Pacemaker Syndrome Workup

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

Measure systolic blood pressure during ventricular pacing and compare to that during atrial or AV synchronous pacing. A drop of 20 mm Hg or more is suggestive of pacemaker syndrome.

No laboratory studies are indicated.

Begin workup by performing pacemaker interrogation. Rule out excessive ventricular pacing, and look for evidence of AV dissociation or VA conduction. Also rule out pacemaker malfunction, end of battery life, mode reversion for energy conservation, and inappropriate mode switching.

The best method of diagnosis is to correlate patients' symptoms with their cardiac rhythms. This may include use of a Holter monitor or event recorder.


Imaging Studies

Transthoracic echocardiogram may reveal decreased cardiac output with ventricular pacing versus either conducted sinus activity or AV synchronous pacing. M-mode tissue Doppler imaging may reveal an altered ventricular activation pattern.

A study by Lee and associates demonstrated possible utility of transesophageal echocardiography in diagnosis of pacemaker syndrome. They noted higher atrial reverse flow velocities, increased frequency of spontaneous echo contrast in the descending aorta, and significant mitral regurgitation in ventricularly paced patients with pacemaker syndrome. [16]

ECG may reveal a prolonged PR interval, VA conduction, or AV dissociation.