Successful management of pacing system malfunctions without surgery: the role of programmable pulse generators.

The value of programmable pulse generators for correcting pacing system malfunction without surgical revision was assessed in 293 patients. Twenty-five patients (8.5%) developed malfunctions from one day to 38 months after implant. Of these, 16 or 64% were successfully managed by programming alone, while nine patients required lead repositioning or a new lead. The majority (75%) of isolated pacing and sensing malfunctions were corrected by programming, but programming restored normal pacing function in only one of five patients who had combined sensing and pacing malfunctions which appeared early after pacemaker insertion. We conclude that programmable pulse generators are particularly useful for managing isolated pacing or sensing malfunctions. However, programmability is not a substitute for careful lead placement.