background\ud In the treatment of atrioventricular block, dual-chamber cardiac pacing is thought to\ud confer a clinical benefit as compared with single-chamber ventricular pacing, but the\ud supporting evidence is mainly from retrospective studies. Uncertainty persists regarding\ud the true benefits of dual-chamber pacing, particularly in the elderly, in whom it is\ud used less often than in younger patients.\ud methods\ud In a multicenter, randomized, parallel-group trial, 2021 patients 70 years of age or\ud older who were undergoing their first pacemaker implant for high-grade atrioventricular\ud block were randomly assigned to receive a single-chamber ventricular pacemaker\ud (1009 patients) or a dual-chamber pacemaker (1012 patients). In the singlechamber\ud group, patients were randomly assigned to receive either fixed-rate pacing\ud (504 patients) or rate-adaptive pacing (505 patients). The primary outcome was death\ud from all causes. Secondary outcomes included atrial fibrillation, heart failure, and a composite\ud of stroke, transient ischemic attack, or other thromboembolism.\ud results\ud The median follow-up period was 4.6 years for mortality and 3 years for other cardiovascular\ud events. The mean annual mortality rate was 7.2 percent in the single-chamber\ud group and 7.4 percent in the dual-chamber group (hazard ratio, 0.96; 95 percent confidence\ud interval, 0.83 to 1.11). We found no significant differences between the group\ud with single-chamber pacing and that with dual-chamber pacing in the rates of atrial\ud fibrillation, heart failure, or a composite of stroke, transient ischemic attack, or other\ud thromboembolism.\ud conclusions\ud In elderly patients with high-grade atrioventricular block, the pacing mode does not\ud influence the rate of death from all causes during the first five years or the incidence of\ud cardiovascular events during the first three years after implantation of a pacemaker
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