Abstract
Endocardial pacing has experienced a tremendous evolution since the 1960s. A lot of challenges associated with pacemaker and ICD devices have already been successfully targeted. However, a relevant number of problems have not been solved to date. Not all patients with accepted indication for biventricular pacing have benefited from cardiac resynchronisation therapy (CRT) despite extensive efforts to reduce the rate of non-responders. Current strategies to optimize lead position, multipolar left-ventricular (LV) pacing leads, new strategies to gain access to the left-ventricle (atrial transseptal or ventricular transseptal access) or alternative right-ventricular (septal, His bundle pacing) pacing sites, and “leadless” LV pacing have the potential to increase response to device-based heart-failure treatment. The opportunity of pacemaker and ICD remote monitoring led to relevant improvements in therapy management by timely detection of events requiring medical or invasive interventions (e.g., external cardioversion of atrial fibrillation, increasing effective biventricular pacing, catheter ablation of ventricular tachycardias, or changes in heart-failure medication). Two completely endocardial leadless “all-in-one” pacemaker systems recently became available. Besides these innovations, new “synergistic” therapy concepts combining catheter ablation and device therapy proved to affect clinical endpoints (e.g., ATAAC study and CASTLE-AF study).
Similar content being viewed by others
References
Pluijmert M, Lumens J, Potse M et al (2015) Computer modelling for better diagnosis and therapy of patients by cardiac resynchronisation therapy. Arrhythm Electrophysiol Rev 4:62–67
Kerckhoffs RC, McCulloch AD, Omens JH, Mulligan LJ (2009) Effects of biventricular pacing and scar size in a computational model of the failing heart with left bundle branch block. Med Image Anal 13:362–369
Niederer SA, Shetty AK, Plank G et al (2012) Biophysical modeling to simulate the response to multisite left ventricular stimulation using a quadripolar pacing lead. Pacing Clin Electrophysiol 35:204–214
Turakhia MP, Cao M, Fischer A et al (2016) Reduced mortality associated with quadripolar compared to bipolar left ventricular leads in cardiac resynchronization therapy. JACC Clin Electrophysiol 2:426–433
Yang M, Li X, Liang J, Asirvatham SJ, Espinosa R, Li Y, Friedman PA, Cha YM (2018) Outcomes of cardiac resynchronization therapy using left ventricular quadripolar leads. Pacing Clin Electrophysiol. https://doi.org/10.1111/pace.13388 (Epub ahead of print)
Behar JM, Jackson T, Hyde E et al (2016) Optimized left ventricular endocardial stimulation is superior to optimized epicardial stimulation in ischemic patients with poor response to cardiac resynchronization therapy: a combined magnetic resonance imaging, electroanatomic contact mapping, and hemodynamic study to target endocardial lead placement. JACC Clin Electrophysiol 2:799–809
Sieniewicz BJ, Behar JM, Gould J et al (2018) Guidance for optimal site selection of a leadless LV endocardial electrode improves acute hemodynamic response and chronic remodeling. JACC Clin Electrophysiol (article in press)
Niazi I, Baker J II, Corbisiero R, Love C, Martin D, Sheppard R, Worley SJ, Varma N, Lee K, Tomassoni G (2017) MPP Investigators. Safety and efficacy of multipoint pacing in cardiac resynchronization therapy: the MultiPoint Pacing Trial. JACC Clin Electrophysiol 3:1510–1518
Vijayaraman P, Naperkowski A, Ellenbogen KA et al (2015) Electrophysiologic insights into site of atrioventricular block: lessons from permanent His bundle pacing. JACC Clin Electrophysiol 1:571–581
Parthiban N, Esterman A, Mahajan R et al (2015) Remote monitoring of implantable cardioverter-defibrillators: a systematic review and meta-analysis of clinical outcomes. J Am Coll Cardiol 65:2591–2600
Hindricks G, Taborsky M, Glikson M et al (2014) Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet 384:583–590
Varma N, Piccini JP, Snell J et al (2015) The relationship between level of adherence to automatic wireless remote monitoring and survival in pacemaker and defibrillator patients. J Am Coll Cardiol 65:2601–2610
Reddy VY, Exner DV, Cantillon DJ et al (2015) for the LEADLESS II Study Investigators. Percutaneous implantation of an entirely intracardiac leadless pacemaker. N Engl J Med 373:1125–1135
Reynolds D, Duray GZ, Omar R, For the Micra Transcatheter Pacing Study Group, et al (2016) A leadless intracardiac transcatheter pacing system. N Engl J Med 374:533–541
Reddy VY, Miller MA, Neuzil P et al (2017) Cardiac resynchronization therapy with wireless left ventricular endocardial pacing: the SELECT-LV study. J Am Coll Cardiol 69:2119–2129
Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378:417–427
Di Biase L, Mohanty P, Mohanty S, Santangeli P, Trivedi C, Lakkireddy D, Reddy M, Jais P, Themistoclakis S, Dello Russo A, Casella M, Pelargonio G, Narducci ML, Schweikert R, Neuzil P, Sanchez J, Horton R, Beheiry S, Hongo R, Hao S, Rossillo A, Forleo G, Tondo C, Burkhardt JD, Haissaguerre M, Natale A (2016) Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation 133:1637–1644. https://doi.org/10.1161/CIRCULATIONAHA.115.019406
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Halbfass, P., Sonne, K., Nentwich, K. et al. Current developments in cardiac rhythm management devices. Clin Res Cardiol 107 (Suppl 2), 100–104 (2018). https://doi.org/10.1007/s00392-018-1313-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-018-1313-4