QUALITY-OF-LIFE AND CLINICAL OUTCOMES IN ELDERLY PATIENTS TREATED WITH VENTRICULAR PACING AS COMPARED WITH DUAL-CHAMBER PACING

Background Standard clinical practice permits the use of either single -chamber ventricular pacemakers or dual-chamber pacemakers for most pa tients who require cardiac pacing. Ventricular pacemakers are less exp ensive, but dual-chamber pacemakers are believed to be more physiologi c. However, it is not known whether either type of pacemaker results i n superior clinical outcomes. Methods The Pacemaker Selection in the E lderly study was a 30-month, single-blind, randomized, controlled comp arison of ventricular pacing and dual-chamber pacing in 407 patients 6 5 years of age or older in 29 centers. Patients received a dual-chambe r pacemaker that had been randomly programmed to either ventricular pa cing or dual-chamber pacing. The primary end point was health-related quality of life as measured by the 36-item Medical Outcomes Study Shor t-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 li fe improved significantly after pacemaker implantation (P<0.001), but there were no differences between the two pacing modes in either the q uality of life or prespecified clinical outcomes (including cardiovasc ular events or death). However, 53 patients assigned to ventricular pa cing (26 percent) were crossed over to dual-chamber pacing because of symptoms related to the pacemaker syndrome. Patients with sinus-node d ysfunction, 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 stat istical significance in clinical end points favoring dual-chamber paci ng were observed in patients with sinus-node dysfunction, but not in t hose with atrioventricular block. Conclusions The implantation of a pe rmanent pacemaker improves health-related quality of life. The quality -of-life benefits associated with dual-chamber pacing as compared with ventricular pacing are observed principally in the subgroup of patien ts with sinus-node dysfunction. (C) 1998, Massachusetts Medical Societ y.