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

Abstract

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2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…Approximately a quarter of patients with either sinus node disease or atrioventricular block develop "pacemaker syndrome" with VVI pacing usually associated with retrograde (ventricular to atrial) conduction, which in turn is associated with a reduction in the quality of life [14]. In crossover trials, symptoms of pacemaker syndrome (dyspnea, dizziness, palpitations, pulsations, and chest pain) were reduced by reprogramming to a dual-chamber mode [14].…”

“…In patients with acquired atrioventricular block, large randomized parallel trials were unable to demonstrate the superiority of dual-chamber pacing over ventricular pacing with regard to hard clinical endpoints of mortality and morbidity [4,[6][7][8]. The benefit of dualchamber over ventricular pacing is primarily due to the avoidance of pacemaker syndrome and to improved exercise capacity [14]. Even if it is a softer endpoint, pacemaker syndrome is associated with a reduction in quality of life that justifies the preference for dual-chamber pacing when reasonable; thus, there is strong evidence for the superiority of dual-chamber pacing over ventricular pacing that is limited to symptom improvement.…”

“…It is of note that most information on pacing modes has been collected from pacemaker patients, and these patients are clinically distinct from ICD recipients. Dual-chamber pacing (atrial and ventricular) has been compared with single-chamber pacing (atrial or ventricular) in patients with bradycardia in 5 multicenter, parallel, randomized trials, in 1 meta-analysis of randomized trials, and in 1 systematic review that also included 30 randomized crossover comparisons and 4 economic analyses [3][4][5][6][7][8][9]. Meta analyses comparing dual-chamber to single-chamber ICDs did not evaluate pacing modes [10,11].…”

2013 Esc Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

“…Двухкамер-ная электростимуляция сравнивалась с однокамерной (желудочковой и предсердной) в 5 многоцентровых, параллельных, рандомизированных исследованиях [3,[11][12][13][14], одном мета-анализе рандо мизированных исследований [2] и в одном систематическом обзоре, который включал 30 рандомизированных перекрё-стных сравнений и 4 экономических анализа [15]. Эти результаты можно суммировать следующим образом (табл.…”

“…Превосходство двухкамер-ной электростимуляции над однокамерной в основном обусловлено устранением синдрома ЭКС, возникающего более чем у четверти пациен-тов с АВБ, и улучшением переносимости физиче-ской нагрузки [15]. Этот эффект наблюдался в 26 перекрёстных исследованиях [15].…”