Pacemaker syndrome other diagnostic studies

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

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Diagnosis of pacemaker syndrome should start with pacemaker interrogation. It includes:

• Ruling out excessive ventricular pacing
• Looking for AV dissociation/VA conduction
• Looking for pacemaker malfunctioning, battery life and mode reversal

Other methods to diagnose Pacemaker Syndrome includes:

• Measuring systolic time intervals
• Measuring finger pulse amplitude by strain gauge
• Correlating cardiac index with pulse pressure
• Cuff blood pressure responses to different modes of pacing

• Holter monitoring can be used to correlate patients’ symptoms with their cardiac rhythm and is considered the best method of diagnosing pacemaker syndrome.

• Systolic blood pressure should be measured during ventricular pacing and should be compared with that during atrial or AV synchronous pacing.
• A drop of 20 mm Hg or more suggests pacemaker syndrome.

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