SINGLE CHAMBER ATRIAL-PACING - AN UNDERUSED AND COST-EFFECTIVE PACINGMODALITY IN SINUS NODE DISEASE

Objective-To determine the safety and cost effectiveness of single cha mber atrial pacing in patients with sinus node disease. Design-Retrosp ective follow up study. Setting-Tertiary referral centre. Patients-81 patients with single chamber atrial pacemakers implanted between 1992 and 1996. Main outcome measures-The development of high grade atrioven tricular block resulting in a further pacemaker procedure. The cost sa vings of changing our current pacing practice to conform with British Pacing and Electrophysiology Group guidelines. Results-During the foll ow up period, four patients (5.8%) required a further procedure to upg rade their atrial pacemaker to a dual chamber system owing to the deve lopment of high grade atrioventricular block. In 1995 and 1996, 343 pa cemakers were implanted in patients with sinus node disease; 19 (5.5%) received single chamber atrial pacemakers and 271 (79%) dual chamber pacemakers. If the current pacing practice was changed so that all pat ients received single chamber atrial pacemakers, with revision for sym ptomatic atrioventricular block, savings in excess of pound 206000 wou ld have been made in the two year period.Conclusions-Atrial pacing in patients with sinus node disease is underused. The need for patients t o undergo further procedures owing to the development of atrioventricu lar block is small and significant cost savings could be made by chang ing pacemaker practice.