Technological developments in bradycardia pacing. Present and future

Since its invention, there has been a continual increase in bradycardia pacemaker functionality. Although bringing increased benefit to the patient, the modern pacing system has become difficult for many clinicians to understand and evaluate. Therefore, current research is targeted to making the device easier to evaluate, program, and follow up. Currently under investigation are advanced data logging capabilities, intelligent programmer facilities, and automatic functions. The goal is to give the clinician more feedback on how the device and patient are performing, make the system simpler to operate, and make the pacer more responsive to the patient's changing needs. Greater than 80% of the implanted pacers remain at nominal settings for the duration of their operation, presumably because many clinicians are not familiar with the technology or do not have the time to perform follow-up evaluations of the device properly. Thus, making the device simpler to use and more automatic should yield significant patient benefit. Some of the areas in which programmer and implant automaticity are being investigated are in regulating pacer output, sensing, rate response, refractory periods, mode, and upper rate. Such features will provide continuous optimal function, while relieving the clinician of the programming task. Increased data logging will permit long-term analysis of pacemaker and cardiac behavior, which will allow for enhanced pacer follow up and programming, as well as provide clues to unexplained pacer-patient symptoms. In addition, data logging functions will permit the development of advanced automatic features.(ABSTRACT TRUNCATED AT 250 WORDS)