Cardiac rhythm disorders: problems of the present, challenges for the future

Arrhythmology has become a well-confirmed subspecialty in cardiology. Many different fields of rhythm disorders are rapidly and constantly evolving. New and more specific oriented antiarrhythmic drugs are under evaluation, especially for the treatment of atrial fibrillation. Sudden cardiac death can be prevented by implantable defibrillators but precise selection of patients at risk and the cost remain still a major health problem. We also are unable at present to treat the substrate and to prevent the occurrence of the lethal arrhythmias which are responsible for sudden cardiac death. Pacemakers are widely used for the treatment of bradycardia but other indications are emerging like the treatment of advanced heart failure through resynchronization by biventricular pacing, as well as remote pressure monitoring in patients suffering from cardiac insufficiency. Cell therapy might one day replace pacemaker devices by correcting the failing automaticity or conduction of the heart. Atrial fibrillation is the most common arrhythmia for which ablation techniques might appear as a definitive treatment possibility but technical improvements are still awaited.