[Latest results of treatment with pacemaker and implantable cardioverter defibrillators]

Abstract

Device-based anti-arrhythmic therapy is one of the most dynamically evolving branches of the medicine. Brady- and tachyarrhythmias can be treated efficiently and cost-effective with current pacemakers and ICDs. Beside conventional indications new indications have appeared in the last years: resynchronization treatment of severe congestive heart failure with biventricular pacing, primary prevention of sudden cardiac death with ICD, reduction of intraventricular gradient in hypertrophic obstructive cardiomyopathy. Several large clinical studies have investigated the efficacy of treatment in conventional indications, so the role of pacemaker therapy in carotid sinus hyperaesthesia or sinus node disease has been elucidated. Newer studies are trying to clarify the type or programming of the pacemaker in a given indication: physiological pacemakers have a more beneficial effect on the quality of life and decrease the incidence of atrial fibrillation. The implanted devices have frequency adaptation with new sensors, and they are even able to detect heart failure in an early phase. In the near future the number of pacemaker and ICD implantations will grow exponentially based on current trend. This will be due to the aging population, the simplification and increasing safety of implantation, and the widening of the indications for antiarrhythmic device implantation.