Which Type of Pacing for High-Grade AV Block in Elders?

For high-grade atrioventricular (AV) block, most cardiologists choose dual-chamber over single-chamber pacing. However, evidence to support this choice is lacking, particularly in elderly patients. Now, in a randomized trial conducted at 46 centers in Britain, 2021 patients (age ≥70; 57% men) with high-grade AV block received dual-chamber or single-chamber pacing. Single-chamber patients were further randomized to fixed-rate or rate-adaptive pacing; in the dual-chamber group, investigators determined programming. Patients with chronic atrial fibrillation or limited life expectancy were excluded from the study. Minimum follow-up was 3 years (median, 4.6).

The two main groups had similar rates of death (about 7% per year); atrial fibrillation …