[The best of 2001. Heart stimulation]

Despite the profusion of articles reported in 2001 related to cardiac stimulation, only 5 will be analysed in this review. The choice which has guided this arbitrary selection is the significance of the results for all cardiologists and not exclusively for a group of specialists. Cardiac stimulation continues advancing little by little in the treatment of severe cardiac insufficiency in patients with a complete left branch block. This year the MIRACLE study takes the limelight. Its very clear protocol (stimulation in one group compared to no stimulation in the other) reaches a conclusion which can be considered as indisputable given the large number of patients included: biventricular stimulation significantly improves the functional state of patients at 6 months. In the framework of incapacitating reflex syncope a third randomised study on highly selected patients confirms the indication for this special therapy, which is cardiac stimulation in this situation, even when it is compared with pharmacological "therapy" (betablockade). Syncope, supplying the greatest indication for stimulation, has indisputably made a "breakthrough" in 2001 with the publication of the first recommendations on the subject by a working group of the European Society of Cardiology and thanks to the publication of 2 studies which used implantable Holters to try to clarify their mechanism and to improve the management of patients.