Brief Answer: Explanations of the possible causes & test needed Detailed Answer: Hi XXXXXXX welcome to our site. I am Dr Saumya Mittal. Read your query. That is a very significant question and i appreciate your problem. I will try my best to answer your query The pacemaker usually does not cause any problems, as you have experienced so far. The usual complication that happens after pacemaker implantation, as you are well aware going by your query are infection, battery life. Now you say there is pain at the site of pacemaker. I understand from your query that your pace maker has been implanted some years back, and you have had the batteries changed recently. Now there are many causes of the pain that you are having. I will list some of them with the steps you should take for them. First, there may be an infection. But you say you have already got a blood test done to rule it out. So i wont worry much about that. Yet a blood culture would be safe to have. Second, the lead of the pacemaker may have moved. This can cause many problems a. the pain may be due to different rates of beating of the heart and the pacemaker. b. abnormal discharges to the skin and surrounding tissue causing the pain when the shock meant for heart affects the tissue. c. the lead may pierce into some tissue. This may be causing pain due to abnormal piercing, and as I said, shock getting delivered to wrong tissue. You could get an x ray of the chest. Usually the leads are reflected nicely in the x rays. Third, and this is usually more common in the newer devices, but is known in old pacemakers too, one should consider the possibility of device moving or rotating. Fourth possibility is that one may have developed a pneumothorax. It is unlikely since you may get very breathless and so one could not miss that. Eitherways, an x ray chest will feature these too. Finally I would think of neuropathy. This is a very rare possibility. A nerve around the pacemaker is not happy about it being there for any number of possible causes- maybe it is being pressed, maybe the lead is affecting it. These is a long range of possible causes of neuropathy. As it cannot be directly tested, I would suggest we test the other causes before we think about it. I hope this helps you. Inform the reports mentioned above so i can be of help further. Best of luck. I have given you the answer to the maximum considering the information provided. The results of the tests could further enhance my answer to you. Please do understand that some details could be extracted from a detailed history and examination. Looking forward to your return query with the details asked so that I can help you further. (If the answer has helped you, please indicate this)

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