Clinical Review Science, medicine, and the future

New pacing technologies for heart failure

BMJ 2003; 326 doi: (Published 15 May 2003) Cite this as: BMJ 2003;326:1073
  1. Anthony W C Chow (, consultant cardiologist1,
  2. Rebecca E Lane, research fellow2,
  3. Martin R Cowie, professor of cardiology3
  1. 1 Department of Cardiology, Royal Berkshire and Battle Hospital, Reading RG30 1AJ
  2. 2 Department of Cardiology, St Mary's Hospital, London W2 1NY
  3. 3 Cardiac Medicine, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London SW3 6LY
  1. Correspondence to: A W C Chow
  • Accepted 16 April 2003

Heart failure is a sizeable problem in elderly populations, and although pharmacological treatment has improved, outcome generally remains poor. New pacing technologies have been developed to treat heart failure, with promising results


The prevalence of heart failure in the general population is estimated to be 1-2% and increases rapidly with age.1 In developed countries heart failure is a leading cause of admission to hospital among elderly patients and accounts for 1-2% of healthcare expenditure.2 Although several pharmacological treatments have improved outcome,35 the prognosis of patients with heart failure remains poor. Alternative non-pharmacological approaches including cardiac transplantation have been limited by availability of organs, and the use of artificial left ventricular assist devices remains restricted.

Recently, several promising new developments have taken place in pacing technology to treat selected patients with heart failure. These include atrio-biventricular pacing to correct abnormal patterns of left ventricular contraction and implantable cardiac defibrillators for treatment of malignant ventricular arrhythmias. As the scale of the problem becomes apparent new treatments that have been shown to improve morbidity and possibly mortality in patients with chronic heart failure will undoubtedly have a major impact on clinical practice and healthcare resources.


Sources and search criteria

We systematically searched PubMed for publications on chronic heart failure and biventricular pacing, cardiac resynchronisation, and implantable cardioverter defibrillators for the years 1985-2003.

The heart failure population

In the developed world the underlying cardiac abnormality for most patients with heart failure is impaired left ventricular systolic function due to ischaemic heart disease or idiopathic dilated cardiomyopathy.6 Despite maximal drug treatment many patients still experience symptoms on minimal exertion or even at rest (New York Heart Association class III-IV), and this functional limitation often has a marked impact on their quality of life. Recurrent and prolonged hospital admissions for periods of decompensation of …

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