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Pacemaker syndrome from ventricular pacing — RCPSC IM MCQ

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HardCardiologyPacemaker syndrome from ventricular pacingRCPSC IM

A 79-year-old woman has fatigue, neck pulsations and presyncope 3 months after single-chamber ventricular pacemaker insertion for intermittent AV block. Blood pressure falls during paced rhythm. ECG shows ventricular pacing with retrograde P waves, and device interrogation shows 88% ventricular pacing. Echocardiography shows preserved systolic function. What is the most likely diagnosis?

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Correct answer: C — Pacemaker syndrome

Symptoms during high-burden ventricular pacing with retrograde atrial activation reflect loss of AV synchrony, consistent with pacemaker syndrome.

Reference: CCS cardiac implantable electronic device guidance