[The best of cardiac pacing in 2002]

The year 2002 was marked by the publication of several studies for which the results have above all brought confirmation but also disappointment. One of them has even revealed a new therapeutic approach. In patients affected by sinus dysfunction the MOST study has shown the absence of superiority of DDD stimulation over VVI stimulation in respect of death and cerebral vascular accidents. However, double chamber stimulation reduces the risk of atrial fibrillation, the signs of cardiac insufficiency and slightly improves the quality of life. In the field of multisite stimulation, the MIRACLE study has in patients with moderate to severe cardiac insufficiency confirmed the results of the MUSTIC study with a significant improvement relating to the 6 minute walking test, the NYHA class, the quality of life, and the ejection fraction. The 12 and 24 month follow up of patients included in the MUSTIC study has shown the persistence of the observed short term benefit. Hopes for prevention of atrial fibrillation by atrial stimulation piloted by special algorithms have not been confirmed by the results of the PIPAF study except for patients with predominantly spontaneous AV conduction. The significance of stimulation in disabling vaso-vagal syncope has been questioned by the publication of the results of the VPS 2 study. Cardiac stimulation could in the future constitute a new treatment for sleep apnoea syndrome because it has been reported that atrial overdrive significantly reduces the amount of central or obstructive apnoea.