Pacemaker Syndrome in an Individual with a Bi-Ventricular Pacemaker

Pacemaker syndrome adversely impacts atrioventricular synchrony. It is associated with different types of pacemakers. Individuals with this condition may be symptomatic or asymptomatic. Generally, pacemakers should be interrogated every 3-12 months, and this can help determine if the device is at risk of progressing to “elective replacement indication” or “end of life” status. When there is a concern for such a status, it is important to change the pacemaker’s generator. We present the case of a 75-year-old male who had a bi-ventricular pacemaker in place. He presented to the hospital due to shortness of breath, chest pain and pressure, and lower extremity edema. His electrocardiogram was concerning for high output pacemaker spikes, complete heart block, and a ventricular paced rhythm. This led us to suspect pacemaker syndrome. Pacemaker interrogation revealed that the device had reached “end of life” several months prior. He successfully underwent pacemaker generator replacement prior to transfer to a different facility for further evaluation of his underlying cardiac disease.