Pacemaker and Internal Cardioverter-Defibrillator Therapies
Cardiac rhythm management devices (CRMD) have evolved significantly since the late 1950s, when the first pacemakers (PM) were implanted . However, transcutaneous electrical cardiac stimulation was used to treat symptomatic advanced second-degree or third-degree atrioventricular (AV) heart block (Stokes-Adams attacks) in the 1920s [1, 2]. The first implantable devices were asynchronous ventricular PM (VOO1) for patients with Stokes-Adams attacks, and then evolved into dual-chamber PMs (DDD) to preserve AV synchrony [1, 2, 3, 4].2 Next, intracardiac sensing was added to avoid competition between paced and intrinsic rhythms in patients with intermittent symptomatic bradycardia due to AV heart block or sinus node dysfunction. The response to sensed events (first ventricular-VVI; then, atrial or dual-chamber sensing-VAT,VDD, DVI, DDD) could be inhibition or the triggering of ventricular pacing stimuli. The next important evolution was adaptive rate pacing (ARP) in the 1980s, whereby a physiologic sensor detected the need for increased paced heart rates with exercise. Physiologic responses that have been investigated and are or might be used clinically in ARP are listed in Table 1.
KeywordsRight Atrial Left Ventricular Lead Left Ventricular Pace Multicenter Automatic Defibrillator Implantation Trial Right Atrial Appendage
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