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Evaluation Of The Two Types Of Cardiac Pacemakers Indicates Only Modest Differences In Value

Implanted cardiac pacemakers have been used to treat people with slow heart rates for more than two decades. But until recently there had never been a comprehensive evaluation made of the quality of life associated with the two different forms of the therapy.

As a result, discretion on which to use has been left to individual institutions or physicians.

Now, in the April 16 issue of The New England Journal of Medicine, researchers representing 10 different institutions report the results of a large-scale, multi-institutional clinical trial assessing the relative merits of the two forms of treatment--the single chamber (ventricular) pacemaker and the dual chamber (ventricular and atrial) pacemaker. Lee Goldman, MD, UCSF professor of medicine and chairman of the Department of Medicine, was the senior author of the study, which was led by Gervasio A. Lamas, MD, chief of the Division of Cardiology at Mount Sinai Medical Center in Miami Beach, Fla., and the University of Miami.

Not surprisingly, the researchers say, both pacemakers dramatically improved the health-related quality of life of patients. Unexpectedly, however, the researchers also determined that the slightly higher quality of life traditionally associated with dual chamber pacing was detectable only in a group of patients with a heart condition known as sinus node dysfunction. "Our study shows that both types of pacemaker make people feel much better," said Goldman. "And, when there are quality of life benefits from the more complicated dual chamber pacemakers, they are seen only in people with sinus node dysfunction. And even there, the degree of improvement is considerably more modest than we had expected."

In the study, 407 patients aged 65 and older and 60 percent male, were assessed for health-related quality of life, as measured by social function, physical ability, emotional mental health and energy, cardiac fun
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Contact: Jennifer O'Brien
jobrien@itsa.ucsf.edu
(415) 476-2557
University of California - San Francisco
16-Apr-1998


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