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Related Experiment Videos

Pacemaker syndrome evaluated by cardiopulmonary exercise testing.

A Fujiki1, M Tani, K Mizumaki

  • 1Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.

Pacing and Clinical Electrophysiology : PACE
|October 1, 1990
PubMed
Summary
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Pacemaker syndrome, causing shortness of breath during exercise, may stem from ventilation-perfusion mismatching during ventricular pacing. Cardiopulmonary exercise testing can identify these exercise-induced symptoms.

Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Biomedical Engineering

Background:

  • Sick sinus syndrome often necessitates pacemaker implantation for symptom management.
  • Fixed rate ventricular pacing (VVI) can sometimes lead to persistent exertional dyspnea, a condition known as pacemaker syndrome.
  • Understanding the physiological mechanisms behind pacemaker syndrome is crucial for optimizing pacing strategies.

Observation:

  • Two patients with sick sinus syndrome experienced persistent dyspnea on effort despite VVI pacemaker insertion.
  • Cardiopulmonary exercise testing revealed heightened and fluctuating ventilatory responses during VVI pacing.
  • These responses correlated with ventilation-perfusion mismatching, likely due to increased pulmonary capillary wedge pressure from ventriculoatrial conduction.

Findings:

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  • Ventricular pacing with intact 1:1 ventriculoatrial conduction, particularly rate-responsive ventricular pacing (VVIR), exacerbated exertional dyspnea.
  • Rate-responsive atrial pacing (AAIR) significantly improved exercise ventilatory responses.
  • High ventilatory equivalents for CO2 during VVI pacing indicated significant ventilation-perfusion mismatching.

Implications:

  • Ventilation-perfusion mismatching during ventricular pacing is a key factor contributing to pacemaker syndrome.
  • Cardiopulmonary exercise testing is a valuable tool for diagnosing exercise-induced symptoms related to pacemaker function.
  • Optimizing pacemaker settings, such as utilizing atrial pacing, can alleviate symptoms and improve patient outcomes.