Pacemaker Syndrome Differential Diagnoses

Updated: Jul 31, 2016
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
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Diagnostic Considerations

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, the potential exists for worsening of quality of life. Thus, 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.

Other conditions to be considered in patients with suspected pacemaker syndrome include the following:

  • Pacemaker malfunction
  • Inappropriate mode switching
  • Worsening heart failure, unrelated to pacemaker function
  • Recent change in medications, particularly antihypertensives
  • Paroxysmal atrial fibrillation
  • Dehydration
  • Neurocardiogenic syncope
  • Postural orthostatic hypotension syndrome
  • Inappropriate sinus tachycardia (common in young women survivors of childhood sex abuse)
  • Infection, particularly upper respiratory infection, pneumonia
  • Autonomic dysfunction
  • Adrenal insufficiency

Differential Diagnoses