Current developments in cardiac rhythm management devices.

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Device Technology

Background:

• Endocardial pacing has evolved significantly since the 1960s, addressing many pacemaker and implantable cardioverter-defibrillator (ICD) challenges.
• Despite advancements, challenges remain, particularly in cardiac resynchronisation therapy (CRT) where not all patients benefit, leading to a significant rate of non-responders.

Purpose of the Study:

• To review current and emerging strategies in endocardial pacing aimed at improving outcomes for heart failure patients.
• To highlight innovations in device therapy, remote monitoring, and combined therapeutic approaches.

Main Methods:

• Review of current literature and recent technological advancements in cardiac pacing and device therapy.
• Discussion of novel pacing lead technologies, alternative pacing sites, and leadless pacing systems.
• Exploration of remote monitoring capabilities and synergistic therapy concepts combining device therapy with catheter ablation.

Main Results:

• Optimized lead positioning, multipolar LV leads, transseptal access techniques, and leadless LV pacing offer potential to increase CRT response rates.
• Remote monitoring of pacemakers and ICDs has improved therapy management through timely event detection and intervention.
• Completely endocardial leadless "all-in-one" pacemaker systems are now available, alongside synergistic therapies like catheter ablation and device therapy showing positive clinical endpoint impacts.

Conclusions:

• Emerging pacing strategies and leadless technologies hold promise for enhancing device-based heart failure treatment and increasing patient response.
• Remote monitoring and integrated therapeutic approaches, combining device therapy with ablation, are crucial for optimizing patient management and clinical outcomes.