Pacemaker syndrome: a non-invasive means to its diagnosis and treatment.

Vertigo, lightheadedness, syncope, and hypotension occurring after implantation of a ventricular pacemaker has become known as pacemaker syndrome. In one patient with this syndrome we have demonstrated an associated decrease in the pulse amplitude of the ophthalmic arteries during ventricular pacing by utilizing ocular pneumoplethysmography (O.P.G.). This non-invasive technique was subsequently used intra-operatively to test the presence of ophthalmic artery pulse amplitude changes after implantation of the ventricular electrode. An A-V sequential pacemaker was then implanted and eliminated all symptoms of pacemaker syndrome.