TREATMENT
■ Depends on underlying malfunction
■ Often requires reprogramming of functions by cardiologist
■ Magnet placement
■ Converts pacer to fixed rate
■ Turns off “inhibit” function
■ For runaway pacemaker
■ Terminate with a magnet
■ Definitive therapy requires reprogramming the atrial refractory period.
PACEMAKERSYNDROME
Most commonly seen with VVI pacemakers as a result of atrial contractions
against a closed AV valve
PATHOPHYSIOLOGY
■ Atrial contractions against closed AV valve →
■ ↑Atrial pressures →pulmonary and hepatic congestion
■ ↓Ventricular filling (lack of “atrial kick”) →decreased cardiac output
(by 20–50%)
SYMPTOMS/EXAM
■ Varied and vague
■ Light-headedness, syncope, or near-syncope
■ Sense of pulsations in neck or abdomen
■ Fatigue
■ Heart failure
■ Chest pain
■ Palpitations
■ Neck and/or abdominal pulsations
DIAGNOSIS/TREATMENT
■ Diagnosis is primarily clinical.
■ Interrogate pacer to rule out malfunction and reprogram setting.
COMPLICATIONS
■ Increased risk of atrial fibrillation, thromboembolic events, and heart failure.
A 58-year-old male presents to the ED complaining of recurrent ICD firing.
On the monitor, you see a narrow complex tachycardia at a rate of 150 bpm,
which is temporarily converted to sinus rhythm with ICD firing. The
patient is hemodynamically stable during the tachydysrhythmia, but has consid-
erable discomfort with each firing. How do you prevent the inappropriate ICD
firing in this patient?
Preventing the underlying tachydysrhythmia and/or ICD reprogramming is
the definitive treatment, but placing a ring magnet over the generator site will
temporarily inactivate the ICD.RESUSCITATIONPlacing a magnet over the
pacemaker generator converts
the pacemaker to a fixed-rate
pacing mode and turns off the
“inhibit” function.Pacemaker syndrome occurs
due to loss of AV synchrony,
most commonly with VVI
pacemakers.