Pacemaker selection: time for a rethinking of complex pacing systems?
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.
Musilli
Nicola
N
Internal Medicine and Cardiology Institute, University of Florence, V.le Morgagni 85, 50134 Florence, Italy.
Padeletti
Luigi
L
D001281:Atrial Fibrillation / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D003657:Decision Making; D006801:Humans; D010138:Pacemaker, Artificial; D016032:Randomized Controlled Trials as Topic