Dr. Israel Carsten
The Sixth Decade of Cardiac Pacing: Still a Bonfire of New Developments
Can there be significant new developments in cardiac pacing 50 years after its introduction? Yes, as this session suggests.
In response to the question “What is new in the European pacing guidelines?”, Mauricio Gasparini from Rozzano, Italy, underscored the growing evidence that cardiac resynchronization therapy (CRT) and prevention of unnecessary right ventricular pacing may be key issues in pacing and have been addressed in the new ESC guidelines for the first time. In his presentation “Pacemaker and magnetic resonance imaging: Where are we, where do we go?”, Torsten Sommer from Bonn, Germany, reported that 17% of patients with pacemakers and ICDs have an indication for MRI, which is considered to be contraindicated. Appropriate safety programming is useful but oxygen monitoring and the presence of an electrophysiologist able to resuscitate the patient are still mandatory. In a randomized trial, the EnRhythm® system specifically designed to allow MRI showed no adverse effects of MRI.
Chu-Pak Lau from Hong-Kong, China, outlined current technical developments in his contribution “Future technologies in cardiac pacing”. New insulation materials may improve lead longevity, while leadless pacing by ultrasound is technically possible and may obviate leads. “Biological” pacemakers via stem cells or gene transfer are also promising developments.
Angelo Auricchio from Lugano, Switzerland, addressed ventricular activation in his talk “Pacing leads in cardiac resynchronization: the more the better?”. Conventional CRT leaves some myocardial areas unsynchronized. The use of an additional right ventricular lead did not show an improvement, while an additional left ventricular lead may help non-responders of conventional CRT. Philippe Mabo outlined the changes in routine pacemaker follow-up that are brought about by the introduction of “Telecardiology: the present and the future”. Technical solutions are safe and can detect life-threatening problems almost immediately. However, legal and reimbursement issues still impede this development.
In conclusion, there is still a lot of “music” in cardiac pacing and revolutionary developments can still be expected in the next years.
What's new in cardiac pacing?
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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