Pacemaker Syndrome

Has anyone had a diagnosis called 'Pacemaker Syndrome.' I have had my pacemaker for 17 years or so and had it replaced three times now. I just had ablation surgery for AFIB last NOV and now I have the above condition. I will suddenly feel alot of pressure in my neck and the veins distend. I get chest pressure,dizziness and go weak in the knees. I feel strong palpitations and then this goes on for one to ten minutes. Then it is gone and I can go about my business. The Dr tried to adjust my rates and timing, I have a dual lead pacer, but that did not help. The next thing we will try is to adjust the beta blockers.

6 Comments

Pseudo pacemaker syndrome

by golden_snitch - 2012-03-22 12:03:05

Hi Rodlyn,

yes, I have it, too, although mine is a "pseudo" pacemaker syndrome, since the pacemaker itself is not causing it. In my case, an accelerated junctional rhythm and a retrograde conduction (ventricle -> atrium, usually the AV-node allows only impulses from the atriums -> ventricles) is the cause. When this junctional rhythm gives an impulse, the impulse makes my atriums and ventricles beat at the same time. The result is that the atriums beat against closed valves, and I get the same symptoms as you do.

For a while, it has helped to increase the pacer base rate to 70bpm. That way the pacer was faster than this accelerated junctional rhythm. However, the junctional rhythm has gotten faster over the years, too. It's around 85bpm at rest now, and sometimes it kicks in when I exercise, so then it's even faster than 100bpm. So, now I'm taking a betablocker, and since I in addition have atrial tachycardia, I'm also on Propafenone. I was on Propafenone without a betablocker for nearly two years, and that worked well, but just a few weeks ago, the accelerated junctional rhythm had it's "comeback", and now we added the betablocker. It works, at least for now.

My cardio has talked to a heart rhythm specialist about ablating the junctional rhythm and this accessory pathway that allows the retrograde conduction, but the specialist said that these pathways are very difficult to ablate. He said that even, if one would do a complete AV-node ablation, one will very likely not be able to destroy this pathway.

Good luck with the betablocker. I hope it helps. B
Best
Inga

wow

by Rodlyn - 2012-03-22 12:03:17

WOW!! Thanks for the imput! Good luck to you! Im am on Betapace 160mg two times a day. Just came off coumadin after the 3months post op. My ablation was 8 hours long and it really helped the AFIB. I am not sure what they can do about this syndrome. The EKG looks like a slow V Tach on the strip. My rate is at 75 bpm. I was on Propafenone prior to this. My Doctor says it is the ventricular pacing.
Thanks Inga.

Sounds more like Ablation Syndrome

by ElectricFrank - 2012-03-23 02:03:02

While this isn't an official diagnosis, the fact that it appeared after the ablation is more than just coincidence. The ablation deliberately destroys heart tissue in the hope of eliminating the source of the afib. In the process it can cause other arrythmia's to appear. It may be necessary to ablate them as well.

frank

Hm, not that easy...

by golden_snitch - 2012-03-23 03:03:28

Hi again!

Well, it's not that easy, Frank. AF ablations usually do not cause other arrhythmias to appear; they might not be very successful in eliminating the AF, but that they make things worse is something, I've never heard or read before. And there are arrhythmias you cannot ablate. Like I said in my first post, my VA-conduction, which is the major cause of my pseudo pacemaker syndrome, cannot be ablated. It wasn't caused by any of my prior ablations; VA-conduction is something you're born with - either your AV-node has the ability for VA-conduction or it doesn't.

At the moment, I don't really understand why Rodlyn should be having a real pacemaker syndrome, as pacemaker syndrome usually is a problem related to VVI-pacing. So, patients who have it, are usually upgraded to a dual-chamber DDD pacer, and then the AV-timing is programmed carefully, and the syndrome is gone. Since Rodlyn HAS a dual-lead pacer, I don't understand what the problem is.
I also don't understand, why a betablocker should help, if the cardio says the problem is caused by ventricular pacing. The betablocker will certainly not affect the pacing at all.
But then I don't know, if the AF ablation was an AV-node ablation or a pulmonary vein isolation. If it was an AV-node ablation, then the atriums are still fibrillating, and so there definitely is AV-dissynchrony (= pacer syndrome always includes AV-dissynchrony). If it was a PVI, and the fibrillation is gone now, then the problem might be the same I'm having: An accelerated junctional rhythm with a retrograde VA-conduction. Or just the VA-conduction that allows the pacer impulse in the ventricles to travel backwards into the atriums.

There is a very good article on pacemaker syndrome at:
http://emedicine.medscape.com/article/159706-overview#showall

Best wishes
Inga

thankyou

by Rodlyn - 2012-03-23 09:03:50

Ill check out that article. I had a pulmonary vein isolation ablation (for the afib) and then they also ablated the severe atrial tach (which I had from infancy.)
The Md is hoping the atrial tach is cured and that is why she wants to withdrawl the beta blockers. I can't even remember what life would be like without these meds! I was also diagnosed years ago with something called neurocardiogenic syncopy. When presented with any stress, and not inculding all stress, I get a funny dizzy sensation in which my brain feels like it is being squeezed! This is not always accompanied with any arrthymias. This lasts several minutes and then passes. Before the pacer I would then pass out. I used to faint all the time as a child up until I had my pacer place at age 37. Also 3 cardiac arrests. One very young and one during an EPS study and one at home a year later when I did not return for my pacer implantation due to denial!

Had an adjustment. Frank and Inga

by Rodlyn - 2012-04-04 02:04:19

Went today to see the Cardio and she feels the pacer is picking up artifacts and reading them at A fib. She turned off the ventricular response to this as the Afib seems to be gone. HOPE HOPE. Well ,I have now gone nearly 8 hours actually feeling good with only two short episodes. It will feel like a miracle if this keeps up as I have been enduring 60-100 of those god awful episodes daily. I was getting near the end of my rope! I am really excited to get to feel good. I told the Pacer Dept and the Cardio about this web site. It only took me seventeen years to find it myself. A lady told me about it.

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I, too, am feeling tons better since my implant.