Abstract
Objective—To determine the safety and cost effectiveness of single chamber atrial pacing in patients with sinus node disease. Design—Retrospective 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 atrioventricular block resulting in a further pacemaker procedure. The cost savings of changing our current pacing practice to conform with British Pacing and Electrophysiology Group guidelines. Results—During the follow up period, four patients (5.8%) required a further procedure to upgrade their atrial pacemaker to a dual chamber system owing to the development of high grade atrioventricular block. In 1995 and 1996, 343 pacemakers 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 patients received single chamber atrial pacemakers, with revision for symptomatic atrioventricular block, savings in excess of £206 000 would have been made in the two year period. Conclusions—Atrial pacing in patients with sinus node disease is underused. The need for patients to undergo further procedures owing to the development of atrioventricular block is small and significant cost savings could be made by changing pacemaker practice. Keywords: sinus node disease; atrial pacing; cost effectiveness
Full Text
The Full Text of this article is available as a PDF (68.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aggarwal R. K., Ray S. G., Connelly D. T., Coulshed D. S., Charles R. G. Trends in pacemaker mode prescription 1984-1994: a single centre study of 3710 patients. Heart. 1996 May;75(5):518–521. doi: 10.1136/hrt.75.5.518. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Andersen H. R., Thuesen L., Bagger J. P., Vesterlund T., Thomsen P. E. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet. 1994 Dec 3;344(8936):1523–1528. doi: 10.1016/s0140-6736(94)90347-6. [DOI] [PubMed] [Google Scholar]
- Cardinal D. S., Connelly D. T., Steinhaus D. M., Lemery R., Waters M., Foley L. Cost savings with nonthoracotomy implantable cardioverter-defibrillators. Am J Cardiol. 1996 Dec 1;78(11):1255–1259. doi: 10.1016/s0002-9149(96)00606-6. [DOI] [PubMed] [Google Scholar]
- Carisma M. B., Manalo J. M., Chua W. T. Atrioventricular conduction in sick sinus syndrome. Pacing Clin Electrophysiol. 1988 Nov;11(11 Pt 2):1636–1640. doi: 10.1111/j.1540-8159.1988.tb06287.x. [DOI] [PubMed] [Google Scholar]
- Charles R. G., McComb J. M. Systematic trial of pacing to prevent atrial fibrillation (STOP-AF). Heart. 1997 Sep;78(3):224–225. doi: 10.1136/hrt.78.3.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rosenqvist M., Brandt J., Schüller H. Atrial versus ventricular pacing in sinus node disease: a treatment comparison study. Am Heart J. 1986 Feb;111(2):292–297. doi: 10.1016/0002-8703(86)90142-0. [DOI] [PubMed] [Google Scholar]
- Rosenqvist M., Brandt J., Schüller H. Long-term pacing in sinus node disease: effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J. 1988 Jul;116(1 Pt 1):16–22. doi: 10.1016/0002-8703(88)90244-x. [DOI] [PubMed] [Google Scholar]
- Rosenqvist M., Obel I. W. Atrial pacing and the risk for AV block: is there a time for change in attitude? Pacing Clin Electrophysiol. 1989 Jan;12(1 Pt 1):97–101. doi: 10.1111/pace.1989.12.p1.97. [DOI] [PubMed] [Google Scholar]
- Sutton R., Bourgeois I. Cost benefit analysis of single and dual chamber pacing for sick sinus syndrome and atrioventricular block. An economic sensitivity analysis of the literature. Eur Heart J. 1996 Apr;17(4):574–582. doi: 10.1093/oxfordjournals.eurheartj.a014911. [DOI] [PubMed] [Google Scholar]
- Sutton R., Kenny R. A. The natural history of sick sinus syndrome. Pacing Clin Electrophysiol. 1986 Nov;9(6 Pt 2):1110–1114. doi: 10.1111/j.1540-8159.1986.tb06678.x. [DOI] [PubMed] [Google Scholar]
- Swiatecka G., Sielski S., Wilczek R., Jackowiak D., Kubica J., Raczak G. Atrioventricular conduction disturbances in patients with sinoatrial node disease and atrial pacing. Pacing Clin Electrophysiol. 1992 Nov;15(11 Pt 2):2074–2076. doi: 10.1111/j.1540-8159.1992.tb03024.x. [DOI] [PubMed] [Google Scholar]
- Zanini R., Facchinetti A. I., Gallo G., Cazzamalli L., Bonandi L., Dei Cas L. Morbidity and mortality of patients with sinus node disease: comparative effects of atrial and ventricular pacing. Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):2076–2079. doi: 10.1111/j.1540-8159.1990.tb06945.x. [DOI] [PubMed] [Google Scholar]
