Cardiac rhythm devices

Pacemaker complications & ICD claims.

Expert witness reports on lead displacement, infection, perforation, device malfunction and inappropriate shock delivery in pacemaker and ICD claims, addressing both breach and causation.

Instruct a cardiology expert Call 0800 161 3395
  • Pacemaker lead displacement
  • ICD implantation negligence
  • Device-related infection
  • CPR Part 35 compliant
what we cover

Pacemaker and ICD complications and the legal questions they raise.

Pacemakers and implantable cardioverter-defibrillators (ICDs) prevent sudden cardiac death and manage bradyarrhythmias, but complications such as lead displacement, infection or inappropriate shock delivery can give rise to clinical negligence claims. Our cardiologists assess whether implantation, follow-up and device management adhered to current standards.

Most instructions arise where lead displacement was not promptly identified, infection was inadequately managed, or inappropriate ICD shocks caused harm. The decisions are tested against the current NICE and ESC guidance for cardiac rhythm devices and device-based therapy.

  • Breach questions address whether implantation technique, lead positioning or follow-up imaging met the standard of care, and whether signs of lead displacement or infection were acted on within a reasonable timeframe.
  • Causation questions turn on whether earlier intervention would have prevented the adverse outcome — for example, whether timely lead revision would have avoided cardiac perforation, or whether prompt extraction would have prevented systemic infection. Sudden cardiac death following device failure is a frequent focus.
  • Inappropriate ICD shocks — whether due to device programming or lead fracture — are assessed against the ESC guidance on device-based therapy and the Bolam and Bolitho standard.
  • Informed consent is frequently in scope, particularly where the risks of lead displacement or infection were not adequately communicated, tested against the Montgomery standard.
Clinical scope

The clinical questions our cardiologists answer.

Reports address the cardiology decisions in issue against current guidance and the Bolam and Bolitho standard.

Included in scope

Questions addressed

  • Whether lead positioning and fixation were performed in accordance with current guidance and whether post-procedural imaging was adequate to confirm stability.
  • Whether signs of lead displacement, infection or device malfunction were recognised and acted on within a reasonable timeframe.
  • Whether ICD programming and shock thresholds were set in line with current ESC device guidance, and whether inappropriate shocks were preventable.
  • Whether informed consent was obtained in accordance with the Montgomery standard, including disclosure of material risks such as lead displacement or infection.
  • Whether, on the balance of probabilities, earlier intervention would have prevented the adverse outcome, with material contribution analysis where appropriate.
Out of scope

Not covered without separate instruction

  • Interventional technique during lead extraction or device revision, which sits with electrophysiology instruction where procedural complications are in issue.
  • Cardiac surgical decisions where thoracotomy or epicardial lead placement was considered, addressed via cardiac surgery instruction.
  • Examination of the claimant or prognosis evaluation, which requires a separate condition and prognosis report.
  • Quantum, life expectancy and care needs, addressed through dedicated reports where the case progresses to that stage.
Common cases

Common scenarios we report on.

These patterns recur in pacemaker and ICD complications claims, most turning on implantation technique, follow-up imaging or device programming.

  • Lead displacement

    Pacemaker lead displacement not identified

    Patient presented with syncope or palpitations post-implantation. Chest X-ray or device interrogation showed lead displacement, but revision was delayed. The report addresses whether post-procedural imaging was adequate and whether signs of displacement were acted on within a reasonable timeframe.

    Often paired with: Breach of Duty Causation

  • Device infection

    Pacemaker pocket infection not extracted

    Erythema, swelling or discharge at the device site, with positive blood cultures. Extraction was delayed or not performed. The report examines whether infection management met the accepted standard and whether earlier extraction would have prevented systemic sepsis.

    Often paired with: Breach of Duty Causation

  • ICD programming

    Inappropriate ICD shocks

    Patient received multiple inappropriate shocks due to device programming or lead fracture. The report assesses whether shock thresholds and detection zones were set in line with current ESC device guidance and whether earlier device interrogation would have prevented the shocks.

    Often paired with: Screening & Merits Breach of Duty

  • Informed consent

    Failure to disclose lead displacement risk

    Patient suffered lead displacement post-implantation, and the consent process did not document discussion of this material risk. The report tests whether the Montgomery standard was met and whether the omission affected the patient’s decision to proceed.

    Often paired with: Causation Condition & Prognosis

Reports

Report types commissioned for this condition.

These cases typically progress from screening into full liability work, with breach and causation often addressed in a single report where the records allow.

Approaching a deadline?

Instruct an expert in pacemaker and ICD complications.

Send a short note on the alleged complications with the records bundle. Quotation returned the same working day; fast-track available where the trial window or limitation deadline requires it.

Instruct a cardiology expert Call 0800 161 3395

GMC-registered consultants Fixed fee where the bundle allows LAA rates available