Pacing cessation just before generator replacement - A life-threatening consequence of pacemaker battery depletion: A case report.

UNLABELLED: We report the case of a 77-year-old man who underwent single-chamber pacemaker implantation 16 years prior. The patient, who did not utilize remote monitoring, was lost to follow-up 14 years after the implantation, leading to profound battery depletion. This lack of surveillance resulted in a critical reduction of the pacing rate to 14 ppm, culminating in the complete cessation of pacing immediately before generator replacement. Despite the Abbott device's specified End-of-Life (EOL) safety mechanism, pacing function failed entirely-a rare but life-threatening complication. Uniquely, this case provides serial electrocardiographic documentation capturing the full progression of severe battery depletion. These findings underscore that continuous follow-up and remote monitoring, as emphasized in recent guidelines, are pivotal for preventing such critical outcomes. LEARNING OBJECTIVE: This case highlights the potential for profound pacemaker rate reduction and complete pacing cessation beyond manufacturer-defined End-of-Life settings in the setting of extreme battery depletion. It emphasizes the importance of regular device follow-up, timely generator replacement, and the use of remote monitoring to detect critical battery status changes and prevent life-threatening complications during pacemaker management.