Since 1977, technological advances have made it possible, to incorporate a microprocessor in an implantable pacemaker. In 1980, the first devices with a microprocessor became available for patient use. At present, a single chip measuring a few square millimeters, contains more than a million active elements. The development of these micro-circuits is very expensive and therefore economically risky for small and medium sized pacemaker companies. Large investments in funds, design and evaluation time forced the pacemaker industry to employ multi-purpose micro-circuits. Microtechnology renders the feasibility to produce almost fully programmable pacemakers and provide the physician with the ability to adapt the device to specific patients needs. Telemetry functions are bidirectional, from programmer to pacemaker and visa versa. Real time intracardiac electrograms can be analyzed and malfunctions of battery or lead performance can be detected. Telemetry and programming functions have significantly decreased the need for surgical reinterventions. Clearly, microtechnology has created the progression from single-chamber fixed rate stimulation to dual-sensor rate- mediated dual-chamber pacing. Optimal cardiac pacing is critically dependent on the pacing mode, the underlying conduction disturbance and the myocardial function. Predictors of patient survival, hemodynamic and electrophysiological factors and the possibility of an adequate follow-up are factors to be considered for selection of the optimal pacing modality.

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J.R.T.C. Roelandt (Jos)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Ruiter, J. H. (1992, January 22). Clinical aspects of cardiac pacing for bradyarrhythmias. Retrieved from