Lack of synchronization between atrial and ventricular contractions is the cause of this syndrome.

  Usually seen in patients with
VVI pacemakers.



Symptoms of pacemaker syndrome:

  Palpitations

  Pulsations in neck, abdomen

  Malaise, fatigue

  Chest pain or fullness

  Headache, jaw pain

  Dyspnoea on exertion

  Presyncope

  Syncope




References

  Br Heart J. 1992;68(2):163-166.

  Clin Cardiol. 1991;14(4):336-340.

  Prog Cardiovasc Dis. 1992;34(5):347-366.

  Clinical cardiac pacing, defibrillation, and resynchronization therapy

      ed. Kenneth A. Ellenbogen et al. - 4th ed. 2011:226-229.





ECG 1a. The ECG above is from an 85 years-old man with normal coronary arteries.
Left anterior fascicular block is seen.
Of every two
P waves, only one is conducted to the ventricles: 2nd degree AV block. PR interval is long.
The above ECG was recorded before pacemaker implantation.

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ECG 1b. The above rhythm tracing is from the 12-channel Holter recording of the same man.
Holter recording shows
2.7 seconds pause.
The above rhythm tracing was recorded before pacemaker implantation.

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ECG 1c. The above ECG belongs to the same man.
It was recorded 10 days after the implantation of a VVI type cardiac pacemaker.
It was recorded at a
standard calibration of 10 mm/mV.
Pacemaker spikes are not easy to notice since bipolar electrodes were used for implantation.
Early after the implantation of his pacemaker, the patient started to complain of palpitations, malaise and
chest fullness suggesting the diagnosis of pacemaker syndrome.
There is a
long interval between atrial contractions (P wave) and paced QRS complexes (360 milliseconds in this patient).
Atrial contractions occur while the atrioventricular valves (mitral and tricuspid) are closed,
and therefore the atria cannot contribute to the filling of the ventricles.

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ECG 1d. The ECG above belongs to the same man.
It was recorded immediately after the ECG 1c, but at a
calibration of 20 mm/mV.
Now,
interatrial block is easily discernible.
Interatrial block results in
prolonged P wave duration (>120 miliseconds).
In this patient, the interval between the
onset and termination of the P wave is 200 milliseconds.
At a
calibration of 20 mm/mV pacemaker spikes can be seen in some leads.

Click here for a more detailed ECG