OBJECTIVE: To estimate the economic and health impact of managing bradycardia by implanting a dual chamber pacemaker equipped with a new algorithm (Adapta) to avoid unnecessary right ventricular pacing compared to a standard dual chamber pacemaker (DDDR) in Sweden. The algorithm allows the pacemaker to provide atrial pacing, and switch to dual-chamber pacing whenever needed. This may lower the risk of developing heart failure or atrial fibrillation. METHODS: A life-time discrete event simulation was developed to follow a patient's course after implantation with a pacemaker. Pairs of identical patients are created, one receives Adapta, the other DDDR. Each patient may develop post-operative complications, heart failure, atrial fibrillation (which may become chronic and require anticoagulants) or have a stroke. Risks for these events depend on cumulative time exposed to ventricular pacing and patient's characteristics based on published data from the MOST trial. Life expectancy is assumed to be identical for both cohorts of patients. Distributions of ventricular pacing are based on data collected during trials of these devices. Direct medical costs drawn from published NORD-DRG payments and physician, laboratory and medication tariffs are reported in 2005 SEK and discounted at 3%. RESULTS: Average life expectancy post-implantation was found to be 11.8 years for both groups. Discounted costs over life-time were about SEK200,000 (€21,220) per patient;. Despite the higher initial cost of Adapta, mean additional cost was only SEK13,430 (€1,425) per patient. Adapta is predicted to increase QALY by a mean 0.23 years, yielding an incremental cost-effectiveness ratio of SEK45,961/QALY (€4,878/QALY). Sensitivity analyses showed results were consistent over a wide range of values. CONCLUSION: Based on these discrete event simulations estimates, Adapta is predicted to provide additional health benefits for an attractive value for patients with sinoatrial-node disease or intermittent atrioventricular block.