Current developments in cardiac rhythm management devices

Abstract

Endocardial pacing has experienced a tremendous evolution since the 1960s. A lot of challenges associated with pacemaker and ICD devices have already been successfully targeted. However, a relevant number of problems have not been solved to date. Not all patients with accepted indication for biventricular pacing have benefited from cardiac resynchronisation therapy (CRT) despite extensive efforts to reduce the rate of non-responders. Current strategies to optimize lead position, multipolar left-ventricular (LV) pacing leads, new strategies to gain access to the left-ventricle (atrial transseptal or ventricular transseptal access) or alternative right-ventricular (septal, His bundle pacing) pacing sites, and "leadless" LV pacing have the potential to increase response to device-based heart-failure treatment. The opportunity of pacemaker and ICD remote monitoring led to relevant improvements in therapy management by timely detection of events requiring medical or invasive interventions (e.g., external cardioversion of atrial fibrillation, increasing effective biventricular pacing, catheter ablation of ventricular tachycardias, or changes in heart-failure medication). Two completely endocardial leadless "all-in-one" pacemaker systems recently became available. Besides these innovations, new "synergistic" therapy concepts combining catheter ablation and device therapy proved to affect clinical endpoints (e.g., ATAAC study and CASTLE-AF study).

Differences in management of telemedicine alerts on weekdays and public holidays: Results from the OptiLink heart failure trial

“…12 Moreover, RM may facilitate optimized device programming and function. 13,14 In patients with CRT devices, RM can help to early recognize biventricular pacing rates of ≤90%, which are associated with increased mortality compared with higher biventricular pacing rates. 15 Furthermore, RM ensures proper ICD function without the need for in-clinic visits.…”

<p>Cardiac Electronic Devices: Future Directions and Challenges</p>

“…16 New strategies, such as leadless pacing, optimization of LV-lead position, multipolar LV pacing, alternative right ventricular (RV) pacing, eg, His-bundle pacing or cardiac contractility modulation, may positively impact on further CIED therapy. 17 MORE-CRT MPP-PHASE II (NCT02006069) 18 is an RCT to assess the impact of multipoint pacing in nonresponders to 6 months of standard biventricular pacing. Preferential LV-only pacing is also considered an alternative to standard biventricular pacing.…”

Sex differences in optimal atrioventricular delay in patients receiving cardiac resynchronization therapy

“…Ideally, optimization should be individualized. However, given the multitude of AV optimization methods without a clearly defined gold standard, interpretation of AV optimization data is difficult and the best method and appropriate timing for optimizing and assessing AV delays remains to be defined [14,15]. Nevertheless, a working understanding of AV optimization is important for all physicians who manage these patients.…”