Pacemaker Syndrome Summary

Pacemaker Syndrome

  • Pacemaker syndrome is a common question asked by nurses and technicians in the pacemaker field.
  • Questions about pacemaker syndrome were on both the NASPExAM (AP Exam in 1990 or 91 and the EP Exam in 1999 or 2000).
  • Simplified answer, taken from Cardiac Pacing, edited by Kenneth Ellenbogen. Section 3 “Hemodynamics of Cardiac Pacing” by Dwight Reynolds, MD

Symptoms

Related to blood pressure and cardiac output
  • Syncope
  • Malaise
  • Easy Fatigability
  • A sense of weakness
  • Light-headedness
  • Dizziness (related to blood pressure and cardiac output)
Related to higher atrial and venous pressures
  • Dyspnea – frequently at rest
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Fullness and/or pulsations in the neck and chest
  • Palpitations
  • Forceful heart beats

Associated with Loss of AV Synchrony

  • VVI Pacing Mode
  • Loss of atrial capture or sensing in DDD mode
  • Retrograde conduction and entrainment of the P wave
  • Careful questioning may be necessary – pt. may deny symptoms

Physical Exam Findings

  • Neck vein distension w/prominent –Cannon- “A” waves
  • Pulmonary rales
  • Peripheral edema (rare)
  • Hypotension (relative or absolute/continuous or fluctuating)

Definition

  • "Any combination of the variety of symptoms and signs occurring with ventricular pacing that are relieved by restoration of AV Synchrony" – Direct Quote from Cardiac Pacing.

Note on the “DAVID Study”

  • This study pursued the hypothesis that dual-chamber ICDs provide improved patient prognosis and reduced health care costs as opposed to single-chamber ICDs.
  • 506 people with indications for ICD therapy participated in this multi-center, randomized clinical study.
  • All participants had an ICD with dual-chamber, rate-responsive pacing capability implanted, which was randomly programmed to VVI or DDDR.
  • For patients with standard indications for ICD therapy, no indication for cardiac pacing, and LVEF of =40= 40%, dual-chamber pacing offered no clinical advantage over ventricular backup pacing and may be detrimental by increasing the combined endpoint of death or hospitalization for heart failure.
  • The DAVID information was important to include in the Pacemaker Syndrome section to illustrate the paradox between DDD pacing (Good) and the DDD ICD in patients with NO indication for pacing (BAD).
  • Three are advantages to dual chamber ICDs, so don’t be mislead by these results.