eMedicine Specialties > Cardiology > Electrophysiology Procedures

Pacemaker Syndrome: Follow-up

Author: Daniel M Beyerbach, MD, PhD,, Consulting Staff, Florida Electrophysiology Associates; Affiliate Clinical Assistant Professor of Biomedical Science, Florida Atlantic University, Regional Campus of University of Miami Miller School of Medicine
Coauthor(s): Christopher Cadman, MD, Director of Arrhythmia Service, Assistant Professor, Department of Internal Medicine, Division of Cardiology, University of New Mexico
Contributor Information and Disclosures

Updated: Nov 13, 2009

Follow-up

Further Inpatient Care

Patients with ventricular pacemakers and pacemaker syndrome may need placement of an additional pacemaker lead. Hospitalize and monitor patients undergoing device or lead implantation for 24 hours after placement surgery.

  • Administer intravenous antibiotics (cefazolin, or vancomycin in patients with beta-lactam allergy) for prophylaxis against skin wound infections.
  • Do not continue intravenous antibiotic therapy for more than 24 hours. If infection develops around the device, it is better detected early in the course in case device explantation is necessary.

Further Outpatient Care

Schedule visits after device or lead implantation as follows: 1-2 weeks for wound check, 1 month for pacemaker interrogation, 3 months for pacemaker interrogation, and every 6 months thereafter for pacemaker interrogation.

Transfer

  • Because diagnosis and treatment require interrogation and reprogramming of pacemaker, patients must be seen in either a clinical or hospital setting in which the appropriate interrogation equipment is available. Each pacemaker manufacturer produces an interrogation computer for its own devices. A major institution will have interrogation computers from several different manufacturers available for use.
  • Some pacemaker manufacturers provide courtesy interrogation services involving site visits for rural populations without easy access to functional facilities.

Deterrence/Prevention

  • Because most cases of pacemaker syndrome occur in the setting of ventricular pacing, institute atrial pacing whenever it is not contraindicated. This includes AAI pacing for most cases of sinus node disease with intact AV nodal conduction. Alternatively, a dual-chamber system can be programmed to a long AV interval to promote intrinsic conduction, provided that the PR interval is not markedly prolonged.
  • Baseline studies by echocardiogram can assess change in cardiac output, stroke volume, and left atrial total emptying fraction in response to ventricular pacing. Examination of these parameters may guide the decision to institute dual-chamber pacing.
  • At time of device implantation, optimize pacing parameters, such as AV delay, PVARP, and rate response slope, for physiologic timing of atrial and ventricular contractions.

Complications

  • Complications of AV dyssynchrony include atrial fibrillation, thromboembolic events, and heart failure.
  • Pacemaker syndrome also can be complicated by syncope or near syncope. Individuals may develop a subjectively worse quality of life with ventricular pacing than they had prior to pacemaker implantation, or they may endure a persistently degraded quality of life, as suggested by Sulke's study of subclinical pacemaker syndrome.
  • Complications of treatment may include the same complications of pacemaker implantation if reimplantation, additional lead placement, or explantation is involved. These complications include infection (4%), pneumothorax (1%), cardiac perforation and tamponade, bleeding, and pain.

Prognosis

Prognosis is excellent with correction of pacing mode.

Patient Education

Educate as in cases of pacemaker implantation in general.

  • Avoid strong electric and magnetic fields. Specifically avoid welding, MRI studies, and proximity to large motors or generators.
  • Use cell phones in ear contralateral to side of device implantation.

Miscellaneous

Medicolegal Pitfalls

In the setting of asymptomatic sinus bradycardia, implantation of a VVI pacemaker may induce symptoms of pacemaker syndrome. Even though this may be a class 2a indication for pacemaker implantation, potential exists for worsening of quality of life.

Special Concerns

As already noted, individuals may develop a subjectively worse quality of life with ventricular pacing than they had prior to pacemaker implantation, or they may endure a persistently degraded quality of life, as suggested by Sulke's study of subclinical pacemaker syndrome.

 


More on Pacemaker Syndrome

Overview: Pacemaker Syndrome
Differential Diagnoses & Workup: Pacemaker Syndrome
Treatment & Medication: Pacemaker Syndrome
Follow-up: Pacemaker Syndrome
Multimedia: Pacemaker Syndrome
References
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References

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Further Reading

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Keywords

pacemaker syndrome, subclinical pacemaker syndrome, pseudopacemaker syndrome, atrioventricular dyssynchrony, AV dyssynchrony, arrhythmia, ventricular pacing

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Contributor Information and Disclosures

Author

Daniel M Beyerbach, MD, PhD,, Consulting Staff, Florida Electrophysiology Associates; Affiliate Clinical Assistant Professor of Biomedical Science, Florida Atlantic University, Regional Campus of University of Miami Miller School of Medicine
Daniel M Beyerbach, MD, PhD, is a member of the following medical societies: American College of Cardiology
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher Cadman, MD, Director of Arrhythmia Service, Assistant Professor, Department of Internal Medicine, Division of Cardiology, University of New Mexico
Christopher Cadman, MD is a member of the following medical societies: American College of Cardiology and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Hanumant Deshmukh, MD †, Former Chief of Cardiology, Veterans Affairs Medical Center; Former Associate Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Brian Olshansky, MD, Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine
Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences
Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Reliant Grant/research funds Other; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

 
 
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