Newer Clinical Applications of Pacing

For many years, the indications for permanent cardiac pacing consisted primarily of AV block and sinus node dysfunction. In recent years, the indications for pacing have expanded considerably. This article details recent advances in the application of permanent pacing and the use of permanent pacing for patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, prevention of atrial fibrillation, and pacing in the long QT syndrome. Pacing is now an accepted therapeutic modality in hypertrophic cardiomyopathy and has rapidly gained acceptance in the United States, although there are still many unknowns about selection of patients and long-term benefits. Even less is known about pacing for dilated cardiomyopathy. Certain patients do respond with definite subjective improvement and improved quality of life, although there are no data to date to suggest improved longevity. Pacing for long QT syndrome is now a well-accepted indication for this relatively small subset of patients. Pacing for the prevention of atrial fibrillation is still in the very early stages of development. Multiple methods have been tried with the current method of choice being dual site atrial pacing. However, it is too early to predict the long-term success of this modality.