Troubleshooting a pacemaker output failure: A case report

The indications for permanent pacemaker (PM) implantation are rapidly expanding resulting in an increasing number of patients receiving PMs. Such PM patients need a good quality medical care. The follow up of these patients and their devices places a heavy burden on cardiology clinics with significant implications for the already stretched hospital resources. This has resulted in increased reliance on the options of automatic and continuous adjustments that the modern PMs offer. One such feature is the ‘automatic sensitivity function’ or ‘AutoSense’ which when turned on, monitors the amplitude of the intrinsic R wave and P wave and continuously adjusts the sensitivity, as a function of measured amplitudes, to avoid undersensing or oversensing. We are describing a case in which oversensing occurred even though the pacemaker's ‘AutoSense’ function was kept on and hence was misunderstood to be a lead problem and was advised ventricular lead replacement.