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 .
Cost-Effectiveness of Dual-Chamber Pacing Compared With Ventricular Pacing for Sinus Node Dysfunction
Background —Compared with single-chamber ventricular pacing , dual-chamber pacing can reduce adverse events and , as a result , improve quality of life in patients paced for sick sinus syndrome . It is not clear , however , how these benefits compare with the increased cost of dual-chamber pacemakers . Methods and Results —We used 4-year data from a 2010-patient , r and omized trial to estimate the incremental cost-effectiveness of dual-chamber pacing compared with ventricular pacing and then projected these findings over the patients ’ lifetimes by using a Markov model that was calibrated to the first 5 years of in-trial data . To assess the stability of the findings , we performed 1000 bootstrap analyses and multiple sensitivity analyses . During the first 4 years of the trial , dual-chamber pacemakers  increased quality -adjusted life expectancy by 0.013 year per subject at an incremental cost-effectiveness ratio of $ 53 000 per quality -adjusted year of life gained . Over a lifetime , dual-chamber pacing was projected to increase quality -adjusted life expectancy by 0.14 year with an incremental cost-effectiveness ratio of ≈$6800 per quality -adjusted year of life gained . In bootstrap analyses , dual-chamber pacing was cost-effective in 91.9 % of simulations at a threshold of $ 50 000 per quality -adjusted year of life and in 93.2 % of simulations at a threshold of $ 100 000 . Its cost-effectiveness ratio was also below this threshold in numerous sensitivity analyses that varied key estimates . Conclusions —For patients with sick sinus syndrome requiring pacing  , dual-chamber pacing  increases quality -adjusted life expectancy at a cost that is generally considered acceptable
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 .