Pacemaker Syndrome Differential Diagnoses

Updated: May 09, 2022
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jose M Dizon, 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