Srpski arhiv za celokupno lekarstvo 2010 Volume 138, Issue 9-10, Pages: 635-638
https://doi.org/10.2298/SARH1010635S
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Pseudopacemaker syndrome and marked first-degree atrioventricular block: Case report
Stanković Ivan
Putniković Biljana
Panić Miloš
Vlahović-Stipac Alja
Nešković Aleksandar N.
Introduction. Pacemaker syndrome consists of the symptoms and signs present
in the single chamber (VVI) pacemaker patient with electrode placed in the
right ventricular apex. It is caused by inadequate timing of atrial and
ventricular contractions. Pacemaker syndrome without a pacemaker (or
pseudopacemaker syndrome) refers to occurrence of symptoms in the presence of
marked first-degree atrioventricular (AV) block, when P wave is too close to
the preceding QRS complex producing the same haemodynamic disturbance as
artificial pacemaker cardiac stimulation with retrograde VA conduction. Case
Outline. We present the patient with acute inferior myocardial infarction due
to late bare metal stent thrombosis, treated with primary pectutaneous
coronary intervention. Hospital course was complicated by complete heart
block which was treated with temporary pacing. During the stand-by mode of
temporary pacing, sinus rhythm with marked first-degree AV block (PQ interval
480 ms) was observed while the patients re-experienced the symptoms that were
present prior to pacemaker implantation. Temporary pacing was continued for
the next 24 hours when spontaneous shorteninig of PQ interval (250-270 ms)
was noticed; since the patient was asymptomatic during the stand-by mode, the
pacemaker electrodes were removed and the patient discharged 11 days after
admission. Conclusion. Conduction disturbances, such as the varying degrees
of AV blocks, are relatively common in acute inferior myocardial infarction.
The first degree AV blok is usually asymptomatic and does not require
treatment, unless when it is associated with pseudopacemaker syndrome. In
that case, temporary pacing provides haemodynamic stability until conduction
system recovers.
Keywords: pseudopacemaker syndrome, atrioventricular block, acute myocardial infarction
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