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European Heart Journal Advance Access published online on October 5, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi591
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received March 25, 2005
Revised August 22, 2005
Accepted September 22, 2005

Current opinion

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

Nicola Musilli 1 and Luigi Padeletti 1*

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

* To whom correspondence should be addressed.
Luigi Padeletti, E-mail: elettrofisiologia{at}dac.unifi.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.

Keywords: Pacemakers; Trials; Atrial fibrillation; Mortality.
The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.
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