Pacemaker syndrome?

I have a question regarding pacemaker syndrome.  I have a pacemaker for sinus node dysfunction.  I also have different  atrial arrythmias, including atrial fibrillation.  I take amiodarone, cartia, coumadin, proamatine, lasix for heart.  

My symptoms have been edema, difficulty lying down with breathing, but also when I lay down my head gets very full like I am standing on my head and my veins pop out.  I often can only sleep sitting up. When I saw my EP doctor he said he thinks it is pacemaker syndrome. He said the symptoms are definately heart related. He also said this happens because the atrium and ventricals beat out of sync with each other.

What exactly causes that?  Is it strictly the function of the pacemaker, my particular conduction problem, or a combination of the two?  Can this always be fixed by changing the mode of the pacemaker?
Also, I am wondering about how an av node ablation is different.  Aren't there alot of people that have had AV node ablations, who have their upper and lower chambers out of sync that don't have any edema or other heart failure symptoms?  

Sorry so many questions.  I am just not quite understanding the problem.

Thankyou so much for taking the time to thoughtfully answer questions.

[CCF-M.D.-CRC]

Dear cn,
"Pacemaker syndrome" is a description of what happens when the upper (atrium) and lower (ventricles) chambers of the heart are not synchronized with each other. The atrium contract against a closed valve and the blood instead of going forward rushes backwards and may cause an unpleasant feeling in the neck and head.  This used to occur when only single chamber pacemakers were implanted.  Nowdays most pacemakers are dual chamber so it rarely occurs secondary to a pacemaker and if it is due to a pacemaker it can be fixed with reprogramming or upgrading the system.  

There may be other causes of "pacemaker syndrome" not due to a pacemaker such as an atrial tachycardia or PAC's.  These can usually be controlled with medication or ablation if needed.

Pacemaker syndrome does not cause edema or shortness of breath.  ProAmatine (midrodrine) on the other hand does elevate the blood pressure and may lead to edema and high blood pressure when lying down.  Have you had an echocardiogram recently?  The other thing to check is to make sure there is no decrease in your heart function.

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