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 .
Late complications following permanent pacemaker implantation or elective unit replacement
Objective To determine the rate of late complications following first implantation or elective unit replacement of a permanent pacemaker system .  Design Analysis of pacemaker data and complications prospect ively acquired on a computerised data base . Complications were studied over an 11 year period from January 1984 to December 1994 . Setting Tertiary referral cardiothoracic centre . Patients Records of 2621 patients were analysed retrospectively . Main outcome measures Complications requiring repeat procedures occurring more than six weeks after pacemaker implantation or elective unit replacement . Results The overall rate of late complications was significantly lower after first implantation of a permanent pacemaker ( 34 cases , complication rate 1.4 % , 95 % confidence interval 0.9 % to 1.9 % ) than after elective unit replacement ( 16 cases , complication rate 6.5 % ( 3.3 % to 9.7 % ) . There were 20 cases of erosion , 18 infections , five electrode problems , and seven miscellaneous problems . Complications were more common with inexperienced operators ( 18.9 % ( 6.0 % to 31.8 % ) ) than with experienced operators ( 0.9 % ( 0.3 % to 1.5 % ) ) . Conclusions The incidence of late complications following pacemaker implantation is low and compares favourably with early complication rates . The majority are caused by erosion and infection . Patients who have undergone elective unit replacement are at particular risk
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 .