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Pacemaker Battery Replacement — RACP Adult Medicine MCQ

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EasyCardiologyPacemaker Battery ReplacementRACP Adult Medicine

A 70-year-old man with a dual-chamber pacemaker (for complete heart block) presents with intermittent dizziness. Device interrogation shows pacing at 60 bpm with 100% ventricular pacing and 95% atrial pacing. Battery voltage is 2.4V (elective replacement indicator). What is the most appropriate management?

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Correct answer: A — Elective pulse generator replacement

Pacemaker battery at elective replacement indicator (ERI) — typically voltage ~2.4-2.6V depending on manufacturer — requires ELECTIVE pulse generator change (battery replacement). This is not an emergency but should be planned within weeks-months. At end-of-life (EOL), the device may revert to a backup pacing mode (e.g., VOO at reduced rate) with limited programmability. In a pacemaker-dependent patient (100% VP, complete heart block), timely generator change is important to prevent symptomatic bradycardia.

Reference: CSANZ – 2024 – Cardiac Devices; HRS 2024