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Pacemaker syndrome – a forgotten diagnosis?

There is no single universal definition of pacemaker syndrome, but this generally refers to the spectrum of symptoms and signs, ranging from non-specific lassitude to severe hypotension and cardiac failure, which result from atrioventricular dyssynchrony, and the fall in cardiac output, elevation in filling pressures and reflex vasodilatation that accompany this. Classically, pacemaker syndrome occurs in conjunction with single chamber ventricular pacing, and may lead to severe and debilitating symptoms when retrograde (VA) conduction is present, as is frequently the case in patients with isolated sinus node disease.1

In the era of physiological dual chamber pacing, the diagnosis…

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Articles of Interest

A case of pacemaker and pacemaker-like syndrome

This report describes the occurrence of both pacemaker syndrome and a pacemaker-like syndrome (so-called "pseudopacemaker syndrome") in a patient who exhibited an atrioventricular junctional rhythm probably on the basis of sick sinus syndrome. The clinical and hemodynamic manifestations of the two clinical situations were similar and associated with regular retrograde ventriculoatrial conduction.

Pacemaker Syndrome and Pacemaker Complications

Pacemaker syndrome: some patients with VVI pacemakers, especially with sinoatrial (SA) rather than atrioventricular (AV) disease, will show retrograde ventriculoatrial (VA) conduction during ventricular pacing which can cause fatigue, dizziness and hypotension. Pacemaker syndrome is associated with atrial cannon waves caused by simultaneous atrial and ventricular contractions. Replacement with a dual chamber is required.

Pacemaker syndrome; an often overlooked diagnosis in patients with pacemakers

Pacemaker syndrome is a common problem faced by physicians who take care of patients with cardiac pacemakers. Patients often present with clinical signs and symptoms of other common cardiac conditions. Clinicians should always have a high index of suspicion for a commonly missed diagnosis of pacemaker syndrome.

The Pacemaker Syndrome — A Matter of Definition

Pacemaker syndrome is an iatrogenic disease that is often underdiagnosed. We propose that pacemaker syndrome represents the clinical consequences of suboptimal atrioventricular (AV) synchrony or AV dyssynchrony, regardless of the pacing mode. Clinicians implanting and programming pacemakers should attempt to optimize AV synchrony to prevent the occurrence of pacemaker syndrome.

The Pacemaker Syndrome: Old and New Causes

A decade after the advent of the implantable cardiac pacemaker, it was realized that artificial stimulation of the heart is sometimes followed by worsening of the patient’s condition, despite normal pulse generator function.

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StatPearls

Pacemaker syndrome is most commonly seen in the setting of a single chamber device with ventricular sensing and pacing lead. Since there is no atrial sensing lead to guide the ventricle, the ventricle contracts at the programmed rate regardless of the timing of atrial contraction. This leads to loss of AV synchrony which leads to a loss in stroke volume and cardiac output. VA conduction, which is usually a ventricular beat finding its way upwards to the atria also leads to a mistimed atrial contraction and produces similar effects.