[Electrophysiological and hemodynamic consequences of pacemaker syndrome].

The pacemaker syndrome is a complex of adverse clinical, hemodynamic and electrophysiologic signs temporally related to the onset of ventricular pacing and having no other causes. We observed 975 patients (454 men and 251 women, mean age 67.1+/-2.4 years) who received ventricular VVI pacemakers because of sick sinus syndrome or complete atrio-ventricular block. The presence of ventriculo-atrial conduction was confirmed by transesophageal ECG. Pacemaker syndrome was diagnosed in 121 patients (12.4%) who had the following complaints: general weakness (n=82), rapid fatigability (n=51), retarded thinking (n=43), dizziness (n=75), exertional dyspnea (n=86), anginal pain at rest (n=14), or exertion (n=43), unpleasant pulsation of neck vessels (n=41), transient hypotension (n=54), syncope (n=5). Retrograde P-wave was registered in standard ECG-leads in 98 (80.9%) and only on transesophageal ECG - in 23 patients (19%). Stroke volume after stopping of ventricular pacing (mean heart rate during sinus rhythm - 52.1+/-3/min) increased in 97 (80.2%) and decreased in 24 patients (19.8%). Main method of treatment of pacemaker syndrome was restoration of atrioventricular synchrony.