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| | Image = Pacemaker_syndrome1.png | | | Image = Pacemaker_syndrome1.png |
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| {{SI}} | | {{Pacemaker syndrome}} |
| {{CMG}}; {{AE}} {{RT}} | | {{CMG}}; {{AE}} {{RT}} {{MIR}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] |
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| ==Overview== | | ==[[Pacemaker syndrome overview|Overview]]== |
| Pacemaker syndrome is a disease that represents the clinical consequences of suboptimal [[Atrioventricular node|atrioventricular]] (AV) synchrony or AV dyssynchrony, regardless of the pacing mode, after the [[Artificial pacemaker#Insertion|pacemaker plantation]].<ref name="pmid9164889">{{cite journal |author=Ellenbogen KA, Gilligan DM, Wood MA, Morillo C, Barold SS |title=The pacemaker syndrome -- a matter of definition |journal=Am. J. Cardiol. |volume=79 |issue=9 |pages=1226–9 |year=1997 |month=May |pmid=9164889 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914997000854 |doi=10.1016/S0002-9149(97)00085-4}}</ref><ref name="pmid12555483">{{cite journal |author=Chalvidan T, Deharo JC, Djiane P |title=[Pacemaker syndromes] |language=French |journal=Ann Cardiol Angeiol (Paris) |volume=49 |issue=4 |pages=224–9 |year=2000 |month=July |pmid=12555483 }}</ref>. It is an [[iatrogenic]] disease that is often underdiagnosed<ref name="pmid9164889">{{cite journal |author=Ellenbogen KA, Gilligan DM, Wood MA, Morillo C, Barold SS |title=The pacemaker syndrome -- a matter of definition |journal=Am. J. Cardiol. |volume=79 |issue=9 |pages=1226–9 |year=1997 |month=May |pmid=9164889 |doi=10.1016/S0002-9149(97)00085-4 }}</ref><ref name="isbn0-07-141652-8">{{cite book |author=Baumgartner, William A.; Yuh, David D.; Luca A. Vricella |title=The Johns Hopkins manual of cardiothoracic surgery |publisher=McGraw-Hill Medical Pub |location=New York |year=2007 |origyear= |pages= |quote= |isbn=0-07-141652-8 }}</ref>. In general, the symptoms of the [[syndrome]] are a combination of decreased [[cardiac output]], loss of [[atrial]] contribution to [[ventricle|ventricular]] filling, loss of [[total peripheral resistance]] response, and nonphysiologic pressure waves.<ref name="pmid12555483" /><ref name="pmid7821326">{{cite journal |author=Frielingsdorf J, Gerber AE, Hess OM |title=Importance of maintained atrio-ventricular synchrony in patients with pacemakers |journal=Eur. Heart J. |volume=15 |issue=10 |pages=1431–40 |year=1994 |month=October |pmid=7821326 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=7821326}}</ref><ref name="pmid7511223">{{cite journal |author=Furman S |title=Pacemaker syndrome |journal=Pacing Clin Electrophysiol |volume=17 |issue=1 |pages=1–5 |year=1994 |month=January |pmid=7511223 |doi=10.1111/j.1540-8159.1994.tb01342.x }}</ref>
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| Individuals with a low heart rate prior to [[pacemaker]] implantation are more at risk of developing pacemaker syndrome. Normally the first chamber of the heart ([[atrium]]) contracts as the second chamber (ventricle) is relaxed, allowing the ventricle to fill before it contracts and pumps blood out of the heart. When the timing between the two chambers goes out of synchronization, less [[blood]] is delivered on each beat. Patients who develop pacemaker syndrome may require adjustment of the pacemaker timing, or another lead fitted to regulate the timing of the chambers separately.
| | ==[[Pacemaker syndrome historical perspective|Historical Perspective]]== |
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| ==Risk Factors== | | ==[[Pacemaker syndrome pathophysiology|Pathophysiology]]== |
| *In the [[implant (medicine)|preimplantation]] period, two variables are predicted to predispose to the syndrome. First is low [[sinus node|sinus rate]], and second is a higher programmed lower rate limit. In [[implant (medicine)|postimplantation]], an increased percentage of [[ventricle (heart)|ventricular]] paced beats is the only variable that significantly predicts development of pacemaker syndrome.<ref name="pmid2032410"/>
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| *Patients with intact [[VA conduction]] are at greater risk for developing pacemaker syndrome. Around 90% of patients with preserved AV conduction have intact [[VA conduction]], and about 30-40% of patients with complete [[Atrioventricular block|AV block]] have preserved [[VA conduction]]. Intact [[VA conduction]] may not be apparent at the time of pacemaker implantation or even may develop at any time after implantation.<ref name="pmid12555483" /><ref name="pmid7511223"/><ref name="pmid2032410"/><ref name="pmid1704534">{{cite journal |author=Heldman D, Mulvihill D, Nguyen H, ''et al.'' |title=True incidence of pacemaker syndrome |journal=Pacing Clin Electrophysiol |volume=13 |issue=12 Pt 2 |pages=1742–50 |year=1990 |month=December |pmid=1704534 |doi=10.1111/j.1540-8159.1990.tb06883.x }}</ref>
| | ==[[Pacemaker syndrome differential diagnosis|Differentiating Pacemaker syndrome from other Diseases]]== |
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| *Patients with noncompliant [[ventricle (heart)|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 cardiomyopathy|hypertensive]], [[hypertrophic cardiomyopathy|hypertrophic]], [[restrictive cardiomyopathy|restrictive]]) and elderly individuals.<ref name="pmid7511223"/><ref name="pmid2316455"/><ref name="pmid2032410"/><ref name="pmid1442632"/>
| | ==[[Pacemaker syndrome epidemiology and demographics|Epidemiology and Demographics]]== |
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| *Other factors correlated with development of pacemaker syndrome include decreased [[stroke volume]], decreased [[cardiac output]], and decreased [[left atrium|left atrial]] total emptying fraction associated with [[ventricle (heart)|ventricular]] pacing.<ref name="pmid7511223"/><ref name="pmid2032410"/>
| | ==[[Pacemaker syndrome risk factors|Risk Factors]]== |
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| | ==[[Pacemaker syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| | ==Diagnosis== |
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| | [[Pacemaker syndrome history and symptoms|History and Symptoms ]] | [[ Pacemaker syndrome physical examination|Physical Examination]] | [[Pacemaker syndrome laboratory findings|Laboratory Findings]] | [[Pacemaker syndrome electrocardiogram|Electrocardiogram]] | [[Pacemaker syndrome chest x ray|Chest X Ray]] | [[Pacemaker syndrome echocardiography|Echocardiography]] | [[Pacemaker syndrome other imaging findings|Other Imaging Findings]] | [[Pacemaker syndrome other diagnostic studies|Other Diagnostic Studies]] |
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| | ==Treatment== |
| | [[Pacemaker syndrome medical therapy|Medical Therapy]] | [[Pacemaker syndrome surgery |Surgery]] | [[Pacemaker syndrome primary prevention|Primary Prevention]] | [[Pacemaker syndrome secondary prevention|Secondary Prevention]] | [[Pacemaker syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pacemaker syndrome future or investigational therapies|Future or Investigational Therapies]] |
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| | ==Case Studies== |
| | [[Pacemaker syndrome case study one|Case #1]] |
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| ==References==
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| {{Reflist|2}}
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
