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(Circulation. 2006;114:3-5.)
© 2006 American Heart Association, Inc.

Editorial

Clinical Trials for Cardiac Pacing in Bradycardia

The End or the Beginning?

Hung-Fat Tse, MD; Chu-Pak Lau, MD

From the Cardiology Division, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

Correspondence to Chu-Pak Lau, MD, Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China. E-mail cplau@hkucc.hku.hk

Key Words: Editorials • pacing • bradycardia • pacemakers • meta-analysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Since the first report of clinical application of cardiac pacing more than 50 years ago,¹ it remains the only effective long-term treatment of symptomatic bradycardia. Although the indications for the use of implantable cardiac pacemakers have expanded significantly over the past several years, sick sinus syndrome (SSS) and atrioventricular (AV) conduction disorders continue to be the major indications for permanent cardiac pacing in the United States² and other parts of the world.³ Technological developments in modern pacemakers have significantly reduced the size of the devices to allow easy implantation and have provided a myriad of programming options to customize therapy. These advances have led to increased patient and physician acceptance of pacemaker therapy. Furthermore, because of the aging of populations worldwide,⁴ the number of patients with cardiac rhythm disturbances requiring pacemaker implantation is increasing. Recent studies in the United States have demonstrated that the annual number of pacemakers implanted has increased by almost 3-fold during the past decade.⁵

Article p 11

In the early 1980s, the concept of "physiological pacing" was proposed to pursue normal cardiovascular physiology and to maintain AV synchronization and heart rate response to exercise.⁶ As a result, sophisticated pacemakers with dual-chamber sensing and pacing and rate-response algorithms have been developed. Pacing has evolved beyond a simple life-saving technology into a therapy that aims to improve patient quality of life and clinical outcomes. These perceived beneficial effects of physiological pacing were supported by early observations from short-term hemodynamic studies and retrospective analysis.⁷ Indeed, the practice of physiological . . . [Full Text of this Article]

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