Pacemakers
Pacing codes and modes, reading a paced ECG step by step, failure to capture or sense, pacemaker-mediated tachycardia, magnets, MRI and surgery, and when a device problem changes management.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- A pacemaker has a pulse generator (battery and circuits, usually 8 to 12 years of life) and one to three leads, or is a single leadless capsule in the RV.
- It does two jobs: sense intrinsic activity, and pace when the rate falls below the programmed lower rate.
- Indications are covered elsewhere: sinus node dysfunction (pace for symptoms) and AV block (Mobitz II or complete block, with or without symptoms). Devices with a defibrillator or an LV lead are in ICDs and CRT.
Loading the rest of the note…
Finished reading?
Sources
- 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapyEuropean Society of Cardiology (European Heart Journal, doi:10.1093/eurheartj/ehab364), 2021
- ESC clinical consensus statement on indications for conduction system pacingEuropean Society of Cardiology and European Heart Rhythm Association (EP Europace), 2025
- Køber L, Adamo M et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J 2026. doi:10.1093/eurheartj/ehag100European Society of Cardiology, 2026
- 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failureHeart Rhythm Society, Asia Pacific Heart Rhythm Society and Latin American Heart Rhythm Society (Heart Rhythm 2023), 2023
- Cardiac Society of Australia and New Zealand (CSANZ) Position Statement on the Follow-Up of Cardiovascular Implantable Electronic Devices 2022AU/NZCardiac Society of Australia and New Zealand (Heart, Lung and Circulation 2022;31(8):1054-63, doi:10.1016/j.hlc.2022.05.001), 2022
- 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devicesHeart Rhythm Society (Heart Rhythm 2017;14:e97-e153), 2017
- Assessing Fitness to Drive for commercial and private vehicle driversAU/NZAustroads and the National Transport Commission, 2022
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy