Pacemaker selection: Time for a rethinking of complex pacing systems?

Nicola Musilli, Luigi Padeletti

Research output: Contribution to journalArticlepeer-review


Evidence from randomized trials indicates that the clinical benefits of dual-chamber (DDD) pacing are modest: (i) no significant differences exist between physiological pacing and single-chamber pacing in mortality and stroke; (ii) ventricular desynchronization resulting from chronic right-ventricular pacing in DDD mode, induces a significantly increased incidence of atrial fibrillation (AF) and heart failure hospitalizations; (iii) AF pacing prevention and therapy algorithms have shown a modest to minimal or absent efficacy; (iv) the widespread use of physiological pacemakers is not an economically attractive strategy. Thus, these data provide a reliable body of evidence on which to make more rationale clinical decisions for individual patients and policy decisions for health costs saving. The cheaper single-chamber AAI(R) or VVI(R) has been shown to satisfy both conditions in most cases of sinus node disease and AV block.

Original languageEnglish
Pages (from-to)132-135
Number of pages4
JournalEuropean Heart Journal
Issue number2
Publication statusPublished - Jan 2006


  • Atrial fibrillation
  • Mortality
  • Pacemakers
  • Trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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