[The best of cardiac pacing in 2005]

In 2005, the main subject of interest in the field of pacing was cardiac resynchronisation. The results of CARE-HF (Cardiac Resynchronisation on Morbidity and Mortality in Heart Failure), a large multicentre trial, were published. The investigators set out to establish whether resynchronisation pacing had a favourable effect on morbidity and mortality in patients with advanced cardiac failure and desynchronised compared with an identical population treated medically. The results showed that resynchronisation decreased the interventricular desynchronisation, decreased mitral regurgitation and, above all, improved symptoms and quality of life with a reduction in the incidence of complications and the risk of death. This publication is too recent for evaluation of the eventual repercussions of these results on the implantation of resynchronising pacemakers in France. The indication recommended by the scientific societies is still based on criteria which do not take echocardiographic data into account. However, the recommendations will probably change in the near future when the conclusions of trials currently under way, are published. From the technical point of view, the advances in cardiac pacing were mainly the new algorithms which avoid inappropriate ventricular stimulation of dual chamber pacemakers. It is well known that patients implanted with dual chamber pacemakers may, despite optimal adjustment of pacing parameters, have ineffective ventricular stimulation as the impulse falls in the phase of spontaneous ventricular depolarisation or effective but absolutely valueless. Several manufactures now propose pacemakers with algorithms which "search" for ventriculogrammes in order to avoid these situations of inadequate stimulation. Their efficacy has been demonstrated. Finally, in 2005, the diffusion of defibrillators equipped with a resynchronisation function has been confirmed. The conclusions of the COMPANION trial have been influential in promoting this usage although the results are mainly observed abroad.