PACE trial: More expensive pacemaker not always better

A more expensive pacemaker may be no better than its cheaper alternative, according to the recent 30-month Pacemaker Selection in the Elderly trial.1 Researchers from 29 centers looked at more than 400 pacemaker patients older than 65 who had either single- (ventricular) or dual-chamber (ventricular and atrial) pacemakers and determined both types improved quality of life, including social function, mental health and energy, and physical and emotional status. Both groups evidenced similar mortality rates and complications. Dual-chamber pacing benefited quality of life only in a subgroup of patients with sinus-node dysfunction, and then only slightly.

The single-chamber pacemaker is less expensive, easier to implant, and lasts longer that its dual-chamber alternative. Also, it creates fewer complications. The dual model mimics the normal electrical sequence of the heart, pacing the atrium first, then the ventricle.

Reference

1. Lamas GA, Orav EJ, Stambler BS, et al, for the Pacemaker Selection in the Elderly Investigators. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. N Engl J Med 1998; 338:1097-104.