacement doesn't require any additional temporary pacing wires

by crustyg - 2023-11-11 12:25:00

The pacing wires are connected to your PM via a locking collar mechanism and then a locking grub screw.  Once that grub screw has been undone, it's usually easy to unscrew the locking collar and connect the wire to a sterile lead that's already connected to the temporary external pacer in the OR.  There's always one ready during a PM replacement.  You might miss one heartbeat as they disconnect and reconnect.

It's much easier to have your pacing wires connected to an external pacer while they remove the old device from the pocket - there can be a lot of scar tissue holding it in, and it can take some time to remove and then, possibly, adjust the pocket to take your new device.  No-one has any intention of leaving you unpaced while they do this!

And relax......

Risk pm battery replacement

by Heartfelt - 2023-11-11 12:26:22

Thank you Dave (Good Dog) and Julros. 

I should add

by Good Dog - 2023-11-11 12:34:47

I have a 37 year old lead and a 30 year old lead. I think it takes a little longer to reattach my leads since they have changed the connectors over the years. As-a-matter-of-fact the Medtronic Rep said to me at my last generator change: "you wouldn't believe what we had to do to connect your old leads"! He did not elaborate, which left me guessing that he had to use bailing wire and electrical tape (lol)..........


There's at least contributor here whose lead(s) couldn't be undone

by crustyg - 2023-11-11 12:44:34

The device vendors are well aware of problems like cold-welding (a real issue with some plastics) and they even provide a tiny torque-wrench tool to avoid having the locking grub-screw over-tightened.

Having said that, at least one contributor here has experienced a PM change where it proved impossible to disconnect one of the leads - had to have a new pacing lead and the old one cut and capped.

So now, Dave, we're both adding to the OP's anxiety.  Not great.

I am the same. It will be fine.

by LondonAndy - 2023-11-11 16:55:44

I have complete heart block, following surgical complication when my aortic valve was replaced with a mechanical one in 2014. When they do the valve operation, they automatically put in an external pacemaker just in case this complication occurs. Each day they adjusted the knob on the external device to see if my natural pacing resumed. On about day 5 when they did this, I passed out: one minute I was sitting in the chair by the hospital bed, the next minute two surgeons were pushing me back into the chair because I had fainted. So that was the decider for them: I needed a pacemaker permanently, and it was inserted 2 days later.

I say all this because it means that as a 100% paced person I expected this to cause complications when they came to change the box due to the battery running out. But no! The day came for the change in October last year, and when I was lying on the operating table and they disconnected the device I didn't even notice! The surgeon told me I was now doing my own pacing.

They were ready to apply temporary pacing if needed, but it wasn't. Later the same day I went home on the train, new device done, and in fact I am now coming up to my first anniversary checkup. 

These operations are completely routine. On the day mine was done, admittedly at a heart specialist hospital (London's St Bartholomew's, aka Barts), they did 8. That's just in one hospital, ad a nurse said it was a quiet day for them. I think globally there are over 700,000 pacemaker procedures every year.

So yes, surgery is never zero risk, but I don't think they get much lower risk than this procedure. You just then have to ensure you keep the scar area clean to avoid the risk of infection.


by Heartfelt - 2023-11-11 17:31:03

Thanks LondonAndy. 
Yours is an amazing story.

five devices

by dwelch - 2023-11-18 23:16:00

Im on number five.  The first one is the worst, relatively, not statistically.  You get your first leads, everything is new, might feel different, first time to recover from this, etc.

Number two on, so long as there are no lead issues (doc broke one between one and two and number five is a biventrical so a new lead), it is in and out as soon as they can get you on the table then open the pocket disconnect, reconnect close the pocket, wait for you to wake up and send you home.  That is the norm and it is simple and easy compared to so many other surgeries one could have from a cardiologists office.

Dwelch - your 5th !?!?

by Heartfelt - 2023-11-19 10:27:54

Thank you dwelch.
A year after my implant in 2016, they had to go in and do a revision because one of the leads wasn't functioning properly. The surgeon said my heart rate went down VERY  fast.  It all turned out ok.  I' guess I'm just anxious...... 

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