Evolutionary innovations in cardiac pacing

Cardiac pacing has played a significant role in mitigating morbidity and mortality associated with bradyarrhythmias. Throughout the years, advances made in battery reliability, lead performance, and device portability have rapidly expanded the use of cardiac pacemakers in many different disease states. Despite the benefits, there has been growing awareness of the potential deleterious effects of long-term artificial electrical stimulation including the development of ventricular dyssynchrony and atrial fibrillation. Given their association with an increased risk for heart failure and possibly death, several advances aimed at minimizing them have been made in recent years including changes in atrioventricular pacing algorithms, novel pacing mode modifications, and better identification of hemodynamically optimal pacing sites. This article reviews the advances made and the future direction of innovations in cardiac pacing.