Bradycardia Management_Pacemaker syndrome

Posted by e-Medical PPT Monday, September 27, 2010
Pacemaker syndrome is a disease that represents the clinical consequences of suboptimal AV dyssynchrony, regardless of the pacing mode, after the pacemaker plantation.It is an iatrogenic disease—an adverse effect resulting from medical treatment—that is often underdiagnosed.The loss of physiologic timing of atrial and ventricular contractions, or sometimes called AV dyssynchrony, leads to different mechanisms of symptoms production. This altered ventricular contraction will decrease cardiac output, and in turn will lead to systemic hypotensive reflex response with varying symptoms.Most of the signs and symptoms of pacemaker syndrome are nonspecific, and many are prevalent in the elderly population at baseline.
Individuals with a low heart rate prior to pacemaker implantation are more at risk of developing pacemaker syndrome. Normally the first chamber of the heart contracts as the second chamber is relaxed, allowing the ventricle to fill before it contracts and pumps blood out of the heart. When the timing between the two chambers goes out of synchronization, less blood is delivered on each beat. Patients who develop pacemaker syndrome may require adjustment of the pacemaker timing, or another lead fitted to regulate the timing of the chambers separately.
Several risk factors are associated with pacemaker syndrome.
  • In the preimplantation period, two variables are predicted to predispose to the syndrome. First is low sinus rate, and second is a higher programmed lower rate limit.
  • Patients with intact VA conduction are at greater risk for developing pacemaker syndrome.
  • Patients with noncompliant ventricles and diastolic dysfunction_such as hypertensive cardiomyopathy, hypertrophic cardiomyopathy,restrictive cardiomyopathy, and aging, can result in loss of atrial contraction and significantly reduces cardiac output.

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