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The risks associated with long term use of a pacemaker are small, but any foreign body in the vascular system can serve as an site of infection. So, there is a very small risk of infection at the site of the pacemaker.
In reality, the greatest risk of infection is greatest immediately after placement, as with any surgery, but there is still some long-term risk for as long as the pacemaker is in place.
The other long term risk of a pacemaker is that it may falsely sense the underlying heart rhythm and and either fail to provide shocks when needed or provide electrical shocks when not needed. If it fails to provide shocks when needed, then the heart may go too slow (which is generally the underlying problem for which the pacemaker was initially placed). If it provides extra shocks when not needed, it may induce abnormal heart rhythms.
All of these long term risks are very low. Most of the risks that occur from pacemaker placement occur around the time of surgical placement.
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