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True incidence of pacemaker syndrome
D Heldman1, D Mulvihill, H Nguyen
1Long Beach Memorial Medical Center, Memorial Heart Institute, California.
Pacing and Clinical Electrophysiology : PACE
|December 1, 1990
Summary
Pacemaker syndrome, often underreported, significantly impacts patients paced in VVI mode. Dual chamber pacing greatly reduces symptoms, highlighting the need for personalized pacing strategies.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- The reported incidence of pacemaker syndrome (PS) is low (5%-15%), primarily based on VVI pacing studies.
- Patient preference for dual chamber pacing suggests PS may be more prevalent than literature indicates.
Purpose of the Study:
- To evaluate patient-reported symptoms comparing VVI and dual chamber pacing modes.
- To determine the incidence and predictors of pacemaker syndrome in a randomized trial.
Main Methods:
- Forty dual-chamber pacemaker patients participated in a blind, randomized crossover trial.
- Patients were programmed to VVI and dual chamber modes for one week each, completing symptom questionnaires.
- Objective measures included blood pressure, LV function, ventriculoatrial conduction, and pacemaker override ability.
Main Results:
- 12 out of 16 assessed symptoms were significantly worse in VVI mode compared to dual chamber pacing (P < 0.005).
- Shortness of breath, dizziness, fatigue, pulsations, cough, and apprehension were highly significant symptoms.
- Pacemaker syndrome was clinically recognized in 83% of patients in VVI mode, with 65% experiencing moderate to severe symptoms.
Conclusions:
- VVI pacing leads to a high incidence of pacemaker syndrome, contrary to previously reported figures.
- No specific clinical, hemodynamic, or electrophysiological parameters predicted pacemaker syndrome development.
- Dual chamber pacing offers significant symptomatic relief compared to VVI pacing.