[The best of cardiac pacing in 2004]

The year 2004 saw the publication of the results of the COMPANION and PAVE studies concerning cardiac pacing. The former underlined, if it was still necessary, the direct relationship between pacing and rhythmology in terms of sudden death due to rhythm disturbances in cardiac failure. COMPANION attempted to discover whether, in severe cardiac failure with intraventricular conduction defects, the addition of multisite pacing either with or without defibrillation is liable to alter the combined risk of death and hospital episodes compared with optimal drug therapy alone. This study confirmed the advantages of resynchronisation pacing already observed in MUSTIC, MIRACLE, InSync and CONTAK CD: retarded progression of cardiac failure, reduction in the number of hospitalisations and functional improvement. Adding defibrillation to anti-bradycardial resynchronisation pacing improved the survival, but only slightly so. On the other hand, the size of the subgroups did not allow any conclusions to be drawn about function and aetiology of cardiac failure, whether ischaemic or not. The PAVE study allowed comparison between biventricular pacing and right ventricular pacing alone in patients in NYHA class II or III, with atrial fibrillation for more than one month and having undergone elective ablation of the nodo-Hissian pathway. The results gave confirmation of the harmful effects of pacing at the apex of the right ventricle in pacing-dependent patients. On the technological front, there was confirmation that probes designed for left ventricular stimulation are stable and increasingly easy to use thanks to a new configuration and the use of bipolar. Finally, telecardiology has started to proliferate and evaluation of its applications is under way, even though its clinical use is confirmed on a daily basis.