@misc{cogprints4184,
          volume = {4},
          number = {4},
           month = {October},
          author = {Michael D Farmer and Mark NA III Estes and Mark S Link},
          editor = {Balbir Singh and Yash Lokhandwala and Johnson Francis and Anup Gupta},
           title = {New Concepts in Pacemaker Syndrome
},
       publisher = {Indian Pacing and Electrophysiology Group},
            year = {2004},
         journal = {Indian Pacing and Electrophysiology Journal},
           pages = {195--200},
        keywords = {VVI = ventricular-based, VVIR = rate modulated ventricular-based, A-V = atrioventricular, V-V = interventricular, V-A = ventricular-atrial, LBBB = left bundle branch block, LVEF = left ventricular ejection fraction, DDDR = rate modulated dual-chamber, SND = sinus node dysfunction, AAI = single-chamber atrial, AF = atrial fibrillation, LV = left ventricular, RV= right ventricular
},
             url = {http://cogprints.org/4184/},
        abstract = {After implantation of a permanent pacemaker, patients may experience severe symptoms of dyspnea, palpitations, malaise, and syncope resulting from pacemaker syndrome.  Although pacemaker syndrome is most often ascribed to the loss of atrioventricular (A-V) synchrony, more recent data may also implicate left ventricular dysynchrony caused by right ventricular pacing.  Previous studies have not shown reductions in mortality or stroke with rate-modulated dual-chamber (DDDR) pacing as compared to ventricular-based (VVI) pacing. The benefits in A-V sequential pacing with the DDDR mode are likely mitigated by the interventricular (V-V) dysynchrony imposed by the high percentage of ventricular pacing commonly seen in the DDDR mode.  Programming DDDR pacemakers to encourage intrinsic A-V conduction and reduce right ventricular pacing will likely decrease heart failure and pacemaker syndrome.  Studies are currently ongoing to address these questions.
}
}

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