Pacemakers in the Elderly: Selection of Pacing Systems.

Abnormalities in impulse formation and conduction are common in the elderly. Changing technology has led to new pacemakers of enormous complexity and flexibility. Hemodynamic changes due to aging include a greater contribution of atrial contraction to ventricular filling. Dual-chamber pacing which maintains atrial transport, is associated with less incidence of chronic atrial fibrillation, stroke, heart failure, pacemaker syndrome, and death. Bipolar systems are free of inhibition due to pectoral myopotentials and cross talk in the case of dual-chamber pacing. Invasive electrophysiologic studies have very low risk of complications and can provide important information at the time of choosing the optimal pacing system for a specific patient. In the patient with stable atrial rhythm, pacing systems that maintain atrial transport are preferred over simple ventricular pacing.