The annual congress of the European Society of Cardiology has traditionally published new recommendations on cardiac pacing and arrhythmias since 2019, but it was not the case in 2023. New guidelines are considered as a beacon of light for many. However, the absence of new guidelines does not mean that this year has not seen any new developments in the field of electrophysiology and pacemakers. Many topics could have been addressed in this review, but we have decided to focus this article on three of the most important ongoing innovations.
The first is a success story: the possibility of implanting leadless pacemakers. The first capsules have been implanted 10 years ago, but the current trend is towards more sophisticated systems, targeting the atrioventricular synchronous pacing, in other words, providing a more physiological stimulation. Pacing as close as possible to normal cardiac physiology is essential to avoid the risks of ventricular dysfunction observed in some patients, especially if the pacing is delivered to the apex of the right ventricle. This is how the pacing of the left branch of the His bundle was developed. This is a particularly ingenious technique, whose feasibility still lacks solid data, but which is extremely promising and constitutes the second point of the review.
The final point refers to the development of an alternative energy source to radiofrequency or cryotherapy for treating atrial fibrillation, known as electroporation. This non-thermal technique applies bipolar electric shocks and disconnects rapidly the pulmonary veins. The results of the first randomized study have just been published, opening up new perspectives in terms of efficacy.
Keywords
Arrhythmias, rhythmology, leadless pacemaker, left bundle branch pacing, atrial fibrillation, electroporation.