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Related Experiment Videos

Effect of recent randomized trials on current pacing practice.

A J Solomon1, B J Gersh

  • 1Division of Cardiology, Georgetown University Medical Center, Washington, DC 20007, USA.

Cardiology in Review
|June 1, 1999
PubMed
Summary
This summary is machine-generated.

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Permanent pacemakers treat symptomatic bradycardia and other heart conditions. New research explores their use in hypertrophic cardiomyopathy, vasovagal syncope, and atrial fibrillation, showing promising results for specific patient groups.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Symptomatic bradycardia is the primary indication for permanent pacemaker implantation.
  • Atrial-based pacing (dual-chamber or atrial) is generally preferred, excluding patients with chronic atrial fibrillation.
  • Recent trials investigate novel indications and optimal pacing strategies.

Purpose of the Study:

  • To review current and emerging indications for permanent pacemaker implantation.
  • To evaluate the efficacy of pacemakers in specific cardiovascular conditions.
  • To discuss optimal pacing modalities for various patient profiles.

Main Methods:

  • Review of prospective, randomized trials evaluating new pacemaker indications.
  • Analysis of data on pacemaker use in hypertrophic cardiomyopathy, dilated cardiomyopathy, vasovagal syncope, atrial fibrillation, and long QT syndrome.

Related Experiment Videos

  • Assessment of symptomatic improvement and objective endpoints.

    • Main Results:

    • Dual-chamber pacemakers can significantly reduce left ventricular outflow tract gradients in hypertrophic cardiomyopathy, with likely placebo effect.
    • Pacemaker implantation is not routinely indicated for dilated cardiomyopathy.
    • Pacemaker therapy markedly reduces syncope in cardioinhibitory/mixed vasovagal syncope with carotid sinus hypersensitivity.
    • Pacing is indicated for atrial fibrillation with symptomatic bradycardia; dual-site atrial pacing shows promise for atrial fibrillation prevention.
    • Permanent pacemakers are crucial for symptomatic long QT syndrome, often with beta-blockers.

    Conclusions:

    • Permanent pacemakers are indicated for symptomatic bradycardia, specific cardiomyopathies, vasovagal syncope, and long QT syndrome.
    • Dual-site atrial pacing may be optimal for preventing atrial fibrillation.
    • Ongoing research continues to refine pacemaker indications and strategies.