Pacemaker syndrome medical therapy

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Pacemaker syndrome Microchapters

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Overview

Historical Perspective

Pathophysiology

Differentiating Pacemaker syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

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Chest X Ray

Echocardiography

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Treatment

Medical Therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Medical Therapy

Diet

Diet alone cannot treat pacemaker syndrome, but an appropriate diet to the patient, in addition to the other treatment regimens mentioned, can improve the patient's symptoms.

Dietary management includes:

Medication

No specific drugs are used to treat pacemaker syndrome directly because treatment consists of upgrading or reprogramming the pacemaker.

Medical Care

  • Prevent ventriculoatrial conduction by slowing the rate of ventricles setting in pacemaker and restoring Atrioventricular synchrony.
  • In ventricularly paced patients, usually the addition of an atrial lead and optimizing the AV synchrony usually resolves symptoms.
  • In patients with pacing modes other than ventricular pacing, symptoms usually resolve after adjusting and reprogramming of pacemaker parameters, such as tuning the AV delay, changing the postventricular atrial refractory period, the sensing level, and pacing threshold voltage. The optimal values of these parameters for each individual differ. So, achieving the optimal values is by experimenting with successive reprogramming and measurement of relevant parameters, such as blood pressure, cardiac output, and total peripheral resistance, as well as observations of symptomatology.
  • Using hysteresis to help maintain AV synchrony, in some instances, can help alleviate symptoms in ventricularly inhibited paced (VVI) patients providing they have intact sinus node function. Hysteresis reduces the amount of time spent in pacing mode, which can relieve symptoms, particularly when the pacing mode is generating AV dyssynchrony.
  • If symptoms persist after all these treatment modalities, replacing the pacemaker itself is sometimes beneficial and can alleviate symptoms.

References

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  1. Ausubel K, Boal BH, Furman S (1985). "Pacemaker syndrome: definition and evaluation". Cardiol Clin. 3 (4): 587–94. PMID 3910239.