How can I differentiate between symptoms related to device malfunction and those due to underlying cardiac issues?

To differentiate between symptoms caused by implanted cardiac device malfunction and those due to underlying cardiac pathology, a thorough clinical assessment combined with device interrogation is essential. Symptoms such as syncope, palpitations, or chest pain may arise from either cause, but device malfunction often presents with abrupt changes in device function detected on interrogation, such as inappropriate shocks, failure to pace, or sensing abnormalities ¹.

Clinically, symptoms related to underlying cardiac issues tend to correlate with known cardiac disease progression or acute events, whereas device-related symptoms may occur unexpectedly or in the absence of new cardiac pathology. For example, transient loss of consciousness due to arrhythmia may be caused by device failure to detect or treat arrhythmias appropriately, which can be confirmed by reviewing device diagnostics and stored electrograms ¹.

Device interrogation and remote monitoring provide objective data to distinguish malfunction from cardiac causes by identifying technical issues like lead fracture, battery depletion, or software errors, which are not evident from clinical symptoms alone. Additionally, imaging and ECG can help assess cardiac function and exclude new or worsening cardiac disease (Federspiel et al., 2023).

In summary, differentiating symptoms requires integrating clinical presentation with device data: unexplained symptoms with abnormal device parameters suggest malfunction, whereas symptoms consistent with cardiac history and normal device function point to underlying cardiac issues. Prompt multidisciplinary evaluation including cardiology and device specialists is recommended to optimise diagnosis and management ¹; (Federspiel et al., 2023).