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The future of cardiac pacing

ESC Congress 2010

Arrhythmias and Device Therapy

Cardiac pacing is one of the most successful therapies ever implemented in medicine. However, there are still unsolved issues such as palliating bradycardia with an implantable device subject to deterioration and pacemaker lead related problems. In addition, these devices provide new opportunities to monitor several biomedical parameters, either in hospital or remotely from the patient’s home, which may have a significant impact on both clinical management and cost.

Dr. Michael Rosen from New York reviewed the current status of research about biological pacemakers. Several approaches have been explored, myocyte genetic modification and stem cell implantation being the most prominent for developing a biological pacemaker. The preliminary results are promising and no tumoral or proarrhythmia adverse effects have been found. However, one of the main problems is cellular migration from the implantation site and cellular encasement within a polymer matrix with the aid of nanotechnology has shown good results.

The second presentation was given by Dr. David Benditt from Minneapolis and focused on leadless pacing. The main advantages of this technique over conventional lead pacing are avoiding the potential risk of lead and connector failure as well as patient aesthetics. However, associated disadvantages are potential communication interferences in dual chamber devices, the size of the sheath used for implantation of the pacemaker-electrode compound, and leading with electrode repositioning and replacement.

The third speaker, Dr. Emmanuelle Simantirakis from Heraklion, Greece, reviewed present and future biological parameters which can be monitored by pacemakers. Some of them can detect signs of heart failure up to 15 days prior to clinical manifestation. He also showed that the device can be used even to diagnose and follow patients with sleep-apnea syndrome and myocardial ischemia.

Finally, Dr. Massimo Santini from Rome discussed the current situation and potential uses of cardiac rhythm device remote monitoring. He presented own data on the potential reduction in thrombo-embolic events by early atrial fibrillation diagnosis. This technology is associated with roughly a 40% decrease in hospital follow-up visits and physician work time without affecting safety and a 60% decrease in patient transportation and hospital costs.




The future of cardiac pacing
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.