Cardiac Pacing - Past, Present and Future

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Abstract

Introduction
Cardiac pacing in humans with implantable devices began on 8 October 1958, when Professor ─éÔÇĞke Senning implanted the first pacemaker in a 43-year old Swedish engineer at Karolinska Hospital in Stockholm, Sweden. 1Today, it is estimated that about three million people worldwide have a pacemaker and each year, about 600,000 pacemakers are implanted. The objective of this article is to give an overview about what can be considered to be standard pacemaker therapy in developed countries and what might be expected from this therapy in the future.

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Pacemaker Therapy Today

The heart’s ‘natural’ pacemaker is called the sinoatrial node or sinus node (see Figure 1). It produces the electrical impulses that cause the heart to beat. These impulses travel down specific electrical pathways to reach the ventricles.

Figure 1: Schematic Illustration of the Heart and its Structures

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Heart rhythm problems occur when the natural pacemaker is defective1 or when the heart’s electrical pathways are blocked, 2 causing the heartbeat to be too slow.

The most frequent rhythm disorders are the sick sinus syndrome, if the sinus node is too slow; and the first, second or third degree atrioventricular (AV) block, if electrical pathways are blocked. The resulting slow heart rate, below 50 beats per minute, is called bradycardia and usually causes symptoms such as fainting, or dizzy spells. These symptoms require therapy: in this case, the implantation of a permanent cardiac pacemaker.

Today, there is general agreement about the symptoms and findings that should be present to justify pacemaker implantation. These agreements have been summarised in pacemaker guidelines, e.g. the joint American College of Cardiology (ACA), American Hospital Association (AHA) and North American Society of Pacing and Electrophysiology (NASPE) guidelines, which have recently been updated. 2

The next question to be answered is what kind of pacemaker device should be chosen in an individual patient. Basically, three different kinds of pacemaker systems are available:

  • the single-chamber ventricular pacemaker (see Figure 2);

Figure 2: Schematic Illustration of a Single-chamber Ventricular Pacemaker

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  • the single-chamber atrial pacemaker (see Figure 3); and

Figure 3: Schematic Illustration of a Singlechamber Atrial Pacemaker

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  • the dual-chamber, AV universal pacemaker (see Figure 4).

Figure 4: Schematic Illustration of a Dual Chamber Pacemaker

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All the available guidelines recommend using a pacemaker device with atrial contribution – i.e. a single-chamber atrial or dual-chamber pacemaker – whenever possible.

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References

 

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