Physiological cardiac pacing

With the availability of reliable transvenous atrial leads and advances in electronic and battery technology, pacing for the restoration of the atrioventricular sequence has become practicable. This paper presents (1) a historical review of physiological cardiac pacing, and (2) a functional description of pacemakers currently available or in clinical validation. The indications and limitations of use for each is discussed on the basis of clinical experience in 176 patients. Predictions are made for future application of sophisticated pacemaker systems after the remaining clinical and technological barriers are overcome.