New Concepts in Pacemaker Syndrome

• Main Authors: D. Michael Farmer, N. A. Mark Estes, III, Mark S. Link
• Format: Article
• Language: English
• Published: Elsevier 2004-10-01
• Series: Indian Pacing and Electrophysiology Journal
• Subjects: VVI = ventricular-based; VVIR = rate modulated ventricular-based; A-V = atrioventricular; V-V = interventricular; V-A = ventricular-atrial; LBBB = left bundle branch block; LVEF = left ventricular ejection fraction; DDDR = rate modulated dual-chamber; SND = sinus node dysfunction; AAI = single-chamber atrial; AF = atrial fibrillation; LV = left ventricular; RV= right ventricular
• Online Access: http://www.ipej.org/0404/link.htm

After implantation of a permanent pacemaker, patients may experience severe symptoms of dyspnea, palpitations, malaise, and syncope resulting from pacemaker syndrome. Although pacemaker syndrome is most often ascribed to the loss of atrioventricular (A-V) synchrony, more recent data may also implicate left ventricular dysynchrony caused by right ventricular pacing. Previous studies have not shown reductions in mortality or stroke with rate-modulated dual-chamber (DDDR) pacing as compared to ventricular-based (VVI) pacing. The benefits in A-V sequential pacing with the DDDR mode are likely mitigated by the interventricular (V-V) dysynchrony imposed by the high percentage of ventricular pacing commonly seen in the DDDR mode. Programming DDDR pacemakers to encourage intrinsic A-V conduction and reduce right ventricular pacing will likely decrease heart failure and pacemaker syndrome. Studies are currently ongoing to address these questions.