TRANSIENT FOCAL CEREBRAL-ISCHEMIA DURING HYPOTENSION DUE TO PACEMAKERSYNDROME

A pacemaker syndrome manifested as transient sensoric aphasia in a 68- year-old woman with a VVI-pacemaker implanted after SA-block. The atta ck occurred during long-term blood pressure recording and Holter monit oring. Borderline hypotension was documented during ventricular pacing which induced a retrograde excitation of the atrium. Clinical investi gations excluded any intracranial abnormality, any source of embolism or stenosis of extra- and intracranial cerebral arteries. Cerebral blo od flow measurements revealed a significant increase during pacing at elevated heart rate. Therefore, a device for AV-sequential pacing was implanted and basic pacing rate was elevated. The present case report indicates that focal and not only global cerebral ischemia can be prod uced by an impairment of systemic hemodynamics due to hypotension and a pacemaker syndrome. Improvement of cerebral blood flow during pacing is an unexpected finding contrasting with the concept of autoregulati on. In addition, pacemaker implantation should be discussed in patient s with transient cerebral perfusion deficits if an improvement of cere bral blood flow is documented along with rising heart rate.