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 comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome.
AIMS In patients with sick sinus syndrome , bradycardia can be treated with a single-lead pacemaker or a dual-chamber pacemaker . Previous trials have revealed that pacing modes preserving atrio-ventricular synchrony are superior to single-lead ventricular pacing , but it remains unclear if there is any difference between single-lead atrial pacing ( AAIR ) and dual-chamber pacing ( DDDR ) . METHODS AND RESULTS We r and omly assigned 1415 patients referred for first pacemaker implantation to AAIR ( n = 707 ) or DDDR ( n = 708 ) pacing and followed them for a mean of 5.4 ± 2.6 years . The primary outcome was death from any cause . Secondary outcomes included paroxysmal and chronic atrial fibrillation , stroke , heart failure , and need for pacemaker reoperation . In the AAIR group , 209 patients ( 29.6 % ) died during follow-up vs. 193 patients ( 27.3 % ) in the DDDR group , hazard ratio ( HR ) 1.06 , 95 % confidence interval ( CI ) 0.88 - 1.29 , P = 0.53 . Paroxysmal atrial fibrillation was observed in 201 patients ( 28.4 % ) in the AAIR group vs. 163 patients ( 23.0 % ) in the DDDR group , HR 1.27 , 95 % CI 1.03 - 1.56 , P = 0.024 . A total of 240 patients underwent one or more pacemaker reoperations during follow-up , 156 ( 22.1 % ) in the AAIR group vs. 84 ( 11.9 % ) in the DDDR group ( HR 1.99 , 95 % CI 1.53 - 2.59 , P < 0.001 ) . The incidence of chronic atrial fibrillation , stroke , and heart failure did not differ between treatment groups . CONCLUSION In patients with sick sinus syndrome , there is no statistically significant difference in death from any cause between AAIR pacing and DDDR pacing . AAIR pacing is associated with a higher incidence of paroxysmal atrial fibrillation and a two-fold increased risk of pacemaker reoperation . These findings support the routine use of DDDR pacing in these patients . CLINICAL TRIAL REGISTRATION URL http://www . clinical trials.gov . Unique identifier : NCT00236158
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 .