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 .
Progression to chronic atrial fibrillation after pacing: the Canadian Trial of Physiologic Pacing. CTOPP Investigators.
OBJECTIVES This study examined the effect of physiologic pacing on the development of  chronic atrial fibrillation ( CAF ) in the Canadian Trial Of Physiologic Pacing ( CTOPP ) . BACKGROUND The role of physiologic pacing to prevent CAF remains unclear . Small r and omized studies have suggested a benefit for patients with sick sinus syndrome . No data from a large r and omized trial are available . METHODS The CTOPP r and omized patients undergoing first pacemaker implant to ventricular-based or physiologic pacing ( AAI or DDD ) . Patients who were prospect ively found to have persistent atrial fibrillation ( AF ) lasting greater than or equal to one week were defined as having CAF . Kaplan-Meier plots for the development of CAF were compared by log-rank test . The effect of baseline variables on the benefit of physiologic pacing was evaluated by Cox proportional hazards modeling . RESULTS Physiologic pacing reduced the development of CAF by 27.1 % , from 3.84 % per year to 2.8 % per year ( p = 0.016 ) . Three clinical factors predicted the development of CAF : age > or = 74 years ( p = 0.057 ) , sinoatrial ( SA ) node disease ( p < 0.001 ) and prior AF ( p < 0.001 ) . Subgroup analysis demonstrated a trend for patients with no history of myocardial infa rct ion or coronary disease ( p = 0.09 ) as well as apparently normal left ventricular function ( p = 0.11 ) to derive greatest benefit . CONCLUSIONS Physiologic pacing reduces the annual rate of development of chronic AF in patients undergoing first pacemaker implant . Age > or = 74 years , SA node disease and prior AF predicted the development of CAF . Patients with structurally normal hearts appear to derive greatest benefits
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 .