New Concepts in Pacemaker Syndrome

Farmer, Michael D and Estes, Mark NA III and Link, Mark S (2004) New Concepts in Pacemaker Syndrome. [Journal (Paginated)]

Full text available as:



After implantation of a permanent pacemaker, patients may experience severe symptoms of dyspnea, palpitations, malaise, and syncope resulting from pacemaker syndrome. Although pacemaker syndrome is most often ascribed to the loss of atrioventricular (A-V) synchrony, more recent data may also implicate left ventricular dysynchrony caused by right ventricular pacing. Previous studies have not shown reductions in mortality or stroke with rate-modulated dual-chamber (DDDR) pacing as compared to ventricular-based (VVI) pacing. The benefits in A-V sequential pacing with the DDDR mode are likely mitigated by the interventricular (V-V) dysynchrony imposed by the high percentage of ventricular pacing commonly seen in the DDDR mode. Programming DDDR pacemakers to encourage intrinsic A-V conduction and reduce right ventricular pacing will likely decrease heart failure and pacemaker syndrome. Studies are currently ongoing to address these questions.

Item Type:Journal (Paginated)
Keywords:VVI = ventricular-based, VVIR = rate modulated ventricular-based, A-V = atrioventricular, V-V = interventricular, V-A = ventricular-atrial, LBBB = left bundle branch block, LVEF = left ventricular ejection fraction, DDDR = rate modulated dual-chamber, SND = sinus node dysfunction, AAI = single-chamber atrial, AF = atrial fibrillation, LV = left ventricular, RV= right ventricular
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4184
Deposited By:Indian Pacing and Electrophysiology, Journal
Deposited On:14 Apr 2005
Last Modified:11 Mar 2011 08:55

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Link MS, Hellkamp AS, Estes NAM, et al. High incidence of pacemaker syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST), JACC, Vol. 43, No. 11, 2004: 2066-2071.

2. Mitsui T, Hori M, Suma K, Wanibuchi Y, Saigusa M. The “pacemaking syndrome.” In: Jacobs JE, ed. Proceedings of the Eighth Annual International Conference on Medical and Biological Engineering. Chicago, Ill: Association for the Advancement of Medical Instrumentation; 1969:29-33.

3. Ellenbogen KA, Gilligan DM, Wood MA, Morillo C, Barold SS. The pacemaker syndrome- a matter of definition. Am J Cardiol 1997;79:1226-9.

4. Ausubel K, Furman S. The pacemaker syndrome. Ann Intern Med 1985;103:420-9.

5. Furman S. Pacemaker Syndrome. Pacing Clin Electrophysiology 1994;17:1-5.

6. Ellenbogen, KA, Wood MA. Cardiac Pacing and ICDs. 3rd Edition: 149-150.

7. Anderson HR, Thuesen L, Bagger JP, Vesturlund T, Thomsen PEB. Prospective randomized trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 1994; 344:1523-8.

8. Heldman D., Mulvihill D, Nguyen H, et al. True incidence of pacemaker syndrome. Pacing Clin Electrophysiol 1990;13:1742-50.

9. Lamas GA, Orav EJ, Stambler BS, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared to dual chamber- pacing. N Engl J Med 1998;338:1097-104.

10. Connolly SJ, Kerr CR, Gent M, et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke or death due to cardiovascular causes. N Engl J Med 2000;342:1385-91.

11. Lamas GA, Lee KL, Sweeney MO et al. Ventricular pacing or dual chamber pacing for sinus node dysfunction. N Engl J Med 2002;346:1854-62

12. Lamas, GA. Physiological consequences of normal atrioventricular conduction: applicability to modern cardiac pacing. J Card Surg. 1989;4:89-98.

13. Zile MR, Blaustein AS, Shimizu G, et al. Right ventricular pacing reduces the rate of left ventricular relaxation and filling. J Am Coll Cardiol. 1987;10:702-709.

14. Burkhoff D, Oikawa RY, Sagawa K. Influence of pacing site on canine left ventricular contraction. Am J Physiolol. 1986;251:H428-H435.

15. Grines CL, Bashore TM, Boudoulas H, et al. Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony. Circulation. 1989; 79:845-53.

16. Rosenqvist M, Isaaz K, Botvinivk EH, et al. Relative importance of activation sequence compared to atrioventricular synchrony in left ventricular function. Am J Cardiol. 1991;67:148-156.

17. Mark JB, Chetman PM. Ventricular pacing can induce hemodynamically significant mitral valve regurgitation. Anesthesiology. 1991;74:375-377.

18. Lamas GA, Ellenbogen KA. Evidence Base for Pacemaker Mode Selection: From Physiology to Randomized Trials. Circulation 2004;109:443-451.

19. Kerr CR, Connolly SJ, Abdullah HM, Roberts RS, et al. Canadian Trial of Physiological Pacing during long term follow-up. Circulation. 2004; 109(3):357-62.

20. Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003;107:2932-2937.


Repository Staff Only: item control page