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 .
Heart failure in patients with sick sinus syndrome treated with single lead atrial or dual-chamber pacing: no association with pacing mode or right ventricular pacing site.
AIMS Previous studies indicate that ventricular pacing may precipitate heart failure ( HF ) . We investigated occurrence of HF during long-term follow-up among patients with sick sinus syndrome ( SSS ) r and omized to AAIR or DDDR pacing . Furthermore , we investigated effects of percentage of ventricular pacing ( % VP ) and pacing site in the ventricle . METHODS AND RESULTS We analysed data from 1415 patients r and omized to AAIR ( n = 707 ) or DDDR pacing ( n = 708 ) . Ventricular pacing leads were recorded as located in either an apical or a non-apical position . The % VP and HF hospitalizations were recorded during follow-up . Patients were classified with new HF , if in New York Heart Association ( NYHA ) functional class IV or if presence of ≥2 of : oedema ; dyspnoea ; NYHA functional class III . Mean follow-up was 5.4 ± 2.4 years . Heart failure hospitalizations did not differ between groups . In the AAIR group , 170 of the 707 ( 26 % ) patients developed HF vs. 169 of the 708 ( 26 % ) patients in the DDDR group , hazard rate ratio ( HR ) 1.00 , 95 % confidence interval ( CI ) 0.79 - 1.22 , P = 0.87 . In DDDR patients , 146 of the 512 patients ( 29 % ) with ventricular leads in an apical position developed HF vs. 28 of the 161 patients ( 17 % ) with the leads in a non-apical position , HR 0.67 , CI 0.45 - 1.00 , P = 0.05 . After adjustments this difference was non-significant . The incidence of HF was not associated with % VP ( P = 0.57 ) . CONCLUSION In patients with SSS , HF was not associated with pacing mode , % VP , or ventricular lead localization . This suggests that DDDR pacing is safe in patients with SSS without precipitating HF
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 .