Pacemaker syndrome: Difference between revisions
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Pacemaker syndrome is a disease that represents the clinical consequences of suboptimal [[Atrioventricular node|atrioventricular]] (AV) synchrony or AV dyssynchrony, regardless of the pacing mode, after the [[Artificial pacemaker#Insertion|pacemaker plantation]].<ref name="pmid9164889">{{cite journal |author=Ellenbogen KA, Gilligan DM, Wood MA, Morillo C, Barold SS |title=The pacemaker syndrome -- a matter of definition |journal=Am. J. Cardiol. |volume=79 |issue=9 |pages=1226–9 |year=1997 |month=May |pmid=9164889 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914997000854 |doi=10.1016/S0002-9149(97)00085-4}}</ref><ref name="pmid12555483">{{cite journal |author=Chalvidan T, Deharo JC, Djiane P |title=[Pacemaker syndromes] |language=French |journal=Ann Cardiol Angeiol (Paris) |volume=49 |issue=4 |pages=224–9 |year=2000 |month=July |pmid=12555483 }}</ref>. It is an [[iatrogenic]] disease that is often underdiagnosed<ref name="pmid9164889">{{cite journal |author=Ellenbogen KA, Gilligan DM, Wood MA, Morillo C, Barold SS |title=The pacemaker syndrome -- a matter of definition |journal=Am. J. Cardiol. |volume=79 |issue=9 |pages=1226–9 |year=1997 |month=May |pmid=9164889 |doi=10.1016/S0002-9149(97)00085-4 }}</ref><ref name="isbn0-07-141652-8">{{cite book |author=Baumgartner, William A.; Yuh, David D.; Luca A. Vricella |title=The Johns Hopkins manual of cardiothoracic surgery |publisher=McGraw-Hill Medical Pub |location=New York |year=2007 |origyear= |pages= |quote= |isbn=0-07-141652-8 }}</ref>. In general, the symptoms of the [[syndrome]] are a combination of decreased [[cardiac output]], loss of [[atrial]] contribution to [[ventricle|ventricular]] filling, loss of [[total peripheral resistance]] response, and nonphysiologic pressure waves.<ref name="pmid12555483" /><ref name="pmid7821326">{{cite journal |author=Frielingsdorf J, Gerber AE, Hess OM |title=Importance of maintained atrio-ventricular synchrony in patients with pacemakers |journal=Eur. Heart J. |volume=15 |issue=10 |pages=1431–40 |year=1994 |month=October |pmid=7821326 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=7821326}}</ref><ref name="pmid7511223">{{cite journal |author=Furman S |title=Pacemaker syndrome |journal=Pacing Clin Electrophysiol |volume=17 |issue=1 |pages=1–5 |year=1994 |month=January |pmid=7511223 |doi=10.1111/j.1540-8159.1994.tb01342.x }}</ref> | Pacemaker syndrome is a disease that represents the clinical consequences of suboptimal [[Atrioventricular node|atrioventricular]] (AV) synchrony or AV dyssynchrony, regardless of the pacing mode, after the [[Artificial pacemaker#Insertion|pacemaker plantation]].<ref name="pmid9164889">{{cite journal |author=Ellenbogen KA, Gilligan DM, Wood MA, Morillo C, Barold SS |title=The pacemaker syndrome -- a matter of definition |journal=Am. J. Cardiol. |volume=79 |issue=9 |pages=1226–9 |year=1997 |month=May |pmid=9164889 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914997000854 |doi=10.1016/S0002-9149(97)00085-4}}</ref><ref name="pmid12555483">{{cite journal |author=Chalvidan T, Deharo JC, Djiane P |title=[Pacemaker syndromes] |language=French |journal=Ann Cardiol Angeiol (Paris) |volume=49 |issue=4 |pages=224–9 |year=2000 |month=July |pmid=12555483 }}</ref>. It is an [[iatrogenic]] disease that is often underdiagnosed<ref name="pmid9164889">{{cite journal |author=Ellenbogen KA, Gilligan DM, Wood MA, Morillo C, Barold SS |title=The pacemaker syndrome -- a matter of definition |journal=Am. J. Cardiol. |volume=79 |issue=9 |pages=1226–9 |year=1997 |month=May |pmid=9164889 |doi=10.1016/S0002-9149(97)00085-4 }}</ref><ref name="isbn0-07-141652-8">{{cite book |author=Baumgartner, William A.; Yuh, David D.; Luca A. Vricella |title=The Johns Hopkins manual of cardiothoracic surgery |publisher=McGraw-Hill Medical Pub |location=New York |year=2007 |origyear= |pages= |quote= |isbn=0-07-141652-8 }}</ref>. In general, the symptoms of the [[syndrome]] are a combination of decreased [[cardiac output]], loss of [[atrial]] contribution to [[ventricle|ventricular]] filling, loss of [[total peripheral resistance]] response, and nonphysiologic pressure waves.<ref name="pmid12555483" /><ref name="pmid7821326">{{cite journal |author=Frielingsdorf J, Gerber AE, Hess OM |title=Importance of maintained atrio-ventricular synchrony in patients with pacemakers |journal=Eur. Heart J. |volume=15 |issue=10 |pages=1431–40 |year=1994 |month=October |pmid=7821326 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=7821326}}</ref><ref name="pmid7511223">{{cite journal |author=Furman S |title=Pacemaker syndrome |journal=Pacing Clin Electrophysiol |volume=17 |issue=1 |pages=1–5 |year=1994 |month=January |pmid=7511223 |doi=10.1111/j.1540-8159.1994.tb01342.x }}</ref> | ||
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 (atrium) contracts as the second chamber (ventricle) 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. | 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 ([[atrium]]) contracts as the second chamber (ventricle) 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. | ||
==Risk Factors== | |||
*In the [[implant (medicine)|preimplantation]] period, two variables are predicted to predispose to the syndrome. First is low [[sinus node|sinus rate]], and second is a higher programmed lower rate limit. In [[implant (medicine)|postimplantation]], an increased percentage of [[ventricle (heart)|ventricular]] paced beats is the only variable that significantly predicts development of pacemaker syndrome.<ref name="pmid2032410"/> | |||
*Patients with intact [[VA conduction]] are at greater risk for developing pacemaker syndrome. 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="pmid12555483" /><ref name="pmid7511223"/><ref name="pmid2032410"/><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.<ref name="pmid7511223"/><ref name="pmid2316455"/><ref name="pmid2032410"/><ref name="pmid1442632"/> | |||
*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 (heart)|ventricular]] pacing.<ref name="pmid7511223"/><ref name="pmid2032410"/> | |||
==References== | ==References== | ||
Revision as of 19:47, 8 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]
Overview
Pacemaker syndrome is a disease that represents the clinical consequences of suboptimal atrioventricular (AV) synchrony or AV dyssynchrony, regardless of the pacing mode, after the pacemaker plantation.[1][2]. It is an iatrogenic disease that is often underdiagnosed[1][3]. In general, the symptoms of the syndrome are a combination of decreased cardiac output, loss of atrial contribution to ventricular filling, loss of total peripheral resistance response, and nonphysiologic pressure waves.[2][4][5]
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 (atrium) contracts as the second chamber (ventricle) 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.
Risk Factors
- 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. In postimplantation, an increased percentage of ventricular paced beats is the only variable that significantly predicts development of pacemaker syndrome.[6]
- Patients with intact VA conduction are at greater risk for developing pacemaker syndrome. 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.[2][5][6][7]
- 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.[5][8][6][9]
- 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.[5][6]
References
- ↑ 1.0 1.1 Ellenbogen KA, Gilligan DM, Wood MA, Morillo C, Barold SS (1997). "The pacemaker syndrome -- a matter of definition". Am. J. Cardiol. 79 (9): 1226–9. doi:10.1016/S0002-9149(97)00085-4. PMID 9164889. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 Chalvidan T, Deharo JC, Djiane P (2000). "[Pacemaker syndromes]". Ann Cardiol Angeiol (Paris) (in French). 49 (4): 224–9. PMID 12555483. Unknown parameter
|month=ignored (help) - ↑ Baumgartner, William A.; Yuh, David D.; Luca A. Vricella (2007). The Johns Hopkins manual of cardiothoracic surgery. New York: McGraw-Hill Medical Pub. ISBN 0-07-141652-8.
- ↑ Frielingsdorf J, Gerber AE, Hess OM (1994). "Importance of maintained atrio-ventricular synchrony in patients with pacemakers". Eur. Heart J. 15 (10): 1431–40. PMID 7821326. Unknown parameter
|month=ignored (help) - ↑ 5.0 5.1 5.2 5.3 Furman S (1994). "Pacemaker syndrome". Pacing Clin Electrophysiol. 17 (1): 1–5. doi:10.1111/j.1540-8159.1994.tb01342.x. PMID 7511223. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 6.2 6.3 Invalid
<ref>tag; no text was provided for refs namedpmid2032410 - ↑ Heldman D, Mulvihill D, Nguyen H; et al. (1990). "True incidence of pacemaker syndrome". Pacing Clin Electrophysiol. 13 (12 Pt 2): 1742–50. doi:10.1111/j.1540-8159.1990.tb06883.x. PMID 1704534. Unknown parameter
|month=ignored (help) - ↑ Invalid
<ref>tag; no text was provided for refs namedpmid2316455 - ↑ Invalid
<ref>tag; no text was provided for refs namedpmid1442632