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Views And Reviews Minerva


BMJ 1998; 316 doi: (Published 02 May 1998) Cite this as: BMJ 1998;316:1398

Dual channel pacemakers are said to be superior to ventricular pacemakers on the grounds that they produce a greater improvement in symptoms and haemodynamics. They are, however, more expensive and need changing more frequently. So cardiologists will read with interest a report in the New England Journal of Medicine (1998;338;1097-104, 1147-8) of a controlled trial of the two techniques in 407 patients with an average age of 76. Patients with sinus node dysfunction did better with dual chamber pacing, but those with atrioventricular block did not. Overall the differences were small; the benefits of dual chamber pacing may not be as clear cut as its proponents believe.

Minerva has lost track of the number of ways in which data may be expressed to show the mortality associated with oral contraceptives. She found, however, that she could understand a paper in the British Journal of Family Planning (1998;24:2-6), which took a hypothetical cohort of one million women taking combined contraceptives and another of one million women using other forms of contraception. By the age of 50, there were 27 953 deaths in the controls, 465 more than in the pill users. By the age of 75, the deaths in controls, a total of 281 910, were 1360 more than in the pill users. All of these differences are small in …

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