Pacemaker syndrome risk factors

Pacemaker syndrome Microchapters
Home
Overview
Historical Perspective
Pathophysiology
Differentiating Pacemaker syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Pacemaker syndrome risk factors On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
slides
Images
American Roentgen Ray Society Images of Pacemaker syndrome risk factors All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Pacemaker syndrome risk factors
CDC on Pacemaker syndrome risk factors
Pacemaker syndrome risk factors in the news
Blogs on Pacemaker syndrome risk factors
Directions to Hospitals Treating Pacemaker syndrome
Risk calculators and risk factors for Pacemaker syndrome risk factors

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

• Patients who are at risk of developing Pacemaker Syndrome includes:
  • People who have left ventricular disease
  • Elderly people
  • People who are recipients of single-chamber ventricular pacemakers
  • People with a sinus rhythm
  • People with retrograde conduction
  • People with decreased stroke volume
  • People with decreased cardiac output
  • People with decreased left atrial total emptying fraction

• According to the MOST trial the only 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). Intact VA conduction is present in as many as 90% of patients with preserved AV conduction, and in about 30-40% of patients with complete AV block. VA conduction may develop at any time after implantation of the pacemaker and may not be apparent at the time of implantation of the device.
• Patients with cardiomyopathy (hypertensive, hypertrophic, restrictive) and elderly individuals are particularly sensitive to the development of pacemaker syndrome because of the presence of noncompliant ventricles and diastolic dysfunction which lead to loss of atrial contribution to ventricular filling and in turn to pacemaker syndrome.