New concepts in pacemaker syndrome

Michael D. Farmer, N. A.Mark Estes, Mark S. Link

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)195-200
Number of pages6
JournalIndian Pacing and Electrophysiology Journal
Issue number4
StatePublished - Oct 1 2004


  • A-V = atriovetricular
  • AAI = single-chamber atrial
  • AF = atrial fibrillation
  • DDDR = rate modulated dual-chamber
  • LBBB - left bundle branch block
  • LV = left ventricular
  • LVEF = left ventricular ejection fraction
  • RV = right ventricular
  • SND = sinus node dysfunction
  • V-A = ventricular-atrial
  • V-V = interventricular
  • VVI = ventricular-based
  • VVIR = rate modulated ventricular-based

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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