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European Heart Journal Advance Access originally published online on October 5, 2005
European Heart Journal 2006 27(2):132-135; doi:10.1093/eurheartj/ehi591
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Pacemaker selection: time for a rethinking of complex pacing systems?

Nicola Musilli and Luigi Padeletti*

Internal Medicine and Cardiology Institute, University of Florence, V.le Morgagni 85, 50134 Florence, Italy

Received 25 March 2005; revised 22 August 2005; accepted 22 September 2005; online publish-ahead-of-print 5 October 2005.

* Corresponding author. Tel: +39 055 4277634/+39 329 4204310. E-mail address: elettrofisiologia{at}dac.unifi.it or lpadeletti{at}interfree.it

Abstract

Evidence from randomized trials indicates that the clinical benefits of dual-chamber (DDD) pacing are modest: (i) no significant differences exist between physiological pacing and single-chamber pacing in mortality and stroke; (ii) ventricular desynchronization resulting from chronic right-ventricular pacing in DDD mode, induces a significantly increased incidence of atrial fibrillation (AF) and heart failure hospitalizations; (iii) AF pacing prevention and therapy algorithms have shown a modest to minimal or absent efficacy; (iv) the widespread use of physiological pacemakers is not an economically attractive strategy. Thus, these data provide a reliable body of evidence on which to make more rationale clinical decisions for individual patients and policy decisions for health costs saving. The cheaper single-chamber AAI(R) or VVI(R) has been shown to satisfy both conditions in most cases of sinus node disease and AV block.

Key Words: Pacemakers • Trials • Atrial fibrillation • Mortality


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