No statistically significant difference was found between the pacing modes for mortality , heart failure , stroke , chronic atrial fibrillation or quality of life .
However , the risk of developing heart failure may vary with age and device .
The risk of heart failure may have an impact on the decision to use dual-chamber or single-chamber atrial pacemakers .
Results from an analysis based on age ( > 75 years or ≤ 75 years ) and risk of heart failure indicate that dual-chamber pacemakers dominate single-chamber atrial pacemakers ( i.e. are less expensive and more effective ) in older patients , whereas dual-chamber pacemakers are dominated by ( i.e. more expensive and less effective ) single-chamber atrial pacemakers in younger patients .
In patients with SSS without evidence of impaired AV conduction , dual-chamber pacemakers appear to be cost-effective compared with single-chamber atrial pacemakers .
BACKGROUND Bradycardia [ resting heart rate below 60 beats per minute ( b.p.m . ) ]
can be caused by conditions affecting the natural pacemakers of the heart , such as sick sinus syndrome ( SSS ) and atrioventricular ( AV ) blocks .
People suffering from bradycardia may present with palpitations , exercise intolerance and fainting .
The only effective treatment for patients suffering from symptomatic bradycardia is implantation of a permanent pacemaker .
OBJECTIVE To appraise the clinical effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber atrial pacemakers for treating symptomatic bradycardia in people with SSS and no evidence of AV block .
A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome.
OBJECTIVES A r and omized trial was done to compare single-chamber atrial ( AAI ) and dual-chamber ( DDD ) pacing in patients with sick sinus syndrome ( SSS ) . Primary end points were changes in left atrial ( LA ) size and left ventricular ( LV ) size and function as measured by M-mode echocardiography . BACKGROUND In patients with SSS and normal atrioventricular conduction , it is still not clear whether the optimal pacing mode is AAI or DDD pacing . METHODS A total of 177 consecutive patients ( mean age 74 + /- 9 years , 73 men ) were r and omized to treatment with one of three rate-adaptive ( R ) pacemakers  : AAIR ( n = 54 ) , DDDR with a short atrioventricular delay ( n = 60 ) ( DDDR-s ) , or DDDR with a fixed long atrioventricular delay ( n = 63 ) ( DDDR-l ) . Before pacemaker implantation and at each follow-up , M-mode echocardiography was done to measure LA and LV diameters . Left ventricular fractional shortening ( LVFS ) was calculated . Analysis was on an intention-to-treat basis . RESULTS Mean follow-up was 2.9 + /- 1.1 years . In the AAIR group , no significant changes were observed in LA or LV diameters or LVFS from baseline to last follow-up . In both DDDR groups , LA diameter increased significantly ( p < 0.05 ) , and in the DDDR-s group , LVFS decreased significantly ( p < 0.01 ) . Atrial fibrillation was significantly less common in the AAIR group , 7.4 % versus 23.3 % in the DDDR-s group versus 17.5 % in the DDDR-l group ( p = 0.03 , log-rank test ) . Mortality , thromboembolism , and congestive heart failure did not differ between groups . CONCLUSIONS During a mean follow-up of 2.9 + /- 1.1 years , DDDR pacing causes increased LA diameter , and DDDR pacing with a short atrioventricular delay also causes decreased LVFS . No changes occur in LA or LV diameters or LVFS during AAIR pacing . Atrial fibrillation is significantly less common during AAIR pacing
No statistically significant difference was found between the pacing modes for mortality , heart failure , stroke , chronic atrial fibrillation or quality of life .
However , the risk of developing heart failure may vary with age and device .
The risk of heart failure may have an impact on the decision to use dual-chamber or single-chamber atrial pacemakers .
Results from an analysis based on age ( > 75 years or ≤ 75 years ) and risk of heart failure indicate that dual-chamber pacemakers dominate single-chamber atrial pacemakers ( i.e. are less expensive and more effective ) in older patients , whereas dual-chamber pacemakers are dominated by ( i.e. more expensive and less effective ) single-chamber atrial pacemakers in younger patients .
In patients with SSS without evidence of impaired AV conduction , dual-chamber pacemakers appear to be cost-effective compared with single-chamber atrial pacemakers .
BACKGROUND Bradycardia [ resting heart rate below 60 beats per minute ( b.p.m . ) ]
can be caused by conditions affecting the natural pacemakers of the heart , such as sick sinus syndrome ( SSS ) and atrioventricular ( AV ) blocks .
People suffering from bradycardia may present with palpitations , exercise intolerance and fainting .
The only effective treatment for patients suffering from symptomatic bradycardia is implantation of a permanent pacemaker .
OBJECTIVE To appraise the clinical effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber atrial pacemakers for treating symptomatic bradycardia in people with SSS and no evidence of AV block .