This review shows a trend towards greater effectiveness with dual chamber pacing compared to single chamber ventricular pacing, which supports the current British Pacing and Electrophysiology Group's Guidelines regarding atrioventricular block. Additional randomised controlled trial evidence from ongoing trials in this area will further inform the debate.
Physiological pacing improves symptoms and increases exercise capacity in the elderly patient.
We evaluated the benefits of physiological pacing in the elderly by recruiting 13 subjects > 75 years of age, already fitted with a physiological pacing system. All had been paced for complete or Mobitz II heart block. Double blind cross over study was performed comparing exercise capacity, measuring distance walked on a 6-min walking test and time taken to climb two flights of stairs; and symptoms, evaluated by an activity of daily living questionnaire, in atrioventricular synchronous and ventricular pacing. Mean distance walked was significantly higher in atrioventricular synchronous than in ventricular pacing (360 +/- 65 m vs. 327 +/- 69 m; P < 0.01). No significant difference was found in the ability to climb stairs but there was a marked improvement in the symptomatic questionnaire score, 19 +/- 5 in physiological pacing increasing to 28 +/- 10 with ventricular. Physiological pacing in the elderly produces an increase in exercise tolerance and improves symptoms; therefore, age alone should not be a contraindication to a physiological system.