Abstract
Background
Nocturnal syncope is a common emergency department presentation often related to orthostatic
hypotension and subsequent loss of cerebral perfusion when patients get up from sleep
to use the restroom faster than their cardiac output and vascular tone can accommodate.
Poor hydration status and antihypertensive medications can increase this risk. Patients
with syncope who present to the emergency department with a pacemaker are usually
evaluated with a pacemaker interrogation to evaluate for runs of non-perfusing rhythms
(e.g. ventricular tachycardia or fibrillation). Sleep Rate Mode (SRM) is a relatively
new feature of modern pacemakers and is not currently recognized by emergency medicine
providers. It was implemented to accommodate for more physiologic fluctuations in
heart rate during rapid eye movement sleep. There is paucity of evidence supporting
the clinical benefit of SRM and similarly no documentation of prior complications
of SRM in the current literature.
Case Report
We report the case of a 92-year-old woman with a Medtronic Avisa pacemaker presenting
with recurrent nocturnal syncope and bradycardia resulting in multiple emergency department
visits. These episodes ultimately resolved by turning off SRM on her pacemaker.
Why should an emergency physician be aware of this?
Sleep mode is not currently flagged on interrogation report summaries provided to
emergency physicians. This report highlights the importance of recognizing this mode
as a potential etiology of nocturnal syncope related to chronotropic incompetence
in patients with pacemakers.
Keywords
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Article info
Publication history
Accepted:
March 11,
2023
Received in revised form:
January 22,
2023
Received:
November 21,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Published by Elsevier Inc.
