| Title: |
Innovations in cardiac device therapy in the era of advanced rhythm management: implantable defibrillators and conduction system pacing |
| Authors: |
Pujol-Lopez, Margarida; Tung, Roderick; Mont, Lluis |
| Contributors: |
Departament de Salut, Generalitat de Catalunya |
| Source: |
Heart ; page heartjnl-2025-325834 ; ISSN 1355-6037 1468-201X |
| Publisher Information: |
BMJ |
| Publication Year: |
2026 |
| Description: |
Cardiac device therapy has significantly evolved since the introduction of the first implantable pacemaker and the subsequent development of the implantable cardioverter-defibrillator (ICD). ICDs are highly effective; however, their main weakness lies in lead-related complications. To avoid the need for venous access and the complications associated with transvenous leads, a fully subcutaneous ICD (S-ICD) system was developed. Despite these advancements, the S-ICD system is limited by its inability to provide bradycardia pacing and antitachycardia pacing. This limitation prompted the development of a modular cardiac rhythm management system, integrating a new leadless pacemaker with an S-ICD that uses unidirectional communication to command the pacemaker to deliver antitachycardia pacing. Conduction system pacing, including His bundle pacing and left bundle branch area pacing (LBBAP), has emerged as a physiological alternative to biventricular resynchronisation therapy and conventional pacing, pending results of large clinical trials. LBBAP offers superior electrical parameters and long-term performance compared with His bundle pacing. The capability to provide defibrillation via the same lead used for LBBAP represents an unresolved challenge that is currently under ongoing research. This state-of-the-art review presents the latest developments and innovations in cardiac device therapy, offering a comprehensive overview of current technologies that increasingly enable therapy to be tailored to individual patient needs. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1136/heartjnl-2025-325834 |
| Availability: |
https://doi.org/10.1136/heartjnl-2025-325834; https://syndication.highwire.org/content/doi/10.1136/heartjnl-2025-325834 |
| Rights: |
https://creativecommons.org/licenses/by-nc/4.0/ |
| Accession Number: |
edsbas.82A94ACB |
| Database: |
BASE |