Heart interwoven with circuit boards, symbolising a pacemaker

Pacemaker Problems: Are Automatic Reprogramming Alerts Putting Patients at Risk?

Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"A new study reveals that automatic reprogramming during pacemaker battery depletion could lead to significant symptoms and clinical events, impacting patient well-being. Understanding the risks is crucial for proactive care."

For over 100,000 individuals in the United States, a pacemaker is a vital device ensuring a consistent heartbeat. As pacemaker batteries deplete, an alert triggers, signaling the need for replacement. However, a concerning side effect known as automatic reprogramming can occur at the time of these replacement notifications.

Automatic reprogramming changes a pacemaker's settings, which can lead to a loss of rate response (the device's ability to adjust heart rate to activity levels) and atrio-ventricular (AV) synchrony (coordinated pumping between the upper and lower chambers of the heart). While intended to maintain basic pacing, this automatic shift can trigger unexpected and adverse physiological changes in some patients.

A recent study aimed to determine if these automatic reprogramming events at replacement notification are associated with noticeable symptoms or clinical events. By understanding these potential risks, both patients and healthcare providers can take proactive steps to ensure optimal care and well-being.

Unveiling the Risks: Symptoms and Clinical Events Linked to Pacemaker Reprogramming

Heart interwoven with circuit boards, symbolising a pacemaker

The study, which reviewed the medical records of 266 pacemaker patients undergoing generator replacement, identified three distinct groups based on how their pacemakers reprogrammed:

Control Group: No change in basic pacing mode.
Loss of Rate Response Group: Pacemakers lost the ability to adjust heart rate according to activity.
Loss of AV Synchrony ± Rate Response Group: Pacemakers lost coordination between heart chambers and potentially the ability to adjust heart rate.

Patients experiencing loss of AV synchrony, with or without loss of rate response, reported notable symptoms. Overall, 31.2% of all subjects experienced symptoms and 10.5% experienced clinical events like unscheduled doctor's visits or hospitalizations.

The data revealed significant differences among the groups: only 4.3% of the control group reported symptoms, compared to 26% in the loss of rate response group and a striking 62.1% in the loss of AV synchrony group. Clinical events were similarly disparate: no events in the control group, 6.5% in the loss of rate response group, and 27.3% in the loss of AV synchrony group. These findings underscore that automatic reprogramming can significantly impact a patient’s well-being.

Staying Ahead: What You Can Do About Pacemaker Reprogramming Risks

The study emphasizes the importance of recognizing that automatic pacemaker reprogramming isn't always a benign event. Patients experiencing symptoms such as fatigue, shortness of breath, or palpitations around the time of a replacement notification should promptly consult their cardiologist.

While remote monitoring can help detect replacement notifications, not all pacemakers are equipped with this technology. The study suggests that closer monitoring and earlier elective replacement may be warranted for certain patients, especially those prone to symptomatic changes with loss of AV synchrony. Additionally, it is crucial for professional societies to develop guidelines to minimize risks associated with patient care.

Ultimately, staying informed, maintaining open communication with your healthcare provider, and advocating for proactive monitoring are key to mitigating the potential risks of automatic pacemaker reprogramming and ensuring continued cardiac health.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/pace.13532, Alternate LINK

Title: The Symptoms And Clinical Events Associated With Automatic Reprogramming (Scare) At Replacement Notification Study

Subject: Cardiology and Cardiovascular Medicine

Journal: Pacing and Clinical Electrophysiology

Publisher: Wiley

Authors: Sunil K. Sinha, Daniel Carlson, Jonathan Chrispin, Andreas S. Barth, John Jack Rickard, David D. Spragg, Ronald Berger, Charles Love, Hugh Calkins, Gordon F. Tomaselli, Joseph E. Marine

Published: 2018-11-11

Everything You Need To Know

What exactly is automatic reprogramming in pacemakers and why does it occur?

Automatic reprogramming in pacemakers refers to the change in the device's settings that occurs when the battery nears depletion. This reprogramming can result in the loss of rate response, which is the pacemaker’s ability to adjust heart rate to activity levels, and/or the loss of atrio-ventricular (AV) synchrony, the coordinated pumping between the upper and lower chambers of the heart. These changes are intended to maintain basic pacing but can sometimes lead to adverse effects.

How did the study categorize patients based on pacemaker reprogramming during battery depletion?

The study identified three groups of patients based on how their pacemakers reprogrammed. The first, the control group, experienced no change in basic pacing mode. The second group experienced a loss of rate response. The third experienced a loss of AV synchrony, sometimes accompanied by a loss of rate response. Patients who lost AV synchrony, with or without rate response, reported more symptoms and clinical events than the other groups.

What should I do if I experience symptoms around the time of my pacemaker replacement notification?

If you have a pacemaker and experience symptoms such as fatigue, shortness of breath, or palpitations around the time you receive a replacement notification, it is crucial to consult your cardiologist promptly. These symptoms may indicate that the automatic reprogramming of your pacemaker is affecting your well-being. Early detection and intervention can help manage and mitigate potential adverse effects.

What is the difference between a loss of 'rate response' and a loss of 'AV synchrony' after pacemaker reprogramming, and how might each affect me?

The loss of rate response means the pacemaker no longer adjusts the heart rate based on your activity level. This can result in symptoms like fatigue or reduced exercise tolerance because the heart isn't increasing its rate to meet the body's needs. In contrast, the loss of AV synchrony means the upper and lower chambers of your heart are no longer pumping in a coordinated manner. This can lead to symptoms such as shortness of breath, fatigue, and palpitations due to inefficient blood flow.

Why is automatic reprogramming a potential concern for individuals with pacemakers?

Automatic reprogramming presents a potential risk because it can disrupt the finely-tuned settings of a pacemaker. While intended as a safety mechanism to ensure basic pacing function as the battery depletes, it can inadvertently lead to a loss of rate response or atrio-ventricular synchrony. The study highlights that a significant percentage of patients experiencing these changes report noticeable symptoms and clinical events, underscoring the need for awareness and proactive monitoring during pacemaker replacement.