The Next 5 Years in Cardiac Pacemakers: A Preview

Abstract

Advances in cardiac pacing continue at an astounding rate, and, occasionally, technologic capabilities are developed almost faster than they can be implemented clinically. The development and implementation of single- and dual-chamber rate-adaptive pacemakers have been the major thrusts in cardiac pacing in recent years. Rate-adaptive pacing will continue to be of primary interest in the future as investigators search for the perfect "sensor" and attempt to develop rate-adaptive pacemakers with multiple sensors. The "smart" pacemaker--that is, an autoprogramming, autodiagnostic device--will also be refined. The ultimate "smart" pacemaker would be capable of automatically adjusting output and sensing factors as well as altering the rate-adaptive variables and even changing the pacing mode in response to variations in the underlying rhythm. Other aspects of cardiac pacing that will be actively investigated include new low-threshold pacing lead designs, refinements of the single-lead pacing system capable of P-synchronous pacing, and diagnostic information that can be derived from sensors used for rate-adaptive pacing.