Pacemaker syndrome medical therapy

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

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:

• For patients with heart failure, low-salt diet is indicated.
• For patients with autonomic insufficiency, a high-salt diet may be appropriate.
• For patients with dehydration, oral fluid rehydration is needed.

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

• 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.

• Medical care includes supportive treatment, in case any of the following complications happen, medical team should be ready.
• Possible complications include heart failure, hypotension, tachycardia, tachypnea, and oxygenation deficit.

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