Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

摘要: BACKGROUND Bradycardia [resting heart rate below 60 beats per minute (b.p.m.)] can be caused by conditions affecting the natural pacemakers of heart, such as sick sinus syndrome (SSS) and atrioventricular (AV) blocks. People suffering from bradycardia may present with palpitations, exercise intolerance fainting. The only effective treatment for patients symptomatic is implantation a permanent pacemaker. OBJECTIVE To appraise clinical effectiveness cost-effectiveness dual-chamber compared single-chamber atrial treating in people SSS no evidence AV block. DATA SOURCES All databases (MEDLINE, EMBASE, Cochrane Central Register Controlled Trials, Health Technology Assessment database, NHS Economic Evaluations Database) were searched inception to June 2014. METHODS A systematic review economic literature was carried out accordance general principles published Centre Reviews Dissemination. Randomised controlled trials (RCTs) evaluating evaluations included. Pairwise meta-analysis out. de novo model developed. RESULTS Of 493 references, six RCTs included review. results predominantly influenced largest trial DANPACE. Dual-chamber pacing associated statistically significant reduction reoperation [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.36 0.63] pacing. difference primarily because development block requiring upgrade device. risk paroxysmal fibrillation also reduced (OR 0.75, CI 0.59 0.96). No found between modes mortality, failure, stroke, chronic or quality life. However, developing failure vary age shows that are more expensive than devices, resulting base-case incremental (ICER) £6506. ICER remains £20,000 probabilistic sensitivity analysis, structural analysis most scenario analyses one-way analyses. have an impact on decision use pacemakers. Results based (> 75 years ≤ 75 years) indicate dominate (i.e. less effective) older patients, whereas dominated younger patients. these subgroup should treated caution. CONCLUSIONS In without impaired conduction, appear cost-effective complete lack tools identify at high condition argue pacemaker programmed minimise unnecessary ventricular considerations made around which depend STUDY REGISTRATION This study registered PROSPERO CRD42013006708. FUNDING National Institute Research programme.