Implantable pace maker is an electrical apparatus used as a substitute for a malfunctioning natural pacemaker to regulate the beating of the heart by a series of rhythmic electrical discharges.

Disorders that cause a need for a pacemaker include: a symptomatic slow heart, atrioventricular block, sinus arrest, sick sinus syndrome, Stokes-Adams syndrome, tachyarrhythmias, and ectopic heart beats due to certain antiarrhythmic drugs.

Indications for the procedure include irregular heart action of the atria or ventricles or both. Symptoms of the irregularities may produce feelings of dizziness and light-headedness, dyspnea, fatigue, fainting, and angina.

On occasion, a temporary pacemaker is used at first to observe a patient's response, and to direct the choice of the implantable type and the rate of the heart.

The pacemaker is the treatment.

There are several activities that should be done by the patient on a daily or regular basis after a pacemaker implant. These activities include: observing the implantation site for signs of infection (necessary until the site is healed); reporting any difficulty in breathing, dizziness, fainting, or swelling of the hands or feet; avoiding lifting heavy objects and stressing muscles near the implant; carrying pacemaker identification; taking special precautions to prevent pacemaker disruption by electrical or electronic devices; and avoiding magnetic resonance imaging (MRI) testing. Pacemaker batteries usually last about five to ten years before the patient needs to be hospitalized for replacement.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• When inpatient hospitalization for sustained ventricular arrhythmia or ventricular aneurysmectomy is required, a 100-percent evaluation begins on the date of hospital admission with a mandatory VA examination six months following hospital discharge. Evaluate post-surgical residuals under the General Rating Formula. Apply the provisions of 38 CFR 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination.

Notes

• Evaluate as supraventricular tachycardia (DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block (DC 7015).

• Evaluate automatic implantable cardioverter-defibrillators (AICDs) under DC 7011

• Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

• One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms.

• For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.