title: New concepts in pacemaker syndrome.
abstract: 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.
authors.affiliation: Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
authors.forename: D Michael
authors.initials: DM
authors.lastname: Farmer
authors.forename: N A Mark
authors.initials: NA
authors.lastname: Estes
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link