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 .
Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome
Objective : To analyse the occurrence of atrial fibrillation ( AF ) and thromboembolism in a r and omised comparison of rate adaptive single chamber atrial pacing ( AAIR ) and dual chamber pacing ( DDDR ) in patients with sick sinus syndrome and normal atrioventricular ( AV ) conduction , in which left atrial dilatation and decreased left ventricular fractional shortening had been observed in the DDDR group . Methods : 177 consecutive patients with sick sinus syndrome ( mean ( SD ) age 74 ( 9 ) years , 104 women ) were r and omly assigned to treatment with one of three pacemakers : AAIR ( n = 54 ) , DDDR with a short rate adaptive AV delay ( n = 60 ) ( DDDR-s ) ; or DDDR with a fixed long AV delay ( n = 63 ) ( DDDR-l ) . Analysis was intention to treat . Results : Mean follow up was 2.9 ( 1.1 ) years . AF at one or more ambulatory visits was significantly less common in the AAIR group ( 4 ( 7.4 % ) v 14 ( 23.3 % ) in the DDDR-s group v 11 ( 17.5 % ) in the DDDR-l group ; p = 0.03 , log rank test ) . The risk of developing AF in the AAIR group compared with the DDDR-s group was significantly decreased after adjustment for brady-tachy syndrome in a Cox regression analysis ( relative risk 0.27 , 95 % confidence interval ( CI ) 0.09 to 0.83 , p = 0.02 ) . The benefit of AAIR was highest among patients with brady-tachy syndrome . Brady-tachy syndrome and a thromboembolic event before pacemaker implantation were independent predictors of thromboembolism during follow up ( relative risk 7.5 , 95 % CI 1.6 to 36.2 , p = 0.01 , and relative risk 4.7 , 95 % CI 1.2 to 17.9 , p = 0.02 , respectively ) . Conclusions : During a mean follow up of 2.9 years AAIR was associated with significantly less AF . The beneficial effect of AAIR was still significant after adjustment for brady-tachy syndrome . Brady-tachy syndrome was associated with an increased risk of thromboembolism
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 .