Rate-responsive and dual-chamber pacemakers improve quality of life and reduce symptoms in elderly patients compared to fixed-rate or ventricular devices, though they are more costly.
Do permanent cardiac pacemakers, particularly complex modalities like rate-responsive and dual-chamber devices, improve quality of life and survival in elderly patients compared to simpler devices?
Permanent pacemakers, particularly rate-responsive and dual-chamber devices, offer quality of life and potential survival benefits in the elderly, though cost and follow-up requirements must be considered.
OBJECTIVE: To review (1) Changes in cardiac impulse generation, conduction, and ventricular filling in normal aging and disease; (2) Pacemaker technology and nomenclature; (3) Expert guidelines about pacemaker use; (4) Studies of pacemaker effectiveness and utilization. DESIGN: Articles were identified through a Medline search, review of articles' bibliographies, and contact with pacemaker manufacturer representatives for information on device features and costs. These articles were reviewed, and the relevant data are presented. RESULTS: Abnormalities in impulse generation and conduction are common in the elderly. Pacemaker use is higher in the elderly than in other population groups. Hemodynamic changes associated with aging include an increased contribution of atrial contraction to ventricular filling. Pacemakers, which maintain the synchrony between the atria and ventricles, may be particularly advantageous in the elderly for this reason. Rate-responsive ventricular pacemakers improve the quality of life compared with fixed rate devices in some patients over the age of 75. Dual-chamber, sequential pacemakers are more likely to reduce symptoms of pacemaker syndrome than ventricular pacemakers and probably also prolong survival and reduce risk of atrial fibrillation in certain groups of patients. However, dual chamber devices are more expensive and require more frequent follow-up. Pacemaker utilization can vary widely by region. Decisions about pacemakers require explicit tradeoffs between risk and quality of life on one hand and cost on the other. In many clinical situations, there is controversy as to whether pacemakers should be used. CONCLUSIONS: Pacemakers provide definite benefits to some patients, whereas in others, the likelihood of benefit is uncertain. More sophisticated devices may provide some additional benefit, but they are more costly. Further data is still required to define precisely which groups of patients substantially benefit from complex and expensive pacing modalities compared with simpler ones.
Bush et al. (Tue,) conducted a review in Cardiac impulse generation and conduction abnormalities. Permanent Cardiac Pacemakers vs. Fixed rate or ventricular pacemakers was evaluated. Rate-responsive and dual-chamber pacemakers improve quality of life and reduce symptoms in elderly patients compared to fixed-rate or ventricular devices, though they are more costly.
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