Pacemaker syndrome without a pacemaker

Abstract

This article presents a case report of pacemaker syndrome without a pacemaker, or pseudopacemaker syndrome. This syndrome refers to a hemodynamic complex similar to the one caused by pacemaker syndrome, that occurs in patients without a cardiac stimulation device. It results from atrial systole during or very close to ventricular systole, which causes atrial contraction against the closed atrioventricular (AV) valves, leading to increased intra-atrial pressure with retrograde transmission to the pulmonary veins and superior vena cava. This causes arterial vasodilation, decreased systolic ventricular volume, a fall in cardiac output, pulmonary congestion and atrial arrhythmias. Its clinical presentation ranges from dyspnea with exertion to full-blown congestive heart failure. Each patient with this syndrome requires personalized treatment, which depends on the triggering cause. Several reports have documented that symptomatic patients with first-degree AV block with a very long PR interval (generally > 300 ms) benefit from stimulation therapy.