Dual-chamber pacing for cardiac arrhythmias: controversies in cloning the conduction system

From the outset, the art and science of cardiac pacing has been beset with a variety of problems. With the passage of time and concentrated effort in the interrelated sciences, many have been solved. We no longer are concerned with premature battery failure or leaking pulse-generator capsules, but now focus on an entirely new set of issues that beg for resolution. Foremost among these is the true role of dual-chamber pacing in the treatment of slow and fast cardiac arrhythmias of a multitude of etiologies. Secondary to that issue is the cascade of problems brought about by a burgeoning of technical capabilities, such as micro-miniaturized computing devices, complex pacemaker programmability with telemetry functions, the impact of these technologies on therapeutic indications and techniques, the proliferation of pacemaker utilization, and the summative socioeconomic implications.