Causes of pacemaker lead dislodgement

The Body's Electrical System - The natural pacemaker of the heart is called the sinoatrial node. Learn how your heart beats and the electrical impulses in your body. Advertisement Have you ever wondered what makes your heart beat? How does ...

Pacemakers are implantable devices that help regulate the heartbeat of individuals with heart conditions. These devices have been in use for decades and have helped improve the quality of life for millions of people worldwide.Lead dislodgement requiring reoperation is a complication that raises the costs of pacemaker implantation surgery, while adding to patient discomfort. Migration of a dislodged lead can cause complications such as undersensing, loss of atrial capture, and loss of atrial function in patients who need AV synchrony.Pacemaker Failure. Pacemaker failure has three causes: (1) failure of capture, (2) lead failure, and (3) generator failure. Failure of capture owing to a defect at the level of the myocardium (i.e., the generator continues to fire but no myocardial depolarization takes place) remains the most difficult problem to treat.Pacing lead dislodgement contributes substantially, to the list of causes of early pacemaker failure. Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing ...Lead dislodgement is more common in the first few weeks after implantation. The hospital stay is usually brief, and the procedure can be performed as an outpatient. ... (less than six inches) to their device. Cell phones without strong magnets are unlikely to cause problems with pacemakers or defibrillators. If you have a pacemaker …Twiddler's syndrome is a rare cause of pacemaker lead dislodgement. We present the case of a 49-year-old male patient with Down's syndrome implanted with a dual chamber pacemaker showing high ventricular impedance, no sensing, and complete loss of capture for both leads at the 3-month follow-up due to Twiddler Syndrome.The dislocated …Pacemakers are implantable devices that help regulate the heartbeat of individuals with heart conditions. These devices have been in use for decades and have helped improve the quality of life for millions of people worldwide.

The unique nature of this case increases the importance of considering device lead dislodgement as the cause for patients presenting with extra-cardiac symptoms. Pacemaker lead stimulation of surrounding structures can present in an unusual fashion, masking the diagnosis.identified causes of undersensing.3,4 As with failure to capture, the onset of undersensing relative to the time of device implantation helps identify the cause. Undersens-ing occurring shortly after implantation may be due to lead dislodgement or malposition or to cardiac perfora-tion. If it occurs later, it could be due to battery deple-Cardiac pacemaker battery malposition; Malposition of cardiac pacemaker battery; ICD-10-CM T82.121A is grouped within Diagnostic Related Group(s) (MS-DRG v 41.0): 308 Cardiac arrhythmia and conduction disorders with mcc; 309 Cardiac arrhythmia and conduction disorders with cc; 310 Cardiac arrhythmia and conduction disorders without cc/mccCardiac pacemaker battery malposition; Malposition of cardiac pacemaker battery; ICD-10-CM T82.121A is grouped within Diagnostic Related Group(s) (MS-DRG v 41.0): 308 Cardiac arrhythmia and conduction disorders with mcc; 309 Cardiac arrhythmia and conduction disorders with cc; 310 Cardiac arrhythmia and conduction disorders without cc/mccEarly diagnosis of defibrillation lead dislodgement. JACC Clin Electrophysiol. 2018; 4:1075–1088. doi: 10.1016/j.jacep.2018.03.015 Crossref Medline Google Scholar; 22. Kreis DJ, LiCalzi L, Shaw RK. Air entrapment as a cause of transient cardiac pacemaker malfunction. Pacing Clin Electrophysiol.Background The pacemaker-twiddler’s syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the ...Lead macro-dislodgement (LMD) is defined as the gross displacement of the lead of an implantable cardiac electronic device that is identified using chest radiography or other imaging modalities ...lead dislodgement. device malfunction. pacemaker syndrome. Early. pneumothorax: one of the more common early complications, particularly when subclavian access is used (incidence of ~2% 6) haemothorax. air embolism. anaphylaxis. Late. pocket erosion. atrioventricular fistula "subclavian crush" syndrome. lead fracture. pectoral …

Pacing lead dislodgement contributes substantially, to the list of causes of early pacemaker failure. Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing ...pacemaker was pacing the right atrium at 5.00V @ 0.4ms due to high atrial pacing threshold, atrial lead impedance was 342ohms, pulse rate was 60bpm and there was loss of atrial sensing and intermittent loss of atrial capture seen on the patient's continuous ECG (Figure 3). This indicated atri-al lead dislodgement.Runaway Pacemaker is due to a malfunction of the pacemaker generator resulting in life-threatening rapid tachycardia (up to 200 bpm). the generator may malfunction for various causes, including battery failure or external damage. the use of a magnet can reduce the rate of the rhythm induced by the defiant pacemaker.As such, my humble opinion is that the wires are not dislodged due to only one wrong movement. An easy way to check is to have a physical count of the pulse & you will find out if it is still in contact with the heart & Pacemaker as you should know how many beats was set for your Pacemaker to work the heart.Postoperatively, electrocardiographic monitoring showed atrial lead malfunction. Chest X-ray revealed that the tip of the active fixation atrial lead was dislocated. We present a case of atrial lead dislodgement after a …

Kitchen and bath gallery marlton nj.

Pacemaker Failure. Pacemaker failure has three causes: (1) failure of capture, (2) lead failure, and (3) generator failure. Failure of capture owing to a defect at the level of the myocardium (i.e., the generator continues to fire but no myocardial depolarization takes place) remains the most difficult problem to treat.PACING SYSTEM COMPONENTS. The traditional pacing system is comprised of the pulse generator ( picture 1 ), also called the pacemaker, and the transvenous or epicardial lead or leads that connect the pulse generator to the heart. The phrase "pacing system malfunction" includes problems that might arise from any of the …Moreover 1-2% of these patients will encounter severe lead-related problems within 30 days of their pacemaker insertion. In this report, we focus on an uncommon but serious complication of PPM insertion: right ventricular lead perforation leading to a pericardial effusion. Although lead perforation is a relatively rare occurrence, this event ...Atrial lead implantation at the low right atrial septum, typically near to the coronary sinus ostium, is frequently difficult. Stability may be hard to achieve at areas of smooth muscle and the risk of lead dislodgement increased due to nearby tricuspid valve movements (Fig. 4). P wave sensing performance can be poor and also compromised by ...Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing electrodes by manipulation of the pulse generator by the patient. We describe here an intriguing case of pacemaker lead dislodgement by a novel and frequently underdiagnosed mechanism that mimicked the fluoroscopic diagnosis of reel's syndrome.

The pacemaker rotates on its long axis, resulting in dislodgement of pacing leads. Can result in diaphragmatic or brachial plexus pacing (e.g. arm twitching) depending on extent of lead migration. ECG in Pacemaker Malfunction. Normal pacemaker rhythms can result in absent pacing activity, irregular pacing and absence of pacing spikes.The pacemaker-twiddler’s syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly …Lead-related problems may occur at any stage following implant and include dislodgement, fracture or breach of insulation. These may prevent the pacemaker from functioning appropriately, and patients may present with the same problems that necessitated implantation of the device in the first place, including dizziness and syncope.Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing electrodes by manipulation of the pulse generator by the patient. We describe here an intriguing case of pacemaker lead dislodgement by a novel and frequently underdiagnosed mechanism that mimicked the fluoroscopic diagnosis of reel's syndrome.Most cases of malfunction are associated with the electronics in the pulse generator or dislodgement or fracture of the leads. External causes are less common and include electrolyte disorders, metabolic disorders, hypoxemia, antiarrhythmic drugs, or electromagnetic disturbance caused by other machines/devices.O Follow-up experience is needed with these modified leads to judge whether their use has reduced dislodgement rates and to determine if untoward prob- lems ...Pacemaker lead is an insulated wire which connects an electrode to a generator. In contrast to this, the electrode is the uninsulated termination of the lead which is connected to the heart. ... It can cause an extreme lead dislodgement, diaphragmatic stimulation, and loss of capture. 7. Step-by-step guide on how to assess chest radiograph ...... pacemaker is removed when dislodgement of the lead or pacemaker malfunction is observed. ... cause of pacemaker failure. Cardiology 105: 119-121. [Crossref] ...The most frequent complication of pacemaker leads has been reported to be dislodgement, and the FOLLOWPACE study showed that dislocation of an atrial lead within 2 months was found in 1.9% of patients with active lead fixation and 3.9% of patients with passive lead fixation (P = .059). For a mean of 5.8 years except the first 2 months, its ...Pacemaker-related complications are acceptable and they can mostly be resolved by minor interventions. The dislodgement of a pacemaker lead is one of the common complications and its incidence is estimated range from around 1-3％ ( 1 ). An active fixation lead is usually applied to avoid this complication, and a J-shaped passive …2 Tem 2021 ... ... pacemaker leads with no evidence of vegetation on the pacemaker leads or tricuspid valve. ... dislodgement and migration causing a large ...Excessive movement can cause a detachment of the generator from the wires, or the wires from the heart muscle, and the device will not work properly. Is it easy to dislodge pacemaker leads? Pacing lead displacement and dislodgement is a relatively common problem and can occur in 5-10 % of the patients (National Pacemaker and ICD …

O Follow-up experience is needed with these modified leads to judge whether their use has reduced dislodgement rates and to determine if untoward prob- lems ...

Although the overall rate of dislodgement of cardiac leads is believed to be decreasing, a previous review revealed that the rate of lead dislodgement could be as high as 2.4%. Most of the lead dislodgements occur within 24–48 hours of implantation, and are most commonly diagnosed through device interrogation showing intermittent …Pacemakers and implantable defibrillators are devices that monitor and help control abnormal heart rhythms. Learn who needs one, and how they work. An arrhythmia is any disorder of your heart rate or rhythm. It means that your heart beats t...The most common causes for ICED revision and lead explantation are dislodgement of the lead, loss of pacing, lead fractures, insulation defects, and infection [12], [13], [16], [18], [21], [45], [46]. ... Pacemaker leads are, accordingly, a blood flow-perturbing element, which can in turn cause thrombosis due to blood recirculation or …Disengagement of a lead tip from connector header is the preventable cause of pacemaker malfunction. It occurs either due to loose set screw or screw tightening before proper lead placement in connector head. This complication is diagnosed by the increase in pacing threshold and an increase in lead impedance during pacemaker interrogation.Symptoms include pulsation and fullness in the neck, dizziness, palpitations, fatigue, light-headedness and syncope. Symptoms and signs of heart failure may ...Lead dislodgement is more common in the first few weeks after implantation. The hospital stay is usually brief, and the procedure can be performed as an outpatient. ... (less than six inches) to their device. Cell phones without strong magnets are unlikely to cause problems with pacemakers or defibrillators. If you have a pacemaker …Background: Pacemaker lead dislodgement may cause malfunction in the pacing system, which may lead to severe adverse events. For patients with sick sinus syndrome but normal atrioventricular conduction, atrial lead dislocation may cause excessive unnecessary ventricular pacing, resulting in nonphysiological pacing leading to heart failure. ThePacemaker Failure. Pacemaker failure has three causes: (1) failure of capture, (2) lead failure, and (3) generator failure. Failure of capture owing to a defect at the level of the myocardium (i.e., the generator continues to fire but no myocardial depolarization takes place) remains the most difficult problem to treat.Additionally, two lead dislodgement-related syndrome is defined below: Lead displacement dysrhythmia refers to when free-floating ventricular leads cause episodes of malignant arrhythmias (12). When a lead is dislodged from the endocardial interface, the patient’s pacemaker dependency determines the symptoms (11). ...be much more unnoticed lead perforation or dislodgement even in the extremely late phase and pay extra attention to the relaxed shapes of atrial leads, especially in patients receiving immunosuppressive agents. Conclusions We report a case of atrial lead dislodgement 9 years after pacemaker implantation. Microperforation, lead instability,

Dr james thorp.

Common mode gain.

The pacemaker-twiddler’s syndrome refers to the perma - nent malfunction of a pacemaker resulting from manip-ulation of the pulse generator within its skin pocket [1]. This leads to a rotation of the device, coiling of the lead and its dislodgement, leading to pacemaker failure. First described by Bayliss in 1968, it is a rare but poten-The most common causes for ICED revision and lead explantation are dislodgement of the lead, loss of pacing, lead fractures, insulation defects, and infection [12], [13], [16], [18], [21], [45], [46]. ... Pacemaker leads are, accordingly, a blood flow-perturbing element, which can in turn cause thrombosis due to blood recirculation or …All leads are involved, at any time from implantation, and frequently damaged. In the past few years, a reel syndrome was also observed: retraction of pacemaker leads into pocket without patient manipulation, owing to lead circling the generator. In other cases, a ‘ratchet’ mechanism has been postulated.Early diagnosis of defibrillation lead dislodgement. JACC Clin Electrophysiol. 2018; 4:1075–1088. doi: 10.1016/j.jacep.2018.03.015 Crossref Medline Google Scholar; 22. Kreis DJ, LiCalzi L, Shaw RK. Air entrapment as a cause of transient cardiac pacemaker malfunction. Pacing Clin Electrophysiol.Lessons learned since the first transvenous pacemakers were implanted >50 years ago have led to important advances in pacing technology. Active-fixation leads make many alternative pacing sites possible, may prevent lead dislodgement, and may provide advantages in cases where lead extraction becomes necessary. 1 However, active …History. Clinical symptoms of pacemaker malfunction are variable and include syncope, dizziness, palpitations, and slow or fast heart rate. Extracardiac stimulation or hiccup may be present. Obtain as much information as possible regarding the pulse generator, leads, and programmed values. Information on time of initial device placement ...In a study by Ward et al transvenous pacemakers placed outside normal business hours in patients with advanced AVB were associated with an increased risk of complications such as lead dislodgement or infection. 10 Brodbelt showed that induction of anaesthesia between 5 PM and 8 AM carries an 11.8 times increased risk of mortality in …Introduction. Leadless intracardiac pacemakers (LICPs) were developed to avoid the complications of traditional transvenous pacing systems. 1, 2 The Micra™ transcatheter pacing system (Medtronic, Inc., Minneapolis, MN) is a 2016 Food and Drug Administration (FDA)–approved LICP that is implanted in the right ventricle (RV). The …"Ratchet" syndrome, another etiology for pacemaker lead dislodgement: a case report. Von Bergen NH 1, Atkins DL, Gingerich JC, Law IH. Author information. Affiliations. 1 author. 1. The Children's Hospital of Iowa, Iowa City, Iowa 52242-1083, USA. ... Twiddler's syndrome in children: an unusual cause of pacemaker failure. Abrams S, …... symptoms were gone and the sensing and pacing parameters went back ... In our report, we diagnosed two leads displacement and one lead perforation of pacemaker ... ….

Description: Pacemaker malfunction is a global term used when a pacemaker is not working properly. It usually involves failure of the pulse generator or the lead (s). It presents as failure to pace, failure to capture, inappropriate sensing (over- or under-sensing), or dysrhythmia.Pacemaker malfunctions are due to multiple reasons like lead dislodgement, lead perforation, lead maturation process, lead conductor or insulation failure, battery …Cardiac pacemakers (CPM) and implantable cardioverter defibrillators (ICD) are indispensable treatment option for the cardiac arrhythmias. The most common complication of pacemaker implantation is lead dislodgement. We will present eight patients with lead dislodgement about Twiddler, Reel and Ratchet Syndromes.Disengagement of a lead tip from connector header is the preventable cause of pacemaker malfunction. It occurs either due to loose set screw or screw tightening before proper lead placement in connector head. This complication is diagnosed by the increase in pacing threshold and an increase in lead impedance during pacemaker interrogation.There is a clear association between low atrial septal lead position and lead dislodgement requiring lead revision. ... 3451 patients (mean age 73.9, 53.4 % male) underwent dual-chamber pacemaker placement. Active fixation leads were associated with a higher incidence of pericardial effusion (81 (2.9 %) vs. 6 (1.0 %), p = 0.005) and ...L ead displacement is a common complication of pacemaker device implantation, often resulting in prolonged hospital stays and increased costs. The frequency of long-term lead displacement ranges between 1.8% and 8.0%. In our case, the patient did not present any symptoms and the lead displacement was seen at a relatively late stage.Pacing lead dislodgement contributes substantially, to the list of causes of early pacemaker failure. Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing electrodes by manipulation of the …A, Frontal chest radiograph shows Medtronic single-chamber pacemaker on right and CPI (Cardiac Pacemakers Incorporated) implantable cardioverter defibrillator (ICD) on left. Each device has different type of bipolar right ventricle (RV) lead. Tip electrodes are located at termination of both RV leads, whereas short proximal metallic … Causes of pacemaker lead dislodgement, The pacemaker-twiddler’s syndrome refers to the perma - nent malfunction of a pacemaker resulting from manip-ulation of the pulse generator within its skin pocket [1]. This leads to a rotation of the device, coiling of the lead and its dislodgement, leading to pacemaker failure. First described by Bayliss in 1968, it is a rare but poten-, Lead dislodgement syndromes (Twiddler, Ratchet or Reel syndromes) are rare causes of cardiac stimulation device malfunction that can occur most commonly early after device …, Pacemakers are implantable devices that help regulate the heartbeat of individuals with heart conditions. These devices have been in use for decades and have helped improve the quality of life for millions of people worldwide., As such, my humble opinion is that the wires are not dislodged due to only one wrong movement. An easy way to check is to have a physical count of the pulse & you will find out if it is still in contact with the heart & Pacemaker as you should know how many beats was set for your Pacemaker to work the heart., Drinking plenty of fluids, especially water, dislodges a pill that is stuck in the throat, advises WebMD. If the medication can be taken with food, eating a piece of bread also helps resolve the problem., Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing electrodes by manipulation of the pulse generator by the patient. We describe here an intriguing case of pacemaker lead dislodgement by a novel and frequently underdiagnosed mechanism that mimicked the fluoroscopic diagnosis of reel's syndrome., May 8, 2014 · Lead-related reasons for re-intervention were categorised into lead dislodgement, malfunctioning or perforation. Results One thousand nine hundred twenty-nine devices including 3909 leads were implanted. In 595 patients (30.8 %) a CRT-D/P was implanted. , ... symptoms were gone and the sensing and pacing parameters went back ... In our report, we diagnosed two leads displacement and one lead perforation of pacemaker ..., O Follow-up experience is needed with these modified leads to judge whether their use has reduced dislodgement rates and to determine if untoward prob- lems ..., “I didn’t think that hiccoughs could be related to the patient’s pacemaker.” Direct stimulation of the diaphragm or the phrenic nerve occurs with lead dislodgement or with high output from a left ventricular lead placed in the coronary sinus. “Ventricular tachycardia clearly wasn’t the cause of his symptoms., Here, we report a case of atrial lead dislodgement 15 years after an implantable cardioverter-defibrillator (ICD) implantation. 2 CASE REPORT. 1), and ICD interrogation revealed a loss of capture of the atrium despite maximal output from the atrial lead and a decreased sensing threshold (P wave, 0.2–0.8 mV). Chest X-rays revealed that the tip ..., Cardiac pacemaker battery malposition; Malposition of cardiac pacemaker battery; ICD-10-CM T82.121A is grouped within Diagnostic Related Group(s) (MS-DRG v 41.0): 308 Cardiac arrhythmia and conduction disorders with mcc; 309 Cardiac arrhythmia and conduction disorders with cc; 310 Cardiac arrhythmia and conduction disorders without cc/mcc, Unfortunately, all these techniques seem doomed to failure. Recurrences have been reported with all of these. However, using leadless pacemaker implantation will also likely reduce lead dislodgement and hence, prevent Twiddler syndrome from occurring . In conclusion, pacemaker lead dislodgement is an unusual occurrence., The venous thrombosis associated with permanent pacemaker leads was first described a few years after the first endocardiac pacemakers were implanted. ... were not the cause of the fatal outcome of our patient. There are several useful imaging techniques for the diagnosis of pacing lead thrombosis in the right heart chambers. Transthoracic ..., lead and its dislodgement, leading to pacemaker failure. First described by Bayliss in 1968, it is a rare but poten- tially fatal complication of pacemaker treatment [1]., A pacemaker is a device placed in your chest or abdomen that sends electrical pulses, helping the heart to beat at a normal rhythm. There are 3 million people living with pacemakers around the world, and 600,000 new pacemakers are implanted each year. These devices are essential to patient health, so it is important to know if your …, lead dislodgement. device malfunction. pacemaker syndrome. Early. pneumothorax: one of the more common early complications, particularly when subclavian access is used (incidence of ~2% 6) haemothorax. air embolism. anaphylaxis. Late. pocket erosion. atrioventricular fistula "subclavian crush" syndrome. lead fracture. pectoral …, lead and its dislodgement, leading to pacemaker failure. First described by Bayliss in 1968, it is a rare but poten- tially fatal complication of pacemaker treatment [1]., Pacemaker malfunctions are due to multiple reasons like lead dislodgement, lead perforation, lead maturation process, lead conductor or insulation failure, battery depletion, loose set screw and ..., The symptoms of pacemaker syndrome included dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, hypotension, pre-syncope, and even syncope . Heart failure signs include elevated neck veins, rales, and pedal edema. Physical exam can often reveal cannon A-waves., The incidence of LCP device dislodgement was 0%, 0.13%, and 1% in three leadless pacemaker studies. Conclusions. The incidence rates of conventional pacemaker lead dislodgement vary in individual studies with an overall high incidence. Use of the currently available LCP systems appears to result in a lower rate of device dislodgement., The cause of lead dislodgement on chronic phase was supposed to be a rough adhesion between the atrial lead and right atrial appendage owing to the past microperforation, the long-time administration of an immunosuppressive drugs, and the stretched lead position upwardly. ... We report a case of atrial lead dislodgement 9 years after pacemaker ..., Why it's performed Pacemaker implantation. Why it's performed. Pacemakers are sometimes recommended for people with conditions that cause the heart to beat abnormally. Each time the heart beats, the heart muscle contracts (pulls inwards) in preparation for pumping blood around the body. The contractions are triggered by …, The Twiddler's syndrome is a rare cause of pacemaker or ICD malfunction, and characterized by the dislodgement of the lead(s), due to rotation or other manipulation of the pulse generator. In some ..., lead and its dislodgement, leading to pacemaker failure. First described by Bayliss in 1968, it is a rare but poten- tially fatal complication of pacemaker treatment [1]., Sensing of such signals normally inhibits the pacemaker. Oversensing may lead to underpacing. Failure to sense ... Most cases of malfunction are associated with the electronics in the pulse generator or dislodgement or fracture of the leads. External causes are less common and include electrolyte disorders, metabolic disorders, hypoxemia ..., Discussion. In this paper, we present a case who had an inserted ICD and abdominal twitches simultaneously with pace activity. As the ICDs have pacemaker (PM) properties and generate pulses below the set limits of heart rate or in case of asystole, in our case, the device did not sense the ventricular systole because of the dislodgement of the lead …, The unique nature of this case increases the importance of considering device lead dislodgement as the cause for patients presenting with extra-cardiac symptoms. Pacemaker lead stimulation of surrounding structures can present in an unusual fashion, masking the diagnosis. Lead dislodgement should always be considered as a differential diagnosis ..., 2.1 Lead dislodgement. Pacing lead displacement and dislodgement is a relatively common problem and can occur in 5-10 % of the patients (National Pacemaker and ICD …, Lead dislodgement requiring reoperation is a complication that raises the costs of pacemaker implantation surgery, while adding to patient discomfort. Migration of a dislodged lead can cause complications such as undersensing, loss of atrial capture, and loss of atrial function in patients who need AV synchrony., This phenomenon has been labelled “Idiopathic lead migration syndrome” and describes leads migrating from their original position (in the heart or pocket), with or without dislodgement or torsion, without a known cause [Citation 14]. In our study, the late dislodgement of the ICD lead in patient II was caused by migration from the RV to the ..., To the Editor, Poor lead positioning of implantable electronic cardiac devices is rare and discovered incidentally on occasion, but can have serious complications. 1 Dislodgement of correctly positioned leads is common, however, and can be a significant source of clinical complications for patients with these devices. Lead dislodgement may be an incidental, …, The pacemaker rotates on its long axis, resulting in dislodgement of pacing leads. Can result in diaphragmatic or brachial plexus pacing (e.g. arm twitching) depending on extent of lead migration. ECG in Pacemaker Malfunction. Normal pacemaker rhythms can result in absent pacing activity, irregular pacing and absence of pacing spikes.