Pacemaker Syndrome Clinical Presentation

Updated: May 09, 2022
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jose M Dizon, MD  more...
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No specific set of criteria has been developed for diagnosis of pacemaker syndrome. Most of the signs and symptoms of pacemaker syndrome are nonspecific, and many are prevalent in the elderly population at baseline. [43] Diagnosis from history depends heavily on correlation between onset of symptoms and onset of pacing or change in pacing mode, with attention to type and severity of symptoms. In the clinical setting, pacemaker interrogation and programming plays a crucial role in determining pacemaker mode contribution to symptoms.


In their detailed review of pacemaker syndrome, Ausubel and Furman [31] categorized symptoms on the basis of presumed etiology. Augmenting their list with that of Ellenbogen and colleagues [8] provides the following:

  • Neurologic: Dizziness, near syncope, and confusion

  • Heart failure: Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and edema

  • Hypotension: Apprehension, mental status change, diaphoresis, and signs of orthostasis and shock

  • Low cardiac output: Fatigue, weakness, dyspnea on exertion, lethargy, and lightheadedness

  • Hemodynamic: Pulsation in the neck and abdomen, choking sensation, jaw pain, right upper quadrant (RUQ) pain, chest colds, headache

  • Arrhythmias: Palpitations

  • Rate related: Chest fullness or pain


Physical Examination

The focus of physical examination is on findings related to etiologies of symptoms mentioned in History. In particular, the examiner should look for the following [44] :

  • Vital signs may reveal hypotension, tachycardia, tachypnea, or low oxygen saturation.

  • Pulse amplitude may vary, and blood pressure may fluctuate.

  • Look for neck vein distension and cannon waves in the neck veins.

  • Lungs may exhibit crackles.

  • Cardiac examination may reveal regurgitant murmurs and variability of heart sounds.

  • Liver may be pulsatile, and the RUQ may be tender to palpation. Ascites may be present in severe cases.

  • The lower extremities may be edematous.

  • Neurologic examination may reveal confusion, dizziness, or altered mental status.