Cardiac pacemaker

The pacemaker an implanted electronic device that managed bradyarrhythmia had attained technological maturity, though not perfection Parsonnet and Bernstein predicted that the next generation of electronic devices would carry multifunctionality to new levels. The implantable multipurpose electronic system of the future would pace the heart, diagnose and interrupt tachyarrhythmias, identify and correct its own internal electronic problems, and adjust its output and sensing levels.
Much of this has come to pass. The past 15 years have seen the immense impact of the incorporation of sensors into the devices to adapt pacing rate and other functions to the activities of daily life. We have focused on bradycardia management in this paper, but atrial and dual chamber pacing evolved into recognized treatments for many supraventricular tachycardias this development is another indication of the remarkable flexibility of modern pacemakers.
Indications for pacing now extend beyond conduction system disease to include AV nodal ablation, while pacing has shown promise as a treatment for hypertrophic and end stage dilated cardiomyopathy, vasovagal syncope, long QT syndrome, and prevention of paroxysmal atrial fibrillation in some patients. The industry is presently investigating numerous refinements in pacing technology, among them improved atrial tachycardia discrimination and algorithms to change the pacing mode automatically in response to a tachycardia elaboration of alternate sensors including Q T interval, temperature, right ventricular pressure, right ventricular dP dt, and pH self diagnostic techniques with automatic adjustment of thresholds for pacing and sensing in both chambers and multisite pacing with electrodes in three or four chambers.
In these developments the manufacturers have played the leading role, with clinicians peripherally involved until the stage of clinical evaluation. The tiny devices of the are increasingly self diagnostic, adjusting their function to the physiological demands of the body, the changes in stimulation and sensing threshold. Pacemakers began as appliances but are becoming fully automated machines. We will shortly see the complete integration of pacemakers with defibrillators in the same can.