[Programmed atrial pacemaker in the treatment of neurogenic orthostatic hypotension in the elderly]

A programmable atrial pacemaker was implanted in an elderly man, 75 years-old, with incapacitating orthostatic hypotension due to automatic dysfunction (Shy-Drager) unresponsive to traditional therapy. Initially, a temporary programmed atrial pacing was implanted paced at 96 beats/minute during the day, reducing the rate at night to 60 betas/minute. An increase in cardiac output was achieved. Favourable results encouraged us to implant a permanent programmed pacemaker. The manufacturer designed a simple, safe programmer operable by the patient which only alters the rate from night (60) to day (96). A marked improvement in symptoms has been observed during a follow-up of nine months without complications. It is recommended that this sort of treatment be considered in elderly patients with symptomatic orthostatic hypotension due to autonomic dysfunction with inadequate compensatory tachycardia who have not responded to traditional therapy.