Pacemaker syndrome: an iatrogenic condition.

Pacemaker syndrome was first described in 1969 by Mitsui when it was referred to as the pacemaking syndrome.' The name pacemaker syndrome was first coined by Erbel (using the German Schrittmacher syndrom) in 1979.2 It can present with symptoms as severe as syncope, presyncope, oedema, dyspnoea, and chest pain, or more moderately and subtly as lethargy, palpitation, or an awareness of venous pulsation all of which may occur when there is atrial systole during ventricular systole. This is most frequent when there is ventriculoatrial conduction from the paced ventricle to the atrium usually via the atrioventricular node.34 The symptoms can be identical to those prompting implant.5 Occasionally pacemaker syndrome can occur in the absence of ventriculoatrial conduction when ventricular pacing is in competition with sinus rhythm.6