Celebrating 50 years of electrical therapies for the heart
1 Institute of Cardiology, University of Bologna and Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy
2 Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
3 Department of Cardiology, St Mary's Hospital, London, UK
* Corresponding author. Tel: +39 051 349858; fax: +39 051 344859. E-mail address: giuseppe.boriani{at}unibo.it
Fifty years ago, on 8 October 1958, Elmqvist and Senning, at the Karolinska Hospital in Stockholm, implanted the first endocardial pacemaker to treat a patient with recurrent Adam–Stokes episodes.1
Since this pioneering experience, arrhythmia management has evolved enormously in the last 50 years, with electrophysiology being one of the areas of medicine where technology has had the strongest impact.2 The technologically driven evolution of devices and tools has been complemented by the acquisition of important scientific evidence of benefit in specific patient settings. Accumulation of hard evidence has allowed us to progress from pioneering experiences with pacemakers, implantable cardioverter-defibrillators (ICDs), and ablative techniques in very sick subjects treated in a handful of research centres to widespread routine use of such interventions in hundreds of thousands of patients around the world. The type of therapeutic target has also evolved: from ‘rescue’ interventions in high-risk conditions (complete atrioventricular block for pacemakers, multiple cardiac arrests for ICDs, high-risk ventricular pre-excitation for ablation) to ‘preventive’ interventions designed to avoid the risk of serious consequences stemming from the development of severe bradyarrhythmias, ventricular tachyarrhythmias or supraventricular tachyarrhythmias, or related to heart failure.3–8
In view of the need to keep clinical practice abreast of the ongoing changes in the potential for care, this evolution has required extensive cooperation between physicians, scientists, engineers, manufacturers, regulatory agencies, and health care providers. Clearly, the rapidity and extent of change has many important practical implications, related to themes such as emerging clinical skills, the complexity of current technology, treatment costs, the need for consensus guidelines, re-organization of care delivery, and the potential of telemedicine.
We have tried to view some of the most prominent issues in the field today in the context of lessons learnt in these 50 years of co-operative engagement. We have chosen to spotlight topical issues within the broad spectrum of electrical therapies for the heart: antibradycardia pacing (current and new indications, sensors, autocapture, alternative sites of pacing, etc.); sudden death prevention (risk stratification, current use of ICDs, and barriers to implementation of current guidelines); cardiac resyncronization therapy for heart failure (patient selection, haemodynamic and clinical effects); arrhythmia ablation (indications and technical advances); atrial fibrillation management in the real world, and ablation therapy for atrial fibrillation (mapping and ablation techniques).
We would like to thank the team of writers—all leading experts from major centres in Europe and around the world—who have agreed to outline and illustrate their authoritative viewpoints.
We thank St Jude Medical for supporting this issue with an educational grant, without exerting any influence on the choice or contents of the articles. Special thanks to Thomas Hengsteler at St Jude Medical for helping us with logistics throughout the preparation of the issue.
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