Abstract
We read with interest the article by Choo WK et al. in the June edition of the Journal (WK Choo, L Tilling, S Gupta. The selection of pacing modalities according to NICE recommendations. J R Coll Physicians Edinb 2009; 39:113–6). In their study they correctly state NICE guidelines currently recommend dual-chamber pacemakers for those with high-degree atrioventricular (AV) block, and their current practice reflects this. It is noteworthy that the UKPACE investigators randomised 2,021 patients over the age of 70 years with second- or third-degree AV block to a single-chamber pacemaker (n = 1,009) or dual-chamber pacemaker (n = 1,012) and followed them up for a median of 4.6 years.1 They found no significant clinical benefit from dual-chamber pacemaker, but in fact an increased risk of complications in the dual-chamber group. The authors conclude that in subjects older than 70 years of age with high degree AV block, single-chamber pacemakers are warranted.
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