Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker Selection in the Elderly Investigators.
BACKGROUND
Standard clinical practice permits the use of either single-chamber ventricular pacemakers or dual-chamber pacemakers for most patients who require cardiac pacing. Ventricular pacemakers are less expensive, but dual-chamber pacemakers are believed to be more physiologic. However, it is not known whether either type of pacemaker results in superior clinical outcomes.


METHODS
The Pacemaker Selection in the Elderly study was a 30-month, single-blind, randomized, controlled comparison of ventricular pacing and dual-chamber pacing in 407 patients 65 years of age or older in 29 centers. Patients received a dual-chamber pacemaker that had been randomly programmed to either ventricular pacing or dual-chamber pacing. The primary end point was health-related quality of life as measured by the 36-item Medical Outcomes Study Short-Form General Health Survey.


RESULTS
The average age of the patients was 76 years (range, 65 to 96), and 60 percent were men. Quality of life improved significantly after pacemaker implantation (P<0.001), but there were no differences between the two pacing modes in either the quality of life or prespecified clinical outcomes (including cardiovascular events or death). However, 53 patients assigned to ventricular pacing (26 percent) were crossed over to dual-chamber pacing because of symptoms related to the pacemaker syndrome. Patients with sinus-node dysfunction, but not those with atrioventricular block, had moderately better quality of life and cardiovascular functional status with dual-chamber pacing than with ventricular pacing. Trends of borderline statistical significance in clinical end points favoring dual-chamber pacing were observed in patients with sinus-node dysfunction, but not in those with atrioventricular block.


CONCLUSIONS
The implantation of a permanent pacemaker improves health-related quality of life. However, the quality-of-life benefits associated with dual-chamber pacing as compared with ventricular pacing are observed principally in the subgroup of patients with sinus-node dysfunction.
Lamas
G A
GA
Division of Cardiology, Mount Sinai Medical Center, and the University of Miami School of Medicine, Miami Beach, Fla 33140, USA.
Orav
E J
EJ
Stambler
B S
BS
Ellenbogen
K A
KA
Sgarbossa
E B
EB
Huang
S K
SK
Marinchak
R A
RA
Estes
N A
NA
Mitchell
G F
GF
Lieberman
E H
EH
Mangione
C M
CM
Goldman
L
L
D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000517:prevention & control / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006327:Heart Block / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011788:Quality of Life; D016037:Single-Blind Method; D016019:Survival Analysis; D016896:Treatment Outcome