Pacemaker capture failure

Educational use only. Not clinically reviewed

76-year-old man for Pacemaker capture-failure rescue and reassessment in a monitored cardiac unit. About 9 simulated minutes.

What you will practise

Reconcile symptoms, pulse, perfusion, pacing artifacts, QRS complexes, and mechanical signals before naming capture failure.
Activate acute bradycardia rescue, backup pacing readiness, and device expertise without waiting for complete troubleshooting.
Review the authored dependency, battery, output, threshold, sensing, impedance-trend, and stored-electrogram report without interrogating or programming a device.
Review lead, generator, myocardial, metabolic, ischemic, medication, procedure, and measurement contributors without assigning one mechanism.
After elapsed time, review the experienced team’s reported restoration of electrical and mechanical capture without claiming learner delivery or durable repair.
After another elapsed interval, hand off capture surveillance, unresolved lead and system integrity, rescue triggers, and named electrophysiology ownership.

Review and sources

Not clinically reviewed. No clinician has signed this scenario.

Wigginton JG, Agarwal S, Bartos JA, et al. Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines for CPR and ECC. Circulation. 2025;152(suppl 2):S538-S577. doi:10.1161/CIR.0000000000001376.
Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. Circulation. 2019;140:e382-e482. doi:10.1161/CIR.0000000000000628.
Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42:3427-3520. doi:10.1093/eurheartj/ehab364.
Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017;14:e503-e551. doi:10.1016/j.hrthm.2017.09.001.

Every scenario in this module

Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.