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Syncope
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Douglas L. Wood, Bernard J. Gersh
Cardiogenic syncope caused by conduction system disease or tachyarrhythmias, most often ventricular in origin, is treated according to the findings of invasive electrophysiologic studies. Patients with isolated conduction system disease and no inducible arrhythmias are treated with permanent pacing and the type of pacemaker chosen depends upon the presence of ventriculoatrial conduction and the potential for the development of the pacemaker syndrome. Patients with inducible arrhythmias are studied serially with antiarrhythmic drugs in an attempt to find a drug that prevents induction of tachycardia. When antiarrhythmic drugs are ineffective, patients are considered for surgical therapy or the implantation of antitachycardia pacemakers or implantable cardioverter defibrillators (AICD).
Indications for Permanent Pacing and Cardiac Resynchronization Therapy
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Shiv Bagga, J. David Burkhardt, Mandeep Bhargava
AV block is classified as first-, second-, or third-degree (complete) block; anatomically, it can occur at various levels in the AV conduction system; above the His bundle (supra-His), within the His bundle (intra-His), and below the bundle of His (infra-His). The site of AV block largely determines the adequacy and reliability of the underlying escape rhythm and hence the need for a permanent pacemaker. First-degree AV block is defined as abnormal prolongation of the PR interval (greater than 0.20 s) and is usually secondary to delay at the level of AV node. Pacing for patients with first-degree AV block is rarely an indication unless the patient has symptoms suggestive of pacemaker syndrome. This has been found in patients with marked (PR greater than 300 ms) first-degree AV block (Class IIb indication).3
Bradyarrhythmias and cardiac pacemakers in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Naktal Hamoud, Fernando Tondato, Win-Kuang Shen
There is a large body of literature from clinical studies assessing the best pacing mode for this condition. The use of exclusive ventricular pacing was a common practice in the past, but several retrospective studies demonstrated increased morbidity and mortality associated with this mode of pacing (19,20). Exclusive ventricular pacing can also cause pacemaker syndrome, which is secondary to loss of AV synchrony. The symptoms related to this pacemaker syndrome can significantly impact the quality of life. Therefore, atrial pacing in SND should be the preferred choice since it promotes a physiologic activation of the ventricles, favoring the propagation of stimulus through the intrinsic conduction system.
Pacing devices to treat bradycardia: current status and future perspectives
Published in Expert Review of Medical Devices, 2021
Mauro Biffi, Claudio Capobianco, Alberto Spadotto, Lorenzo Bartoli, Sergio Sorrentino, Alessandro Minguzzi, Giuseppe Pio Piemontese, Andrea Angeletti, Sebastiano Toniolo, Giovanni Statuto
Moreover, the DANPACE study did not show beneficial effect on AF of AAI/R (no ventricular pacing at all) compared to DDD/R pacing in SND patients, when an upper boundary of PR interval as 260 ms was accepted for enrollment: new-onset AF was related to prolonged AV interval rather than to Cum %VP [40]. The disappointing results of these studies based on minimization of ventricular stimulation focused the attention on the AV delay. A long PR is not rare in the general population and it is highly prevalent in SND and paroxysmal AVB patients [41,42]. Delayed AV conduction was independently associated to AF incidence, HF, and in some cases to all-cause mortality in community studies and in specific populations like hypertensive and chronic coronary disease patients [43–45]. Nevertheless, permanent pacing may be considered only for patients with persistent symptoms similar to pacemaker syndrome attributable to AVB 1st (PR interval >300 ms) (class IIa recommendation with level of evidence C), according to current guidelines [1].
Single-lead VDD pacing: a literature review on short-term and long-term performance
Published in Expert Review of Medical Devices, 2023
Davide Antonio Mei, Jacopo Francesco Imberti, Marco Vitolo, Niccolò Bonini, Luigi Gerra, Giulio Francesco Romiti, Marco Proietti, Gregory Y. H. Lip, Giuseppe Boriani
Pacemaker syndrome has been defined as the presence of signs and symptoms resulting from the loss of AV synchrony during ventricular pacing [34,35]. Symptoms usually include fatigue, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, orthostatic hypotension, and syncope. The pathogenesis of pacemaker syndrome is complex and involves the heart, vascular reflexes and neurohumoral system, as well as direct hemodynamic consequences of loss of atrial systole [36–38]. As already discussed above, AV synchronous pacing has other hemodynamic advantages. The loss of AV synchrony may worsen mitral regurgitation in predisposed patients and may cause symptomatic episodes of hypotension.
Current state of leadless pacemakers: state of the art review
Published in Expert Review of Cardiovascular Therapy, 2019
Muhammad R. Afzal, Nupur Shah, Georges Daoud, Mahmoud Houmsse
The two patients with a major complication related to pacemaker syndrome, as expected, were among the 36% of patients who had no persistent atrial arrhythmias at baseline. Both patients were upgraded: one to dual-chamber pacing and one to cardiac resynchronization therapy. All six patients with a major complication related to heart failure had persistent atrial arrhythmias at baseline. Only one of these patients was upgraded to cardiac resynchronization therapy. The remainder were managed with medication.