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 .
Health values before and after pacemaker implantation.
BACKGROUND Health value or utility is the abstract ed magnitude of a person 's preference for quality and quantity of life . It reflects how much lifetime with the patient 's current health condition a patient is willing to exchange for a life in excellent health . Health values are used in cost-effectiveness analysis as a means of calculating quality -adjusted years of life . OBJECTIVE This study assessed the health values of elderly patients before and after pacemaker implantation . METHODS We prospect ively examined 398 patients from the Pacemaker Selection in the Elderly study , in which patients were r and omized to either VVIR or DDDR mode .  Health values were estimated with the  time tradeoff method  before implantation and at 3 , 9 , and 18 months after implantation . RESULTS The mean age of patients was 76 + /- 6 years ; 234 patients ( 59 % ) were male . At baseline , patients were , on average , willing to exchange 5 years of current health for approximately 4 years in perfect health ( value 0.76 + /- 0.06 ) . There was no difference in baseline health values with implant diagnosis ( sinus node dysfunction n = 172 , 0.72 , atrioventricular block n = 227 , 0.75 , other diagnoses n = 39 , 0.78 , P = not significant ) . The overall improvement in health values at 3 months after pacemaker implantation was 0.165 + /- 0.4 ( P = .0001 ) . The improvement in health values was independent of pacing mode ( P = .6 ) . The time tradeoff score was modestly correlated with other measurements of health-related quality of life . The change in time tradeoff score with time was not influenced by demographic characteristics such as age and sex , diagnoses , pacing mode , employment status , or history of angina . Patients with a lower functional class at enrollment ( III or IV on the Specific Activity Scale ) demonstrated an absolute improvement of 23 % in their health values , whereas patients in class I or II improved only by 12 % , ( P = .03 ) . CONCLUSIONS Permanent pacemaker implantation for st and ard indications improves health values and descriptive health status measures . The values reported here may be used as a means of calculating the cost-effectiveness of different pacing modalities
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 .