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 .
Effect of pacing mode on health-related quality of life in the Canadian Trial of Physiologic Pacing.
BACKGROUND Both " physiologic " ( dual-chamber or atrial only ) or ventricular-pacing-only permanent pacemakers provide chronotropic competence , with unknown health-related quality of life ( QOL ) differences between these options . The QOL studies within the Canadian Trial of Physiologic Pacing were performed to assess whether QOL differences exist in patients r and omized to these 2 pacing modes . METHODS Two QOL protocol s were performed : 1 ) a sub study of 269 patients with detailed QOL measures ( The Medical Outcomes Study , Short-Form [ SF-36 ] , the Pacemaker Syndrome Scale , an activity scale , and a pacemaker-specific scale ) at baseline and 6 months after implantation ; and 2 ) a parent study assessment of QOL in 1721 patients with a 12-item QOL instrument package ( SF-6 , " ladder of life , " and pacemaker syndrome scale ) given 6 months after implantation only . RESULTS In the sub study , pacing was associated with an average significant ( P < .05 ) 0.36 SD unit improvement in QOL across all domains ( SF-36 : 38 + /- 9 to 41 + /- 11 for physical scores , 47 + /- 11 to 52 + /- 9 for mental health scores , both P < .001 ) . Similar improvements were seen with the pacemaker-specific scales . There were no significant differences in the absolute or relative improvement in QOL between assigned pacing modes . The parent study similarly showed no differences in QOL between pacing modalities . Presyncope occurred in 31 % of patients in the physiological pacing group , compared with 38 % of the patients in the ventricular pacing group ( P < .01 ) . No other symptoms were different between the 2 groups . Pacemaker dependency , defined as an escape heart rate < 50 beats per minute , did not influence the lack of difference in QOL scores between the 2 assigned pacing modes . CONCLUSION In this largest r and omized assessment of QOL in patients with pacemakers , with the instruments used , there was no significant health-related QOL difference seen between " physiologic " pacing and ventricular 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 .