evekhm/cms_iom_500 huggingface dataset:
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
Lamas, 2002Mode Selection Trial in Sinus Node Dysfunction (MOST)dual chamber (n = 1014) vs programming (ventricular n = 996)median age=74 years;52% men;sinus node dysfunctiondeath any cause or nonfatal stroke; 21.5% vs 23%, respectively;HR 0.93 95% CI 0.78-1.13; p = 0.48.median follow-up = 33 months.all death 19.7% vs 20.5% respectively, HR 0.97 95% CI 0.8-1.18.atrial fibrillation 21.4% vs 27.1% respectively, HR 0.79; 95% CI 0.66-0.94; p = 0.008.perioperative 30d complication rate 4.8% (all patients received dual chamber).Nielsen, 2011Danish Multicenter Randomized Trial on Single Lead Atrial Pacing versus Dual Chamber Pacing in Sick Sinus Syndrome (DANPACE)single lead atrial (n = 707) to dual chamber (n = 708)mean age = 73 years;35% men;sick sinus syndromedeath any cause;29.6% vs 27.3% respectively; HR 1.06 95% CI 0.88-1.29; p = 0.53.mean follow-up = 5.4 years.paroxysmal atrial fib 28.4% vs 23% respectively, HR 1.27 95% CI 1.03-1.56; p = 0.024.chronic atrial fib 11.2% vs 10.7% respectively, HR 1.02 95% CI 0.74-1.39; p = 0.93.stroke and heart failure did not differ.complications not reported.
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
Toff, 2005United Kingdom Pacing and Cardiovascular Events (UKPACE)single ventricular (n = 1009) to dual chamber (n = 1012)mean age=80 years;57% men;2ndAV block 26.1%;complete AV block 73.3%;83% symptomaticdeath all causes;mean annual mortality 7.2% vs 7.4%; respectively, HR 0.96 95% CI 0.83-1.11; p = 0.56.median follow-up = 4.6 years.no significant differences in atrial fib, heart failure, stroke/TIA/thromboembolism.annual rate atrial fib 3.0% vs 2.8% HR 1.05 95% CI 0.78-1.41).procedure complications single 3.5% vs dual 7.8%; p < 0.001.
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
Appendix CReferences Excluded from AnalysisStudy Design, Sample size (n<50)Attuel P, Pellerin D, Mugica J and Coumel P. DDD pacing: an effective treatment modality for recurrent atrial arrhythmias. Pacing Clin Electrophysiol. 1988; 11: 1647-54.Dhingra RC, Denes P, Wu D, Chuquimia R and Rosen KM. The significance of second degree atrioventricular block and bundle branch block. Observations regarding site and type of block. Circulation. 1974; 49: 638-46.Gammage M, Schofield S, Rankin I, Bennett M, Coles P and Pentecost B. Benefit of single setting rate responsive ventricular pacing compared with fixed rate demand pacing in elderly patients. Pacing Clin Electrophysiol. 1991; 14: 174-80.Kay R, Estioko M and Wiener I. Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation. Am Heart J. 1982; 103: 338-42.Ouali S, Neffeti E, Ghoul K, et al. DDD versus VVIR pacing in patients, ages 70 and over, with complete heart block. Pacing Clin Electrophysiol. 2010; 33: 583-9.Shohat-Zabarski R, Iakobishvili Z, Kusniec J, Mazur A and Strasberg B. Paroxysmal atrioventricular block: clinical experience with 20 patients. Int J Cardiol. 2004; 97: 399-405.Steinbach M, Douchet MP, Bakouboula B, Bronner F and Chauvin M. Outcome of patients aged over 75 years who received a pacemaker to treat sinus node dysfunction. Arch Cardiovasc Dis. 2011; 104: 89-96.Tachyarrhythmias, Atrial Fibrillation/Flutter, Resynchronization Therapy, Biventricular Pacing, Other ConditionsAbraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002; 346: 1845-53.
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002; 346: 1845-53.Albertsen AE, Nielsen JC, Poulsen SH, et al. Biventricular pacing preserves left ventricular performance in patients with high-grade atrio-ventricular block: a randomized comparison with DDD(R) pacing in 50 consecutive patients. Europace. 2008; 10: 314-320.Barold SS, Wyndham CR, Kappenberger LL, Abinader EG, Griffin JC and Falkoff MD. Implanted atrial pacemakers for paroxysmal atrial flutter. Long-term efficacy. Ann Intern Med. 1987; 107: 144-9.Elkayam LU, Koehler JL, Sheldon TJ, Glotzer TV, Rosenthal LS and Lamas GA. The Influence of Atrial and Ventricular Pacing on the Incidence of Atrial Fibrillation: A Meta-Analysis. Pacing Clin Electrophysiol. 2011.Fananapazir L, Cannon RO, 3rd, Tripodi D and Panza JA. Impact of dual-chamber permanent pacing in patients with obstructive hypertrophic cardiomyopathy with symptoms refractory to verapamil and beta-adrenergic blocker therapy. Circulation. 1992; 85: 2149-61.Fisher JD, Johnston DR, Furman S, Mercando AD and Kim SG. Long-term efficacy of antitachycardia pacing for supraventricular and ventricular tachycardias. Am J Cardiol. 1987; 60: 1311-6.Galve E, Sambola A, Saldana G, et al. Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study. Heart. 2010; 96: 352-6.Gillis AM, Koehler J, Morck M, Mehra R and Hettrick DA. High atrial antitachycardia pacing therapy efficacy is associated with a reduction in atrial tachyarrhythmia burden in a subset of patients with sinus node dysfunction and paroxysmal atrial fibrillation. Heart Rhythm. 2005; 2: 791-6.
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Herre JM, Griffin JC, Nielsen AP, et al. Permanent triggered antitachycardia pacemakers in the management of recurrent sustained ventricular tachycardia. J Am Coll Cardiol. 1985; 6: 206-14.Jeanrenaud X, Goy JJ and Kappenberger L. Effects of dual-chamber pacing in hypertrophic obstructive cardiomyopathy. Lancet. 1992; 339: 1318-23.Kappenberger L, Linde C, Daubert C, et al. Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group. Eur Heart J. 1997; 18: 1249-56.Kass DA, Chen CH, Curry C, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation. 1999; 99: 1567-73.Leclercq C, Cazeau S, Lellouche D, et al. Upgrading from single chamber right ventricular to biventricular pacing in permanently paced patients with worsening heart failure: The RD-CHF Study. Pacing Clin Electrophysiol. 2007; 30 Suppl 1: S23-30.Lee MA, Weachter R, Pollak S, et al. The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias. J Am Coll Cardiol. 2003; 41: 1926-32.Maron BJ, Nishimura RA, McKenna WJ, Rakowski H, Josephson ME and Kieval RS. Assessment of permanent dual-chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-PATHY). Circulation. 1999; 99: 2927-33.Nishimura RA, Trusty JM, Hayes DL, et al. Dual-chamber pacing for hypertrophic cardiomyopathy: a randomized, double-blind, crossover trial. J Am Coll Cardiol. 1997; 29: 435-41.
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Saad EB, Marrouche NF, Martin DO, et al. Frequency and associations of symptomatic deterioration after dual-chamber defibrillator implantation in patients with ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2002; 90: 79-82.Steinberg JS, Fischer A, Wang P, et al. The clinical implications of cumulative right ventricular pacing in the multicenter automatic defibrillator trial II. J Cardiovasc Electrophysiol. 2005; 16: 359-65.Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003; 107: 2932-7.Thambo JB, Bordachar P, Garrigue S, et al. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation. 2004; 110: 3766-72.Vanderheyden M, Goethals M, Anguera I, et al. Hemodynamic deterioration following radiofrequency ablation of the atrioventricular conduction system. Pacing Clin Electrophysiol. 1997; 20: 2422-8.Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002; 288: 3115-23.Zeltser D, Justo D, Halkin A, et al. Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug. J Am Coll Cardiol. 2004; 44: 105-8.Intermediate Outcomes/Other Outcomes
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Intermediate Outcomes/Other OutcomesAlbertsen AE, Nielsen JC, Poulsen SH, et al. DDD(R)-pacing, but not AAI(R)-pacing induces left ventricular desynchronization in patients with sick sinus syndrome: tissue-Doppler and 3D echocardiographic evaluation in a randomized controlled comparison. Europace. 2008; 10: 127-33.Brecker SJ, Xiao HB, Sparrow J and Gibson DG. Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy. Lancet. 1992; 340: 1308-12.Choo WK and Gupta S. The impact of NICE (UK) recommendations on outcomes of cardiac pacemaker implantations - a single-centre, district hospital experience. J Eval Clin Pract. 2011.Dorenkamp M, Breitwieser C, Morguet AJ, Seegers J, Behrens S and Zabel M. T-wave alternans testing in pacemaker patients: comparison of pacing modes and long-term prognostic relevance. Pacing Clin Electrophysiol. 2011; 34: 1054-62.Kafkas N, Patsilinakos S, Makris K, et al. Brain natriuretic peptide: a marker of cardiac dysfunction with ventricular or dual-chamber pacing. Acta Cardiol. 2011; 66: 589-94.Knight BP, Gersh BJ, Carlson MD, et al. Role of permanent pacing to prevent atrial fibrillation: science advisory from the American Heart Association Council on Clinical Cardiology (Subcommittee on Electrocardiography and Arrhythmias) and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Heart Rhythm Society. Circulation. 2005; 111: 240-3.Kristensen L, Nielsen JC, Mortensen PT, Pedersen AK and Andersen HR. Evaluation of pacemaker telemetry as a diagnostic feature for detecting atrial tachyarrhythmias in patients with sick sinus syndrome. Europace. 2004; 6: 580-5.
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Lelakowski J, Majewski J, Malecka B, Bednarek J, Stypula P and Szeglowski M. Retrospective analysis of reasons for failure of DDD pacemaker implantation in patients operated on between 1993 and 2005. Cardiol J. 2007; 14: 155-9.Linde-Edelstam C, Nordlander R, Pehrsson SK and Ryden L. A double-blind study of submaximal exercise tolerance and variation in paced rate in atrial synchronous compared to activity sensor modulated ventricular pacing. Pacing Clin Electrophysiol. 1992; 15: 905-15.Maurer G, Torres MA, Corday E, Haendchen RV and Meerbaum S. Two-dimensional echocardiographic contrast assessment of pacing-induced mitral regurgitation: relation to altered regional left ventricular function. J Am Coll Cardiol. 1984; 3: 986-91.Nahlawi M, Waligora M, Spies SM, Bonow RO, Kadish AH and Goldberger JJ. Left ventricular function during and after right ventricular pacing. J Am Coll Cardiol. 2004; 44: 1883-8.Nery PB, Fernandes R, Nair GM, et al. Device-related infection among patients with pacemakers and implantable defibrillators: incidence, risk factors, and consequences. J Cardiovasc Electrophysiol. 2010; 21: 786-90.Quirino G, Giammaria M, Corbucci G, et al. Diagnosis of paroxysmal atrial fibrillation in patients with implanted pacemakers: relationship to symptoms and other variables. Pacing Clin Electrophysiol. 2009; 32: 91-8.Rubaj A, Rucinski P, Sodolski T, et al. Comparison of the acute hemodynamic effect of right ventricular apex, outflow tract, and dual-site right ventricular pacing. Ann Noninvasive Electrocardiol. 2010; 15: 353-9.Sutton R and Bourgeois I. Cost benefit analysis of single and dual chamber pacing for sick sinus syndrome and atrioventricular block. An economic sensitivity analysis of the literature. Eur Heart J. 1996; 17: 574-82.Search Time
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Search TimeAndersen HR, Nielsen JC, Thomsen PE, et al. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet. 1997; 350: 1210-6.Kusumoto FM and Goldschlager N. Cardiac pacing. N Engl J Med. 1996; 334: 89-97.Mymin D, Mathewson FA, Tate RB and Manfreda J. The natural history of primary first-degree atrioventricular heart block. N Engl J Med. 1986; 315: 1183-7.Rasmussen K. Chronic sinus node disease: natural course and indications for pacing. Eur Heart J. 1981; 2: 455-9.Strasberg B, Amat YLF, Dhingra RC, et al. Natural history of chronic second-degree atrioventricular nodal block. Circulation. 1981; 63: 1043-9.Pacing Site, Device ProgrammingCarlson MD, Ip J, Messenger J, et al. A new pacemaker algorithm for the treatment of atrial fibrillation: results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT). J Am Coll Cardiol. 2003; 42: 627-33.Gillis AM, Purerfellner H, Israel CW, et al. Reducing unnecessary right ventricular pacing with the managed ventricular pacing mode in patients with sinus node disease and AV block. Pacing Clin Electrophysiol. 2006; 29: 697-705.Heldman D, Mulvihill D, Nguyen H, et al. True incidence of pacemaker syndrome. Pacing Clin Electrophysiol. 1990; 13: 1742-50.Hermida JS, Kubala M, Lescure FX, et al. Atrial septal pacing to prevent atrial fibrillation in patients with sinus node dysfunction: results of a randomized controlled study. Am Heart J. 2004; 148: 312-7.Israel CW, Hugl B, Unterberg C, et al. Pace-termination and pacing for prevention of atrial tachyarrhythmias: results from a multicenter study with an implantable device for atrial therapy. J Cardiovasc Electrophysiol. 2001; 12: 1121-8.
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Lamas GA, Knight JD, Sweeney MO, et al. Impact of rate-modulated pacing on quality of life and exercise capacity evidence from the Advanced Elements of Pacing Randomized Controlled Trial (ADEPT). Heart Rhythm. 2007; 4: 1125-32.Madan N and Saksena S. Long-term rhythm control of drug-refractory atrial fibrillation with "hybrid therapy" incorporating dual-site right atrial pacing, antiarrhythmic drugs, and right atrial ablation. Am J Cardiol. 2004; 93: 569-75.Nguyen CT, Moreno-Cabral CE and Mahnke CB. Pacemaker upgrade causing new-onset heart failure in a patient with complete congenital atrioventricular block. Pediatr Cardiol. 2010; 31: 106-7.Nielsen JC, Pedersen AK, Mortensen PT and Andersen HR. Programming a fixed long atrioventricular delay is not effective in preventing ventricular pacing in patients with sick sinus syndrome. Europace. 1999; 1: 113-20.Nikoo MH, Ghaedian MM, Kafi M, et al. Effects of right ventricular septal versus apical pacing on plasma natriuretic peptide levels. J Cardiovasc Dis Res. 2011; 2: 104-9.Nitardy A, Langreck H, Dietz R and Stockburger M. Reduction of right ventricular pacing in patients with sinus node dysfunction through programming a long atrioventricular delay along with the DDIR mode. Clin Res Cardiol. 2009; 98: 25-32.Olshansky B, Day JD, Moore S, et al. Is dual-chamber programming inferior to single-chamber programming in an implantable cardioverter-defibrillator? Results of the INTRINSIC RV (Inhibition of Unnecessary RV Pacing With AVSH in ICDs) study. Circulation. 2007; 115: 9-16.Saksena S, Prakash A, Hill M, et al. Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol. 1996; 28: 687-94.
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Saksena S, Prakash A, Hill M, et al. Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol. 1996; 28: 687-94.Sanfins V, Alves A, Rodrigues B, et al. RIVER: Portuguese registry to monitor unnecessary right ventricular pacing. Rev Port Cardiol. 2010; 29: 581-9.Sharma AD, Rizo-Patron C, Hallstrom AP, et al. Percent right ventricular pacing predicts outcomes in the DAVID trial. Heart Rhythm. 2005; 2: 830-4.Sulke N, Chambers J, Dritsas A and Sowton E. A randomized double-blind crossover comparison of four rate-responsive pacing modes. J Am Coll Cardiol. 1991; 17: 696-706.Sweeney MO, Bank AJ, Nsah E, et al. Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease. N Engl J Med. 2007; 357: 1000-8.Sweeney MO, Ellenbogen KA, Miller EH, Sherfesee L, Sheldon T and Whellan D. The Managed Ventricular pacing versus VVI 40 Pacing (MVP) Trial: clinical background, rationale, design, and implementation. J Cardiovasc Electrophysiol. 2006; 17: 1295-8.Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Prospective randomized study of mode switching in a clinical trial of pacemaker therapy for sinus node dysfunction. J Cardiovasc Electrophysiol. 2004; 15: 153-60.Tops LF, Schalij MJ and Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J Am Coll Cardiol. 2009; 54: 764-76.
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Veasey RA, Arya A, Silberbauer J, Sharma V, Lloyd GW, Patel NR, Sulke AN. The relationship between right ventricular pacing and atrial fibrillation burden and disease progression in patients with paroxysmal atrial fibrillation: the long-MinVPACE study. Europace. 2011 Jun;13(6):815-20. doi: 10.1093/europace/euq463. Epub 2011 Jan 5.Editorials, CommentariesConnelly DT and Steinhaus DM. Mobitz type I atrioventricular block: an indication for permanent pacing? Pacing Clin Electrophysiol. 1996; 19: 261-4.Das MK, Dandamudi G and Steiner HA. Modern pacemakers: hope or hype? Pacing Clin Electrophysiol. 2009; 32: 1207-21.El Gamal M. Atrial pacing, the forgotten pacing mode. Neth Heart J. 2008; 16: S25-7. AbstractModi S, Krahn A and Yee R. Current concepts in pacing 2010-2011: the right and wrong way to pace. Curr Treat Options Cardiovasc Med. 2011; 13: 370-84.
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Appendix DECG Grid:  Waves, Intervals, and SegmentsClinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.  Walker HK, Hall WD, Hurst JW, editors.  Boston: Butterworths; 1990.  Copyright  1990, Butterworth Publishers, a division of Reed Publishing.  NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.Figure 33.3ECG grid. Waves, intervals, segments.From: Chapter 33, ElectrocardiographyAppendix ENASPE/BPEG Generic Code for Antibradycardia, Adaptive-Rate, and Multisite PacingBritish Pacing and Electrophysiology Group. Recommendations for pacemaker prescription for symptomatic bradycardia. Report of a working party of the British Pacing and Electrophysiology Group.  Br Heart J. 1991 Aug;66(2):185-91.Bernstein AD, Daubert JC, Fletcher RD, Hayes DL, Lderitz B, Reynolds DW, Schoenfeld MH, Sutton R.  NASPE Position Statement:  The Revised NASPE/BPEG Generic Code for Antibradycardia, Adaptive-Rate, and Multisite Pacing.  J of Pacing and Clinical Electrophysiology.  Vol. 25, No. 2, February 2002.Appendix FHRS/ACCF Expert Consensus Statement Classification of RecommendationsReproduced from:Gillis AM, Russo AM, Ellenbogen KA, Swerdlow CD, Olshansky B, Al-Khatib SM, Beshai JF, McComb JM, Nielsen JC, Philpott JM, Shen WK; Heart Rhythm Society; American College of Cardiology Foundation. HRS/ACCF expert consensus statement on pacemaker device and mode selection. Developed in partnership between the Heart Rhythm Society (HRS) and the American College of Cardiology Foundation (ACCF) and in collaboration with the Society of Thoracic Surgeons. Heart Rhythm. 2012 Aug;9(8):1344-65. doi: 10.1016/j.hrthm.2012.06.026.Bibliography
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
Andersen HR, Nielsen JC, Thomsen PE, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet. 1997 Oct 25;350(9086):1210-6.Beck H, Boden WE, Patibandla S, Kireyev D, Gupta V, Campagna F, Cain ME, Marine JE.  50thAnniversary of the first successful permanent pacemaker implantation in the United States:  historical review and future directions.  Am J Cardiol. 2010 Sep 15;106(6):810-8.Bernstein AD, Camm AJ, Fletcher RD, Gold RD, Rickards AF, Smyth NP, Spielman SR, Sutton R.  The NASPE/BPEG generic pacemaker code for antibradyarrhythmia and adaptive-rate pacing and antiachyarrhythmia devices.  Pacing Clin Electrophysiol.  1987 Jul;10(4 Pt 1):794-9.Bernstein AD, Daubert JC, Fletcher RD, Hayes DL, Lderitz B, Reynolds DW, Schoenfeld MH, Sutton R.  NASPE Position Statement:  The Revised NASPE/BPEG Generic Code for Antibradycardia, Adaptive-Rate, and Multisite Pacing.  J of Pacing and Clinical Electrophysiology.  Vol. 25, No. 2, February 2002.Bernstein AD, Parsonnet V. Survey of cardiac pacing and implanted defibrillator practice patterns in the United States in 1997. Pacing Clin Electrophysiol. 2001 May;24(5):842-55.Castelnuovo E, Stein K, Pitt M, Garside R, Payne E.  The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation. Health Technol Assess 2005;9(43).Chardack WM, Gage AA, Greatbatch W.  A transistorized, self-contained, implantable pacemaker for the long-term correction of complete heart block.  Surgery.  1960 Oct;48:643-54.
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
Chardack WM, Gage AA, Greatbatch W.  A transistorized, self-contained, implantable pacemaker for the long-term correction of complete heart block.  Surgery.  1960 Oct;48:643-54.Connolly SJ, Kerr CR, Gent M, Roberts RS, Yusuf S, Gillis AM, Sami MH, Talajic M, Tang AS, Klein GJ, Lau C, Newman DM.  Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med. 2000 May 11;342(19):1385-91.Curtis LH, Al-khatib SM, Shea AM, Hammill BG, Hernandez AF, Schulman KA.  Sex differences in the use of implantable cardioverter-defibrillators for primary and secondary prevention of sudden cardiac death.  JAMA. 2007 Oct 3;298(13):1517-24.Daugherty SL, Peterson PN, Wang Y, Curtis JP, Heidenreich PA, Lindenfeld J, Vidaillet HJ, Masoudi FA; NCDR.  Use of implantable cardioverter defibrillators for primary prevention in the community; do women and men equally meet trial enrollment criteria? Am Heart J. 2009 Aug;158(2):224-9. Doi: 10.1016/j.ahj.2009.05.018.Dretzke J, Toff WD, Lip GYH, Raftery J, Fry-Smith A, Taylor RRS.  Dual chamber versus single chamber ventricular pacemakers for sick sinus syndrome and atrioventricular block. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.:CD003710. DOI: 10.1002/14651858.CD003710.pub2.Edhag O, Swahn A.  Prognosis of patients with complete heart block or arrhythmic syncope who were not treated with artificial pacemakers.  A long-term follow-up study of 101 patients.  Acta Med Scand.  1976;200(6):457-63