Pacemaker syndrome risk factors
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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). 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.[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.