Pacemaker syndrome: an underestimated cause of heart failure

Signs and symptoms of heart failure (HF) or atrial fibrillation (AF) in patients with pacemakers, particularly in the elderly with multiple co-morbidities, are often attributed to different pathophysiological mechanisms. Pacemaker syndrome is a relatively common entity, which is usually underestimated or misdiagnosed and can affect the quality of life of many patients with devices. The prevalence of this syndrome is variable and can occur in patients with both unicameral pacemaker (VVI) and dual chamber pacemakers (DDD). There are essentially two main mechanisms involved in the genesis of pacemaker syndrome: loss of atrio-ventricular synchrony and persistence of ventricular-atrial retrograde conduction. The mode of pacing and device model may result in an increased morbidity, by increasing the development of AF, stroke or HF.

Keywords: Pacemakers syndrome ; Heart failure ; Atrial fibrillation