In this issue of HEART, Parry et al (1) report results of a double-blind trial of pacing in elderly recurrent fallers with carotid sinus hypersensitivity (CSH). The so-called PERF-CSH trial utilized a cross-over design to determine whether dual-chamber cardiac pacing diminishes susceptibility to recurrent 'falls' in older CSH patients. Despite the encouraging findings with regard to pacing prevention of falls in the original SAFE-PACE findings, the current report indicates that pacing offers, at best, only marginal benefit. The outcome of PERF-CSH may seem to be a setback for our understanding of how to manage 'falls' in the elderly. However, the clinical problem that PERF-CSH addresses remains an important one, and the insight it provides will certainly prove valuable.
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