This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cowan, D. B. Articles by McGowan, F. X. Search for Related Content PubMed PubMed Citation Articles by Cowan, D. B. Articles by McGowan, F. X., Jr Related Collections Other heart failure Pacemaker Animal models of human disease Other Treatment

(Circulation. 2006;114:986-988.)
© 2006 American Heart Association, Inc.

Editorial

A Paradigm Shift in Cardiac Pacing Therapy?

Douglas B. Cowan, PhD; Francis X. McGowan, Jr, MD

From the Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston and Harvard Medical School, Boston, Mass.

Correspondence to Douglas B. Cowan, Children’s Hospital Boston, 300 Longwood Ave, Enders 1220, Boston, MA 02115. E-mail douglas.cowan@childrens.harvard.edu

Key Words: Editorials • conduction • gene therapy • heart block • pacemakers • sinoatrial node • adenoviruses

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

Artificial pacemakers have been continuously improved since 1949, when Jack Hopps, from the National Research Council of Canada in Ottawa, first assembled an external generator for Wilfred Bigelow and John Callaghan in the basement of the Banting Institute at the University of Toronto.¹ Although Hopps’ device was not the first artificial pacemaker,^2–4 the presentation by Callaghan at the 1950 American College of Surgeons meeting in Boston, Mass, stimulated a surge of experimentation that quickly led to demonstration of the utility of cardiac pacing in humans and subsequent manufacture of implantable devices.³ Since that time, remarkable advances in lead design, battery duration, programming capability, and electronic circuitry have given rise to one of the most successful and accepted life-saving, palliative therapies in modern medicine.^3,5 Furthermore, medical indications for pacing therapy have expanded beyond the management of symptomatic bradycardia to include treatments for hypertrophic cardiomyopathy, neurocardiogenic syncope, ventricular tachyarrhythmia, congestive heart failure, and atrial fibrillation.^6,7 Nevertheless, in spite of the fact that pacemakers represent a state-of-the-art technology, there are significant problems associated with long-term cardiac pacing.

Articles pp 992 and 1000

The permanent implantation of an electronic pacemaker device is associated with complications that "...vary in clinical significance from benign to life-threatening."⁷ These include the need for replacement of generators (primarily attributable to limited battery life) and leads (because of fracture, displacement, inappropriate stimulation, loss of insulating material, or tissue perforation). These problems are often exacerbated in pediatric patients owing to their size and the demands imposed by growth. Other complications include . . . [Full Text of this Article]