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 .
Cost-effectiveness of physiologic pacing: results of the Canadian Health Economic Assessment of Physiologic Pacing.
OBJECTIVES The purpose of this study was to determine the cost-effectiveness of physiologic pacemakers . BACKGROUND The Canadian Trial of Physiologic Pacing ( CTOPP ) was a large r and omized trial that evaluated the efficacy of physiologic pacing compared with ventricular pacing . CTOPP also included a prospect i ve cost-effectiveness sub study . METHODS Re source usage and costs were collected from a subset of 472 patients ( of 1,094 ) who received a physiologic pacemaker and 586 ( of 1,474 ) who received a ventricular pacemaker .  Costs included initial pacemaker implantation and all health care follow-up costs over a follow-up of 5.2 years . Costs are reported in 2004 Canadian dollars ( 1 Canadian dollar = 0.76 US dollars ) , with adjustments for censoring . Incremental cost-effectiveness was estimated as the ratio of the difference ( treatment-control ) in mean cost to the difference in life expectancy ( mean survival ) , with costs and effects discounted at 3 % per year . RESULTS Over a mean follow-up of 3.1 years , physiologic pacing was associated with a gain of 0.01 life-years . This benefit increases to 0.25 life-years in the subgroup of patients with an intrinsic ( unpaced ) heart rate < or = 60 bpm . Physiologic pacing was more expensive than ventricular ( 16,833 Canadian dollars vs 13,857 US dollars ) , largely because of the increased cost of dual-chamber devices . Among all sub study patients , the incremental cost-effectiveness of physiologic pacing is 297,600 Canadian dollars per life-year gained ; however , this value falls to 16,343 Canadian dollars in patients with an intrinsic heart rate > 60 . CONCLUSIONS In the short term , a strategy of routine implantation of physiologic pacemakers is not cost-effective by currently accepted st and ards . The selective use of these devices in patients likely to be pacemaker dependent appears to be cost-effective . Further studies with longer follow-up and which consider the benefit of reducing nonfatal cardiac events would be valuable
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 .