Pacemaker syndrome risk factors: Difference between revisions
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==Risk Factors== | ==Risk Factors== | ||
*According to the MOST trial the two variables that predict the development of pacemaker syndrome in the pre-implantation period are low [[sinus node|sinus rate]], and a higher programmed lower rate limit. | * According to the MOST trial the two variables that predict the development of pacemaker syndrome in the pre-implantation period are low [[sinus node|sinus rate]], and a higher programmed lower rate limit. Similarly in the post-implantation period, an increased percentage of [[ventricle|ventricular]] paced beats is the only variable that significantly predicts the development of pacemaker syndrome. | ||
* | * One major risk factor for the development of pacemaker syndrome is the presence of an intact VA conduction (retrograde ventriculo-atrial conduction). Around 90% of patients with preserved AV conduction have intact VA conduction, and about 30-40% of patients with complete [[Atrioventricular block|AV block]] have preserved VA conduction. Intact VA conduction may not be apparent at the time of pacemaker implantation or even may develop at any time after implantation.<ref name="pmid1704534">{{cite journal |author=Heldman D, Mulvihill D, Nguyen H, ''et al.'' |title=True incidence of pacemaker syndrome |journal=Pacing Clin Electrophysiol |volume=13 |issue=12 Pt 2 |pages=1742–50 |year=1990|month=December |pmid=1704534 |doi=10.1111/j.1540-8159.1990.tb06883.x }}</ref> | ||
*Patients with noncompliant [[ventricle (heart)|ventricles]] and [[diastolic]] dysfunction are particularly sensitive to loss of [[atrial]] contribution to ventricular filling, where that highly increase the chance of developing the syndrome. This includes patients with [[cardiomyopathy]] ([[hypertensive cardiomyopathy|hypertensive]], [[hypertrophic cardiomyopathy|hypertrophic]], [[restrictive cardiomyopathy|restrictive]]) and elderly individuals. | * Patients with noncompliant [[ventricle (heart)|ventricles]] and [[diastolic]] dysfunction are particularly sensitive to loss of [[atrial]] contribution to ventricular filling, where that highly increase the chance of developing the syndrome. This includes patients with [[cardiomyopathy]] ([[hypertensive cardiomyopathy|hypertensive]], [[hypertrophic cardiomyopathy|hypertrophic]], [[restrictive cardiomyopathy|restrictive]]) and elderly individuals. | ||
*Other factors correlated with development of pacemaker syndrome include decreased [[stroke volume]], decreased [[cardiac output]], and decreased [[left atrium|left atrial]] total emptying fraction associated with [[ventricle|ventricular]] pacing. | * Other factors correlated with development of pacemaker syndrome include decreased [[stroke volume]], decreased [[cardiac output]], and decreased [[left atrium|left atrial]] total emptying fraction associated with [[ventricle|ventricular]] pacing. | ||
==References== | ==References== | ||
Revision as of 20:32, 10 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Risk Factors
- According to the MOST trial the two variables that predict the development of pacemaker syndrome in the pre-implantation period are low sinus rate, and a higher programmed lower rate limit. Similarly in the post-implantation period, an increased percentage of ventricular paced beats is the only variable that significantly predicts the development of pacemaker syndrome.
- One major risk factor for the development of pacemaker syndrome is the presence of an intact VA conduction (retrograde ventriculo-atrial conduction). Around 90% of patients with preserved AV conduction have intact VA conduction, and about 30-40% of patients with complete AV block have preserved VA conduction. Intact VA conduction may not be apparent at the time of pacemaker implantation or even may develop at any time after implantation.[1]
- Patients with noncompliant ventricles and diastolic dysfunction are particularly sensitive to loss of atrial contribution to ventricular filling, where that highly increase the chance of developing the syndrome. This includes patients with cardiomyopathy (hypertensive, hypertrophic, restrictive) and elderly individuals.
- Other factors correlated with development of pacemaker syndrome include decreased stroke volume, decreased cardiac output, and decreased left atrial total emptying fraction associated with ventricular pacing.