How does one die when a pacemaker is present?

  My 89-yr-old mother lies awake at night worrying about how she will be
  able to die, fearing her pacemaker will interfere with the process.
  Has had pacemaker for about 4 years.
  Last August had heart attack, has frequent unstable angina attacks, is
  weak, lethargic, no appetite, insomnia - and all the medications her doctors
  prescribe keep her alive, but miserable. She knows she cannot live forever
  but doesn't understand how she will die - if a killer heart attack hits,
  will the heart stop, and the stimulation of the pacemaker just have no
  effect? I know this sounds like a silly problem, but this insomnia is
  more debilitating than anything. Thanks in advance for your response.

[CCF Cardio MD - MTR]

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Dear Evelyn, thank you for your question.  A pacemaker is designed to stimulate the heart
to beat when it can't beat fast enough on its own.  Some pacemakers are working 100% of the
time while others stimulate heartbeats only occassionally.  Each patient with a pacemaker is
different but most don't even realize it when the pacemaker is stimulating a heartbeat.
Your mother sounds debilitated by her worsening angina and she sounds like she has a grim
prognosis but discussions about what type of care and what type of comfort measures need
to be undertaken at this point should be held with her primary physician.  If she were to
have a large heart attack, it's doubtful a pacemaker would artificially prolong her life.
A pacemaker would only do this if her heart rhythym would be too slow - which is an unusual
cause of mortality in patients with a heart attack.  I would suggest that you speak with
the cardiologist who monitors her pacemaker about what its purpose is in her and how
dependent she is on the pacemaker function.  It is possible to deactivate a pacemaker but
I don't know if that would be a good idea in your mother's case.  Additionally, your mother
could be made more comfortable with better pain relief and perhaps better medical control
of her angina.  I hope this information helps her sleep better at night.
Information provided in the heart forum is for general purposes only.  Specific diagnoses
and therapies can only be provided by your physician.