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An insulation break can lead to oversensing, which occurs when the pacing system interprets non-cardiac signals as if they are actual cardiac activity. This is primarily due to electrical noise or signals that leak in through the breach in the insulation of the pacing lead. When the system is unable to differentiate between actual heartbeats and extraneous electrical signals, it may inhibit pacing when it should not, leading to the identified condition of oversensing.

In contrast to oversensing, undersensing would imply the device fails to recognize existing cardiac activity, which could occur due to different issues not typically associated with an insulation break. Loss of capture refers to the inability of the pacemaker to consistently stimulate the heart, which could stem from various factors, including lead displacement or fiber fracture, rather than insulation problems. Increased pacing threshold, where a higher voltage is required to depolarize the myocardium, typically relates to lead position or myocardial condition rather than insulation integrity.