Runaway pacemaker: A forgotten phenomenon?

Abstract

Runaway is an uncommon pacemaker dysfunction, characterized by fast and erratic spikes at non-physiological rates. This infrequent but potentially lethal failure mode may be related to low battery voltage. Four single chamber pacemaker patients were analyzed (Medtronic Minix ST 8330, Minneapolis, MN, had been implanted in two patients and two CPI Triumph VR 1124, St Paul, MN, in the other two). They had been admitted because of presyncopal episodes. Typical high rate stimuli at 2000 ppm alternating with pacing at 60-65 ppm were recorded in all ECGs. Lead system tests were normal. The pulse generators had to be replaced.

Should they stay, or should they go: Do we need to remove the old cardiac implantable electronic device if a new system is required on the contralateral side?

“…There are rare reports of erratic behavior of pacemakers at ERI, 16 but we did not observe any erratic or runaway phenomena in our cohort. However, knowledge of this rare phenomenon is important to inform shared decision making.…”

The power of three: Atrial rate limit power‐on‐reset — A non‐electromagnetic cause of pacemaker‐induced extracardiac stimulation

“…This case demonstrates a unique cause of PoR unrelated to electromagnetic interference and triggered by a series of events leading to violation of the atrial rate limit. Historically, the maximum rate limit was implemented as a safety measure to prevent “runaway pacemaker” syndrome, which is potentially lethal 7 . Through a unique set of physiologic circumstances and device parameters, the maximum atrial rate limit was violated, resulting in a PoR, unipolar maximum output, and pacemaker‐induced extracardiac stimulation of the pectoral muscle (Figure 2D).…”

Report of a Case of Pacemaker Depletion Presenting with Wide QRS Tachycardia

“…The runaway phenomenon is mostly seen in case of a delay in the elective replacement time and excessive decline of battery voltage, particularly in old-generation pacemakers (4). ECG in cases of the typical runaway phenomenon has a slower intermittent ventricular capture or a very-high-rate pacemaker capture, which looks like an artifact.…”